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Abstract Number: 0267

Gastrointestinal Disease in SLE: Does It Indicate a Worse Prognosis?

Beatriz Tejera Segura1, Irene Altabás González2, Iñigo Rúa-Figueroa3, Natalia Pérez Veiga4, Victor del Campo Pérez5, Alejandro Olivé-Marqués6, Maria Galindo-Izquierdo7, Jaime Calvo-Alén8, Juan Ovalles-Bonilla9, Antonio Fernandez-Nebro10, Raul Menor Almagro11, Eva Tomero Muriel12, N. Del-val-del-amo13, Maria Esther Uriarte14, VM Martínez Taboada15, Jose Luis Andreu Sanchez16, Alina Lucica Boteanu17, Francisco Javier Narváez18, A Morasat19, Carlos Montilla Morales20, JM Senabre Gallego21, Blanca Hernández Cruz22, Mariano Andrés23, Eva Salgado Pérez24, Mercedes Freire-González25, Sergio Ramon Machin Garcia1, Clara Moriano26, Lorena Expósito27, Clara E. Perez-Velasquez28, ML Velloso-Feijoo29, Ana Paula Cacheda30, Nuria Lozano Rivas31, Gema Bonilla32, Marta Arévalo33, Inmaculada Jimenez34, VE Quevedo-Vila35, Francisco Manero-Ruiz36, Paloma García de la Peña37, TR Vázquez-Rodríguez38, J Ibáñez-Ruan39, Tatiana Cobo-Ibañez40 and Jose Maria Pego-Reigosa41, 1Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain, 2Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain, 3Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain, 4Grupo IRIDIS, Universidad de Vigo, Vigo, Pontevedra, 5Hospital Universitario Meixoeiro, Vigo, Vigo, Pontevedra, Spain, 6Hospital Germans Trias i Pujol, Barcelona, Spain, 7Hospital Universitario 12 de Octubre, Madrid, Spain, 8Hospital Universitario Araba, Vitoria-Gasteiz, Pais Vasco, Spain, 9Hospital General Universitario Gregorio Marañón, Madrid, Spain, 10University of Malaga, Malaga, Spain, 11Hospital General Universitario de Jerez de la Frontera, Puerto De Santa Mar�a, Spain, 12Hospital Universitario de la Princesa, Madrid, Madrid, Spain, 13Complejo Hospitalario de Navarra, Pamplona, Spain, 14Hospital Universitario Donostia, San Sebastian, Spain, 15Hospital Universitario Marqués de Valdecilla, Santander, Spain, 16Hospital Universitario Puerta de Hierro, Majadahonda, Spain, 17PRINTO, Istituto Giannina Gaslini, Genova, Italy, 18Hospital Bellvitge, BARCELONA, Spain, 19Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain, 20Hospital Universitario de Salamanca, Salamanca, Spain, 21Hospital Marina Baixa, Alicante, Spain, 22Universidad de Sevilla, Sevilla, Spain, 23Hospital General Universitario de Alicante, Alicante, Spain, 24Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain, 25CHU Coruña, Coruña, Spain, 26Complejo Asistencial Universitario de León, León, Spain, 27Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, 28Basurto University Hospital, Bilbao, Spain, 29Hospital Universitario de Valme, Sevilla, Spain, 30Hospital son LLátzer, Palma de Mallorca, Spain, 31Hospital Clínico Universitario Virgen de Arrixaca, Murcia, Spain, 32Rheumatology, La Paz University Hospital-IdiPAZ, Madrid, Spain, 33Hospital Universitari Parc Taulí I3PT, Sabadell, Spain, 34Hospital Clínico San Ceciio Granada, Granada, Spain, 35Hospital Comarcal de Monforte, Lugo, Spain, 36Hospital Universitario Miguel Servet, Zaragoza, Spain, 37Hospital HM, Madrid, Spain, 38Hospital Universitario Lucus Augusti, Lugo, Spain, 39Hospital Povisa, Vigo, Pontevedra, Spain, 40Hospital Infanta Sofia, Madrid, Spain, 41University Hospital of Vigo, Galicia Sur Health Research Institute, Vigo, Spain

Meeting: ACR Convergence 2020

Keywords: Damage Index, glucocorticoids, Mortality, prognostic factors, Systemic lupus erythematosus (SLE)

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Session Information

Date: Friday, November 6, 2020

Title: SLE – Diagnosis, Manifestations, & Outcomes Poster I: Clinical Manifestations

Session Type: Poster Session A

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

Background/Purpose: To describe the GI manifestations of SLE in the RELESSER (Registry of Systemic Lupus Erythematosus Patients of the Spanish Society of Rheumatology) cohort and to determine if those are associated with a more severe disease, damage accrual and a worse prognosis.

Methods: We conducted a nationwide, retrospective, multicenter, cross-sectional cohort study of 3658 SLE patients who fulfill ≥ 4 ACR-97 criteria. Data on demographics, disease characteristics, activity (SELENA-SLEDAI), damage (SLICC/ACR/DI) and therapies were collected. Table 1 shows the different gastrointestinal manifestations among the RELESSER cohort. Demographic and clinical characteristics were compared between lupus patients with and without GI damage to establish whether GI damage is associated with a more severe disease (Table 2). χ2 tests for categorical variables and Student t-test for continuous variables were used. For non-continuous variables, either Mann-Whitney U test or logarithmic transformation were used (data expressed as median and interquartile range – IQR). Univariate linear and multivariate logistic regression analyses were performed to establish the relation of demographics, different SLE clinical manifestations, damage and GI manifestations.

