ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1605

Lupus Low Disease Activity State Protects Against Most Subtypes of Organ Damage in SLE

Michelle Petri1, Daniel Goldman2 and Laurence S Magder3, 1Medicine (Rheumatology), Division of Rheumatology, Johns Hopkins University School of Medicine, MD, USA, Baltimore, MD, 2Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, 3Epidemiology and Public health, University of Maryland School of Medicine, Baltimore, MD

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords:

Session Information

Date: Monday, November 6, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities

Session Type: ACR Poster Session B

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

Background/Purpose: In SLE the most common types of organ damage are osteoporotic fractures and cataracts. Other types of organ damage, such as end stage renal disease, are more life-threatening. We asked whether achieving the Lupus Low Disease Activity State (LLDAS) was protective against all – or only some – types of organ damage in SLE.

Methods: LLDAS was defined as by Franklyn et al: SLEDAI < =4, PGA<=1, prednisone <=7.5 mg/day, no major organ involvement (renal, CNS, serositis, vascular, or constitutional), no recent increase in disease activity. Each month of each follow-up was classified based on the proportion of prior months that the patient was in LLDAS. The rate of each damage event (expressed in rate per year) was calculated in each class. P-values were constructed to assess the significance of trends in rates by proportion of months in LLDAS based on a logistic regression model. If a patient had the specific damage prior to cohort entry, then they were not included. The patients were 92% female, 53% Caucasian, 39% African-American.

Results: Table 1 shows the specific type of organ by percent time that LLDAS was achieved, based on a logistic regression model treating percent time in LLDAS as a quantitative predictor.

Table 1: Rates of specific damage per person year and prior LLDAS experience

Damage Type

Number of events/Number of person years
(Rate per 1000 person years)

P-value for trend

<25%

25-50%

50-75%

75%+

Arthritis (deforming or erosive

15/1358
(11.0)

1/972
(1.0)

6/1418
(4.2)

1/1046
(1.0)

0.0010

Avascular Necrosis

36/1214
(29.7)

13/867
(15.0)

16/1378
(11.6)

2/1004
(2.0)

<0.0001

Cataract

57/1199
(47.6)

26/838
(31.0)

54/1283
(42.1)

39/959
(40.7)

0.49

Claudication

0 /1506
(0.0)

4/1049
(3.8)

5/1502
(3.3)

6/1082
(5.5)

0.018

Cognitive Impairment

11/1413
(7.8)

9/955
(9.4)

5/1367
(3.7)

11/1012
(10.9)

0.94

Cardiomyopathy

13/1411
(9.2)

6/1004
(6.0)

6/1468
(4.1)

1/1078
(0.9)

0.0059

Cranial or Peripheral Neuropathy

20/1374
(14.6)

14/935
(15.0)

15/1357
(11.1)

7/1005
(7.0)

0.076

CVA

23/1386
(16.6)

13/1004
(12.9)

10/1417
(7.1)

6/1020
(5.9)

0.016

Diabetes

19/1387
(13.7)

9/988
(9.1)

6/1420
(4.1)

13/1050
(12.4)

0.16

DVT

4/1493
(2.7)

4/1033
(3.9)

1/1455
(0.7)

1/1057
(0.9)

0.31

End Stage Renal Disease

26/1463
(17.8)

5/1027
(4.9)

2/1482
(1.3)

1/1076
(0.9)

<0.0001

GFR<50%

11/1397
(7.9)

0/993
(0.0)

3/1472
(2.0)

1/1057
(0.9)

0.0017

Infarction or resection of bowel below duodenum

25/1295
(19.3)

18/944
(19.1)

11/1362
(8.1)

13/932
(14.0)

0.045

Malignancy

41/1429
(28.7)

22/982
(22.4)

25/1388
(18.0)

19/988
(19.2)

0.12

Myocardial Infarction

21/1493
(14.5)

10/999
(10.0)

6/1448
(4.1)

3/1083
(2.8)

<0.0001

Osteomyelitis

5/1506
(3.3)

1/1057
(0.9)

0/1510
(0.0)

1/1084
(0.9)

0.037

Osteoporosis with fracture or vertebral collapse

60/1323
(45.5)

33/889
(37.1)

43/1351
(31.8)

28/1003
27.9

0.0053

Pericarditis for 6 months or pericardectomy

4/1470
(2.7)

2/1049
(1.9)

1/1498
(0.7)

1/1082
(0.9)

0.26

Pleural Fibrosis

13/1478
(8.8)

9/1004
(9.0)

8/1457
(5.5)

1/1084
(0.9)

0.018

Premature gonadal failure

13/1350
(9.6)

3/986
(3.0)

1/1413
(0.7)

1/1025
(1.0)

0.0003

Proteinuria 24hr ≥3.5g

5/1314
(3.8)

0/962
(0.0)

2/1453
(1.4)

0/1060
(0.0)

0.034

Pulmonary Fibrosis

23/1361
(16.9)

12/943
(12.7)

14/1409
(9.9)

15/1031
(14.5)

0.31

Pulmonary Hypertension

15/1381
(10.9)

14/960
(14.6)

13/1460
(8.9)

9/1052
(8.6)

0.41

Retinal change or optic atrophy

10/1452
(6.9)

7/974
(7.2)

6/1451
(4.1)

6/1016
(5.9)

0.71

Ruptured Tendon

16/1484
(10.8)

8/997
(8.0)

9/1490
(6.0)

6/1072
(5.6)

0.075

Extensive scarring of panniculum other than scalp and pulp space

6/1420
(4.2)

2/1001
(2.0)

1/1472
(0.7)

0/1082
(0.0)

0.013

Seizures requiring therapy for at least 6 months

9/1415
(6.4)

5/995
(5.0)

1/1444
(0.7)

1/1073
(0.9)

0.0045

Significant Tissue Loss

4/1494
(2.7)

2/1048
(1.9)

0/1499
(0.0)

1/1093
(0.9)

0.13

Skin ulceration present for more than 6 months

4/1476
(2.7)

2/1026
(1.9)

1/1503
(0.7)

0/1095
(0.0)

0.12

Valvular Disease

10/1444
(6.9)

8/1007
(7.9)

7/1480
(4.7)

2/1083
(1.8)

0.046

Conclusion: Time in LLDAS was protective against most major organ damage, including myocardial infarction, stroke, and end stage renal disease. It was not protective against DVT damage (likely because the initial DVT was due to antiphospholipid antibodies), pulmonary fibrosis, pulmonary hypertension, cognitive impairment, or malignancy. It was not protective against cataract, which is associated with lower doses of prednisone than the 7.5 mg cut-off of the LLDAS.

Disclosure: M. Petri, Anthera Inc, 5,GlaxoSmithKline, 5,EMD Serono, 5,Eli Lilly and Company, 5,Bristol Meyer Squibb, 5,Amgen, 5,United Rheumatology, 5,Global Academy, 5,Exagen, 2; D. Goldman, None; L. S. Magder, None.

To cite this abstract in AMA style:

Petri M, Goldman D, Magder LS. Lupus Low Disease Activity State Protects Against Most Subtypes of Organ Damage in SLE [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/lupus-low-disease-activity-state-protects-against-most-subtypes-of-organ-damage-in-sle/. Accessed .

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