Differences between Early and Adult-Onset Systemic Lupus Erythematosus in Cohort of Argentinian Patients

Rodrigo Aguila Maldonado¹, Dora Pereira², Gisela Pendon³, Alberto Spindler⁴, Cecilia N. Pisoni⁵, Julio Hofman⁶, María Victoria Collado⁷, Judith Sarano⁸, Cesar Graf⁹, Graciela N Gómez¹⁰, Paula Alba¹¹, Claudia Elizabeth Pena¹, Ana Carolina Costi¹², Adrian Salas¹³, Ana Curti¹⁴, Oscar Rillo¹⁵, Silvia Beatriz Papasidero¹⁶, Veronica Bellomio¹⁷, Susana Roverano¹⁸, Marcela Schmid¹⁹, Alberto Allievi²⁰, Sebastián Muñoz²⁰, Walter J. Spindler²¹, Andrea Gonzalez²², Ana María Beron²³, Rosana Quintana²⁴, Agustina Damico²⁵, Andrea Gómez²⁶, Sergio Tolosa²⁷, Enrique Soriano²⁸, Alicia Eimon²⁹, Marta Silvia Espósito⁶, Leila Romina Ferreyra Mufarregue³⁰, Juan Pablo Ruffino³⁰, Verónica Saurit³¹, Edson Hernán Chiganer³⁰, Fabian Risueño³², Flavia Caputo³³, Edson Velozo³⁴, Juan Soldano³⁵, Monica Diaz³⁶ and Mercedes Garcia¹, ¹Rheumatology, HIGA General San Martin La Plata, La Plata, Argentina, ²Rheumatology Section, Hospital Dr. Ricardo Gutiérrez, Argentina, Buenos Aires, Argentina, ³H Gutiérrez de La Plata, La Plata, Argentina, ⁴Centro Médico Privado de Reumatología, Centro Médico Privado de Reumatología, Argentina, ⁵Internal Medicine, CEMIC, Rheumatology and Immunology, CEMIC, Buenos Aires, Argentina, ⁶Consultorio Privado, Buenos Aires, Argentina, ⁷Rheumatology, Instituto de Investigaciones Medicas Alfredo Lanari, Buenos Aires, Argentina, ⁸Instituto Lanari, Buenos Aires, Argentina, ⁹Centro Médico Mitre, Paraná, Argentina, ¹⁰Diaz Colodrero 2537 8° A, Instituto de Investigaciones Medicas Alfredo Lanari, Capital Federal, Argentina, ¹¹Universidad Nacional de Cordoba, Rheumatology Unit Cordoba and Materno Neonatal Hospital, Córdoba, Argentina, ¹²Rheumatology Section, HIGA General San Martin La Plata, La Plata, Argentina, ¹³Rheumatology, HIGA General San Martin, La Plata, Argentina, ¹⁴Htal Lagomaggiori, Mendoza, Argentina, ¹⁵Hospital General de Agudos Dr Ignacio Pirovano, Argentina, Buenos Aires, Argentina, ¹⁶Rheumatology Section, Hospital General de Agudos Dr. Enrique Tornú, Argentina, Buenos Aires, Argentina, ¹⁷Hospital Padilla, San Miguel de Tucumán, Argentina, ¹⁸Hospital José Maria Cullen, Santa Fe, Argentina, ¹⁹Hospital Jose María Cullen, Santa Fe, Argentina, ²⁰SAR, Buenos Aires, Argentina, ²¹Centro Médico Privado de Reumatología, Tucuman, Argentina, ²²Hospital Eva Perón, San Martín, Argentina, ²³Hospital de Clínicas, Buenos Aires, Argentina, ²⁴Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Rosario, Argentina, ²⁵Hospital Británico, Buenos Aires, Argentina, ²⁶Hospital Británico de Buenos Aires, CABA, Argentina, ²⁷Hospital San Juan Bautista, San Fernando del Valle de Catamarca, Argentina, ²⁸Hospital Italiano, Buenos Aires, Argentina, ²⁹CEMIC, Buenos Aires, Argentina, ³⁰Hospital Durand, Buenos Aires, Argentina, ³¹Hospital Privado Centro Médico de Córdoba, Cordoba, Argentina, ³²Itemédica, Bahia Blanca, Argentina, ³³Hospital Posadas, Buenos Aires, Argentina, ³⁴Sanatorio Adventista del Plata, Entre Ríos, Ecuador, ³⁵Hospital Provincial, Rosario, Argentina, ³⁶SAR, Bariloche, Argentina

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Systemic lupus erythematosus (SLE)

Session Information

Date: Monday, October 22, 2018

Title: Systemic Lupus Erythematosus – Clinical Poster II: Biomarkers and Outcomes

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Approximately 20% of patients with Systemic Lupus Erythematosus (SLE) begin their illness in childhood or adolescence. These patients are described with a phenotype of greater severity. The aim of this study was to evaluate the prevalence of early onset SLE and the clinical and laboratory manifestations of these patients.

