Relationship between Damage and Mortality in Juvenile-Onset Systemic Lupus Erythematosus: Cluster Analyses in a Large Cohort from the Spanish Society of Rheumatology Lupus Registry

JM Pego-Reigosa¹, TC Salman-Monte², Irene Altabás-González³, Iñigo Rúa-Figueroa⁴, Jacobo de Uña⁵, V Balboa-Barreiro⁶, Francisco Javier López Longo⁷, María Galindo⁸, Jaime Calvo-Alen⁹, Alejandro Olivé-Marqués¹⁰, Coral Mouriño-Rodriguez¹¹, Eva Tomero¹², Maria Loreto Horcada¹³, Ana Sánchez Atrio¹⁴, Carlos Alberto Montilla-Morales¹⁵, Eva Salgado¹⁶, Elvira Diez Alvarez¹⁷, Ricardo Blanco¹⁸, Jose Luis Andreu¹⁹, O Fernández-Berrizbeitia²⁰, José Hernández Beiraín²¹, Marian Gantes²², Blanca Hernández-Cruz²³, Angela Pecondon-Español²⁴, Carlos Marras Fernandez-Cid²⁵, María Gema Bonilla Hernán²⁶, Jesús García-Villanueva²⁷ and Vicente Torrente²⁸, ¹Complexo Hospitalario Universitario de Vigo, Vigo, Spain, ²Rheumatology, Hospital del Mar/Parc de Salut Mar, Barcelona, Spain, ³Rheumatology, Hospital Doctor Negrin, Las Palmas GC, Spain, ⁴Rheumatology Division, Hospital Doctor Negrin, Las Palmas GC, Spain, ⁵Statistics and OR, Vigo University, Vigo, Spain, ⁶Department of Statistics and OR, Vigo University, Vigo (Spain), Vigo, Spain, ⁷Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain, ⁸Servicio de Reumatología, Hospital 12 de Octubre, Madrid, Spain, ⁹Rheumatology, Txagorritxu Hospital, Araba, Vitoria, Vitoria, Spain, ¹⁰Rheumatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, ¹¹Rheumatology, Rheumatology Section, Complexo Hospitalario Universitario de Vigo, Pontevedra, Spain, Vigo, Spain, ¹²Rheumatology, Hospital de La Princesa. Madrid. Spain, Madrid, Spain, ¹³Rheumatology, Hospital de Navarra, Pamplona, Spain, ¹⁴University Hospital Príncipe de Asturias, Immune System Diseases, Rheumatology Department, Alcalá de Henares, Madrid, Spain, ¹⁵Hospital Clínico Universitario de Salamanca. Spain, Salamanca, Spain, ¹⁶RheumatologyDepartment, Hospital Complex of Ourense, Ourense (Spain), Ourense, Spain, ¹⁷Complejo Asistencial Universitario de León, León, Spain, ¹⁸Rheumatology Department,, Hospital Marqués de Valdecilla, Santander, Spain, ¹⁹Rheumatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, ²⁰Rheumatology Department Basurto Hospital, País Vasco, Basurto (Spain), Bilbao, Spain, ²¹Rheumatology, Hospital Insular de Gran Canaria, Las palmas Gran Canarias, Spain, ²²Rheumatology, Hospital Universitario de Canarias, La Laguna; Tenerife, