Evaluation of Mild to Moderate SLE Flare in Patients with Childhood-Onset Disease

Malki Peskin¹, Dawn Wahezi^2,3, Chaim Putterman⁴, Tamar Rubinstein^5,6 and Nicole Jordan^4,7, ¹Pediatrics, Albert Einstein College of Medicine, Bronx, NY, ²Pediatric Rheumatology, The Children's Hospital at Montefiore, Bronx, NY, ³Pediatric Rheumatology, Albert Einstein College of Medicine, Bronx, NY, ⁴Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, ⁵Pediatric Rheumatology, Children's Hospital at Montefiore, Bronx, NY, ⁶Rheumatology, Albert Einstein College of Medicine, Bronx, NY, ⁷Montefiore Medical Center, New York, NY

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: biomarkers and pediatric rheumatology, Disease Activity, SLE

Session Information

Date: Monday, November 14, 2016

Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects - Poster II: Myositis, Systemic Lupus Erythematosus, Sjögren's Syndrome

Session Type: ACR Poster Session B

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

Background/Purpose: One aspect of childhood SLE lacking understanding is the prediction of disease flares. The objective of this study is to identify predictors of mild to moderate flare in pediatric patients with SLE. The specific aims of this study are to investigate predictors of SLE flare in a high risk, urban, minority population. We aim to use this information to formulate a way to better predict and prevent flares among the pediatric population.

Methods: Included participants were enrolled in the pediatric Einstein Lupus Cohort (a database created in 2009 of patients meeting ACR criteria for SLE at the Children’s Hospital at Montefiore), have evidence of mild to moderate flare during participation in the cohort, and have data recorded 1, 6, and 12 months prior to flare. To investigate predictors of flare within our population, we evaluated demographic variables including age, gender, race, ethnicity, education, household income, original criteria for diagnosis, and autoantibody profile. We also evaluated disease specific measures such as disease duration, medication usage, SELENA SLEDAI score, BILAG score and SLICC damage index. Laboratory variables assessed include ANA titer, anti-dsDNA antibodies, C3, C4, CBC, albumin, creatinine and urinalysis. Mild to moderate flare wass defined based on the following parameters: (1) Change in SELENA SLEDAI of ≥3 points OR (2) development of 1 new BILAG A score or 2 new BILAG B scores. All predictors identified in univariate analyses with p<0.25 were included into a multivariate model.

Results: We enrolled 102 pediatric patients with SLE (as defined by ACR criteria) and have data recorded for over 369 follow-up visits. General demographics for included participants are listed in Table 1. In multivariate analysis, elevated dsDNA antibodies, low WBC and sledai score were identified as independent predictors of disease flare at the next visit (within 6 months) (Table 2).

Conclusion: We have identified elevated dsDNA and low WBC count as important predictors of upcoming disease flare in pediatric patients with SLE. Interestingly, conventional markers including C3 and C4 were not found to be predictive. With this research, we hope to be able to identify flares before they manifest and ultimately be able to reduce disease burden among the pediatric SLE population.

Table 1: Demographics
Total patients enrolled	102
Total # of specimens collected	369
Mean age at Diagnosis	14.2 ± 3.7 (range 6-20)
Gender	Females: 83 (81.4%) Males: 19 (18.6%)
Race	African American: 41 (40.2%) Asian: 5 (4.9%) White: 5 (4.9%) Other: 4 (3.9%)
Ethnicity	Hispanic: 45 (44.1%) Non-Hispanic: 51 (51.0%)
Patient Level of Education	Grammar School: 11 (11%) High School: 55 (54%) College: 24 (24%)
Household Income	Less than $25,000: 21 (20.1%) $25-75,000: 12 (11.8%) Greater than $75,000: 9 (9%) Deferred: 43 (42.1%)
Patients with a family history of SLE	30 (29%)
Patients with renal disease	61 (59.8%)
Class of renal disease	Class II – 9 (8.8%) Class III – 21 (20.1%) Class IV – 15 (14.7%) Class V – 22 (21.6%)
Patients on Steroids	89 (87.3%)
Patients currently on an additional oral immunosuppressive therapy	37 (36.2%) 9% azathioprine 21% MMF 6% methotrexate
Patients previously received immunosuppressive infusions	39 (38.2%) cyclophosphamide 23 (22.5%) rituximab 7 (6.8%) IVIG 8 (7.8%) belimumab 3 (2.9%) abatacept

Table 2: Factors predictive of lupus flare
	OR	CI	p-value
Male gender	0.896	0.343, 2.352	0.824
Hispanic ethnicity	1.269	1.668, 2.687	0.534
Black race	0.697	0.325, 1.494	0.353
Elevated dsDNA	3.053	1.393, 6.686	0.005
Low WBC	2.235	1.275, 3.918	0.005
SLEDAI score	0.934	0.877, 0.993	0.030

Disclosure: M. Peskin, None; D. Wahezi, None; C. Putterman, None; T. Rubinstein, Lupus Foundation of America, 2; N. Jordan, None.

To cite this abstract in AMA style:

Peskin M, Wahezi D, Putterman C, Rubinstein T, Jordan N. Evaluation of Mild to Moderate SLE Flare in Patients with Childhood-Onset Disease [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/evaluation-of-mild-to-moderate-sle-flare-in-patients-with-childhood-onset-disease/. Accessed .

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