Results: From 3654 lupus patients, 3.7% developed GI damage (Table 1). Patients in this group (group 1) were older (53.1 vs 46 years; p< 0.001), they had longer disease duration (16.4 vs 11.7 years; p=0.001) and were more likely to have vasculitis (14.1% vs 8.7% p=0.056), renal disease (56.1% vs 42.4% p=0.003) and serositis (40.5% vs 28.5% p=0.005) than patients without GI damage (group 2). With regard to treatment, there were statistically significant differences between both groups in terms of glucocorticoids (96.9% vs 88.6% p=0.001), azathioprine (44.2% vs 33.9% p=0.01), mycophenolate mofetil (23.7% vs 14.9% p=0.009) and cyclophosphamide (37.4% vs 21.8% p< 0.001).The use of hydroxychloroquine was more common among SLE patients with no GI manifestations related to damage (83.4% vs 75.2%, p=0.022). Hospitalizations and mortality were significantly higher in group 1 suggesting that having GI damage is linked to a worse prognosis. Moreover, patients in group 1 had higher modified SDI (2; IQR 1-4; p< 0.001) (Table 2). After the multivariable analysis, older age, high daily dose of glucocorticoids (≥ 30 mg prednisone) and higher SDI remained significant. Interestingly, even the prevalence of oral ulcers was slightly similar in both groups, the multivariable analysis revealed that the presence of oral ulcers reduced risk of developing damage in 30% of patients (Table 3).

Conclusion: Having GI damage is associated with clinical involvement of other target organs in lupus and with a worse prognosis. Patients on high dose of glucocorticoids are at higher risk of developing GI damage which reinforces the strategy of minimizing glucocorticoids. Oral ulcers are common in SLE and seem to be protective from GI damage.

Table 1. GI manifestations in the RELESSER cohort

Table 2. Demographics and clinical characteristics. *Modified SLICC/SDI was calculated excluding gastrointestinal damage manifestations

Table 3. Multivariable analysis. Variables independently associated with GI damage


Disclosure: B. Tejera Segura, None; I. Altabás González, None; I. Rúa-Figueroa, None; N. Pérez Veiga, None; V. del Campo Pérez, None; A. Olivé-Marqués, None; M. Galindo-Izquierdo, None; J. Calvo-Alén, None; J. Ovalles-Bonilla, None; A. Fernandez-Nebro, Roche, 1, Nordic, 1, Stada, 1, Sanofi, 1, Janssen, 1, Pfizer, 1, Abbvie, 1, Novartis, 1, Gedeon, 1, Lilly, 1; R. Menor Almagro, None; E. Tomero Muriel, None; N. Del-val-del-amo, None; M. Uriarte, None; V. Martínez Taboada, None; J. Andreu Sanchez, None; A. Boteanu, AbbVie, 8, Novartis, 8, Roche, 8; F. Narváez, None; A. Morasat, None; C. Montilla Morales, None; J. Senabre Gallego, None; B. Hernández Cruz, None; M. Andrés, None; E. Salgado Pérez, None; M. Freire-González, None; S. Machin Garcia, None; C. Moriano, None; L. Expósito, None; C. Perez-Velasquez, None; M. Velloso-Feijoo, None; A. Cacheda, None; N. Lozano Rivas, None; G. Bonilla, None; M. Arévalo, None; I. Jimenez, None; V. Quevedo-Vila, None; F. Manero-Ruiz, None; P. García de la Peña, None; T. Vázquez-Rodríguez, None; J. Ibáñez-Ruan, None; T. Cobo-Ibañez, None; J. Pego-Reigosa, None.

To cite this abstract in AMA style:

Tejera Segura B, Altabás González I, Rúa-Figueroa I, Pérez Veiga N, del Campo Pérez V, Olivé-Marqués A, Galindo-Izquierdo M, Calvo-Alén J, Ovalles-Bonilla J, Fernandez-Nebro A, Menor Almagro R, Tomero Muriel E, Del-val-del-amo N, Uriarte M, Martínez Taboada V, Andreu Sanchez J, Boteanu A, Narváez F, Morasat A, Montilla Morales C, Senabre Gallego J, Hernández Cruz B, Andrés M, Salgado Pérez E, Freire-González M, Machin Garcia S, Moriano C, Expósito L, Perez-Velasquez C, Velloso-Feijoo M, Cacheda A, Lozano Rivas N, Bonilla G, Arévalo M, Jimenez I, Quevedo-Vila V, Manero-Ruiz F, García de la Peña P, Vázquez-Rodríguez T, Ibáñez-Ruan J, Cobo-Ibañez T, Pego-Reigosa J. Gastrointestinal Disease in SLE: Does It Indicate a Worse Prognosis? [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/gastrointestinal-disease-in-sle-does-it-indicate-a-worse-prognosis/. Accessed .
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