Session Information
Date: Tuesday, November 15, 2016
Session Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster III: Biomarkers and Nephritis
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: To compare disease characteristics in patients with early and delayed onset of lupus nephritis(LN) and their outcomes after 5 years of follow-up.
Methods: Patients with LN were identified from a prospective cohort of single lupus center. Only patients who entered the cohort within 2 years from SLE diagnosis were considered. Patients who developed LN within 3 years of diagnosis (Early LN group) were compared with patients in whom LN diagnosed after 3 years of SLE diagnosis (Delayed LN).Five outcomes were evaluated: complete renal remission (CR, normalization of all of RBCs, protein, casts, pyuria), partial renal remission (PR, 50% improvement),renal flares (Increase in any of renal SLEDAI-2K score after CR), renal failure, renal damage progression (SDI) and death. Outcomes were assessed by Cox proportional hazard regression analyses.
Results: A total of 277(85%)Early LN patients (83.3% female,61%caucasian) and 49(15%) Delayed LN patients(87.8% female, 65.3% Caucasian)were included.
|
Variables at LN |
Early (N= 277) |
Delayed (N=49) |
P value |
|
Age* |
33.55 ± 13.03 |
41.97 ± 15.17 |
<0.001 |
|
Disease duration* |
0.68 ± 0.69 |
7.78 ± 4.61 |
0.001> |
|
SLEDAI-2k score* |
12.71 ± 8.59 |
9.47 ± 6.93 |
0.013 |
|
SLEDAI-2k non renal score* |
6.47 ± 6.32 |
4.57 ± 3.97 |
0.043 |
|
SDI Score* |
0.15 ± 0.48 |
0.82 ± 1.07 |
<0.001 |
|
Low Complements † |
155 (56.2%) |
25 (51.0%) |
0.505 |
|
Anti DNA † |
152 (59.1%) |
27 (55.1%) |
0.599 |
|
High Serum creatinine† |
55 (19.9%) |
2 (4.1%) |
0.007 |
|
GCS use |
255 (92.1%) |
39 (79.6%) |
0.007 |
|
Antimalarial use |
138 (49.8%) |
33 (67.3%) |
0.024 |
|
IS use |
177 (63.9%) |
27 (55.1%) |
0.241 |
| *Mean ± SD; †n(%); GCS: Glucocorticosteroid; IS: immunosuppressive | |||
At nephritis, Early LN patients had more active disease but less damage accrual. After 5 years of follow-up, CR was higher in Early LN group. SDI scores increased significantly in the early LN group. There were no differences in renal flares, renal failure or death. Multivariate regression analysis revealed that patients with higher SLEDAI-2K and SDI scores were less likely to achieve CR. Using GCS and IS increased SDI, whereas antimalarial use and high DNA levels were protective. Caucasian ethnicity, older age at diagnosis of LN, early onset of LN, high SDI scores, high SLEDAI-2K scores, low complement levels, and GCSuse, were associated with poorer survival, while the use of antimalarial and IS were protective. Older age at CR was the only factor predicting less renal flares.
Conclusion: Patients with delayed development of LN had a milder disease course and more favorable outcomes than those with early LN.
To cite this abstract in AMA style:
ALJohani R, Gladman DD, Su J, Urowitz M. Outcomes in Patients with Early and Delayed Onset Lupus Nephritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/outcomes-in-patients-with-early-and-delayed-onset-lupus-nephritis/. Accessed July 23, 2019.« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-in-patients-with-early-and-delayed-onset-lupus-nephritis/