Background/Purpose:

SLE onset may be insidious with clinically evident disease developing over years. Current SLE classification criteria may not classify patients with early SLE well. The ability of SLE classification criteria to include patients with earlier stages of SLE would allow studies of disease progression and the testing of therapies aimed at the prevention of organ involvement and damage. The aim of this multicenter study was to describe the characteristics of patients with early SLE to inform for the development of classification criteria which would capture patients with earlier stages of disease.

Methods:

Clinical and laboratory data at disease onset of patients newly diagnosed with SLE in the past 3 years (1/1/2012-12/31/2014) at 4 referral centers in Europe (2) and North America (2) were collected. All patients were diagnosed by SLE clinical experts. A data extraction form with all current ACR and SLICC items, as well as an additional list of 30 items (clinical and laboratory), was developed. Patients’ medical records were reviewed and reviewers were encouraged to add to the existing list of items any other presenting manifestations. Two-step cluster analysis followed by discriminant analysis were used to identify potential subgroups of patients with distinct SLE presentations, and to identify the important variables contributing to SLE diagnosis.

Results:

Two hundred and thirty one patients (F 203; M 27) were identified, of these 73% were White, 10.5% Black and 9.5% Asian and 7% of mixed ethnicities. Mean age at first symptoms was 32.3 ±12.6 and at diagnosis 34.5 ± 12.8 years. At diagnosis, 48% of patients had < 3 ACR classification criteria, 52% had > 4. The most common clinical manifestations and serologies at diagnosis are in Table. Less common manifestations were oral ulcers (18%), discoid lesions (9%), CNS involvement (6%). Less than 5% of patients had alveolar hemorrhage, myocardial infarction, livedo reticularis, thrombosis, subacute cutaneous lesions and thrombocytopenia. Although the numbers were small, no statistically significant differences in manifestations at onset were observed in ANA positive (96%) vs. ANA negative (4%) patients. Twenty nine (12.6%) ANA positive patients, had no more specific serologies. Cluster analysis identified a group of 58 younger patients (29.0 vs. 33.5 years for others) with SLE onset characterized by constitutional symptoms (weight loss, fatigue, fever), thrombosis, anti-dsDNA antibodies, Coomb’s test, and renal involvement.

Conclusion:

Almost half of patients had < 3 ACR criteria at diagnosis, mean duration of symptoms was 2.2 years, and 4% of patients were ANA negative. There may be a group of young patients presenting with a specific pattern of disease onset. Additional analyses are required to understand the manifestations most likely found in early SLE.

Acknowledgement. This project has been jointly funded by EULAR and ACR

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-do-patients-with-newly-diagnosed-sle-present-a-multicenter-cohort-analysis-to-inform-the-development-of-new-classification-criteria-for-sle/