Methods: A total of 659 consecutive patients were included in one year. All met at least four diagnostic criteria from the American College of Rheumatology (ACR 82/97). Early-onset SLE was defined as disease diagnosed before 18 years of age and late onset or adult when age at diagnosis was ≥ 18 years. Criteria for diagnosis and damage were measured by cumulative Systemic Lupus Collaborating Clinical Damage Index (SLICC-SDI). Disease activity was measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) at the time of entry into the study. SLEDAI ≥12 was considered as severe activity. Manifestations were compared between early and late-onset SLE patients. Statistical analysis for categorical variables was performed with chi-square test or Fisher exact test as appropriate and for continuous variables with Student t-test. Strength of association were obtained by odds ratio and 95% confidence interval (CI). Multivariate analysis was performed using early-onset Lupus as outcome variable.

Results: 82/659 (12,44 %) met criteria for early-onset SLE, 90% of these patients were women vs. 87% late onset (p = 0.408, OR: 1.38, 95% CI: 0.63-3.45). Mean age at diagnosis was 15 ± 2 (7-17) vs. 32 ± 11 years (18-76), with a median time of 134 ± 86 vs. 96 ± 92 months (p = 0.00034) at diagnosis. Mean number of classification criteria was 7 vs. 6 (p = 0.016), and for SLEDAI score was 2 (0-36) vs. 2 (0-73), p = 0.955. At the time of their inclusion in the study, they had severe activity: 18% vs. 8.5% (p = 0.005, OR: 2.41, 95% CI: 1-19-4.6). Mean SLICC score was 1.14 (0-8) vs. 1.02 (0-9), p = 0.57. Univariate analysis also showed that Malar erythema (p: 0,014), nephritis (p: 0.010), glomerulonephriris Class IV (p: 0,0001), CNS (p: 0,019), cataracts (p: 0,019) were statistically significant. In the multivariate analysis, there was a significant association with early onset-SLE mestizo ethnicity: OR: 1.65, 95% CI: 1.01-2.69, p = 0.041; Malar erythema: OR: 1.81, 95% CI: 1.009- 3.25, p = 0.046 and renal disease: OR: 1.86, 95% CI: 1.15-3.006, p = 0.01.

Conclusion: In this cohort of SLE patients, 12.4% were classified as early onset, with a mean age at diagnosis of 15 years (7-17). Multivariate analysis persisted as independent variables associated with early-onset Lupus, mestizo ethnicity, cutaneous involvement with malar erythema and nephropathy. Association with damage index was not significant.

Disclosure: R. Aguila Maldonado, None; D. Pereira, None; G. Pendon, None; A. Spindler, None; C. N. Pisoni, None; J. Hofman, None; M. V. Collado, None; J. Sarano, None; C. Graf, None; G. N. Gómez, None; P. Alba, None; C. E. Pena, None; A. C. Costi, None; A. Salas, None; A. Curti, None; O. Rillo, None; S. B. Papasidero, None; V. Bellomio, None; S. Roverano, None; M. Schmid, None; A. Allievi, None; S. Muñoz, None; W. J. Spindler, None; A. Gonzalez, None; A. M. Beron, None; R. Quintana, None; A. Damico, None; A. Gómez, None; S. Tolosa, None; E. Soriano, None; A. Eimon, None; M. S. Espósito, None; L. R. Ferreyra Mufarregue, None; J. P. Ruffino, None; V. Saurit, None; E. H. Chiganer, None; F. Risueño, None; F. Caputo, None; E. Velozo, None; J. Soldano, None; M. Diaz, None; M. Garcia, None.

To cite this abstract in AMA style:

Aguila Maldonado R, Pereira D, Pendon G, Spindler A, Pisoni CN, Hofman J, Collado MV, Sarano J, Graf C, Gómez GN, Alba P, Pena CE, Costi AC, Salas A, Curti A, Rillo O, Papasidero SB, Bellomio V, Roverano S, Schmid M, Allievi A, Muñoz S, Spindler WJ, Gonzalez A, Beron AM, Quintana R, Damico A, Gómez A, Tolosa S, Soriano E, Eimon A, Espósito MS, Ferreyra Mufarregue LR, Ruffino JP, Saurit V, Chiganer EH, Risueño F, Caputo F, Velozo E, Soldano J, Diaz M, Garcia M. Differences between Early and Adult-Onset Systemic Lupus Erythematosus in Cohort of Argentinian Patients [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/differences-between-early-and-adult-onset-systemic-lupus-erythematosus-in-cohort-of-argentinian-patients/. Accessed .

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