Session Information
Title: Systemic Lupus Erythematosus - Clinical Aspects I - Renal, Malignancy, Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose: Candida is the most common opportunistic fungal infection identified in SLE. In a previous autopsy study, 14 percent of deaths in SLE patients were associated with Candida infection. We assessed the frequency of oral candidiasis and the association between demographic variables, disease-related variables, corticosteroid treatment, other treatments and the occurrence of oral candidiasis in the Hopkins Lupus Cohort.
Methods: In a prospective cohort study of 2,209 SLE patients, there were 92% female, 56% Caucasian, and 37% African-American patients. There were 318 (14.4%) patients with oral candidiasis. Among these 318 patients, 124 (39.0%) patients had more than 1 episode of oral candidiasis. The demographic, clinical and treatment associates of oral candidiasis were determined by univariate and multivariate analyses.
Results:
|
Variable |
Odds Ratio (95% CI) |
p-value* |
|
African-American ethnicity (vs Caucasian) |
2.6 (1.8, 3.7) |
<.0001 |
|
Smoking |
1.1 (0.7, 1.5) |
0.79 |
|
Depression |
1.1 (0.8, 1.5) |
0.69 |
|
Prednisone dose (mg/day) |
1.02 (1.01, 1.03) |
0.0004 |
|
Hydroxychloroquine use |
0.8 (0.6, 1.1) |
0.11 |
|
Immunosuppressive use |
1.4 (1.0, 2.0) |
0.046 |
|
White blood count (per 1,000) |
1.04 (0.99, 1.10) |
0.10 |
|
Low C3 |
1.0 (0.6, 1.6) |
0.99 |
|
Serum creatinine (mg/dl) |
1.1 (0.9, 1.3) |
0.26 |
|
Urine protein/creatinine ratio |
1.1 (1.0, 1.2) |
0.0048 |
|
Bacterial infection |
1.6 (1.1, 2.3) |
0.024 |
* Generalized estimating equations were used to account for multiple observations on the same patient
In the multivariable model, African-American ethnicity, prednisone, prednisone dose (in mg), immunosuppressive use, a history of bacterial infection and the urine protein to creatinine ratio remained significant. The use of hydroxychloroquine lowered the risk of oral thrush, but was not statistically significant.
Conclusion: This study identified multiple risk factors for oral candidiasis in SLE. African-American ethnicity, one of the strongest predictors, has never been recognized in previous studies. Prednisone use, prednisone dose (in mg), immunosuppressive use, and a history of bacterial infection were expected risk factors. Secondary Sjogren’s syndrome, which we had hypothesized would be a risk factor, was not. Proteinuria had an independent association beyond the effect of prednisone and immunosuppressive use. Treatment with hydroxychloroquine reduced the risk, but was not statistically significant in the multivariate models.
Disclosure:
M. Fangtham,
None;
H. Fang,
None;
M. Petri,
None.
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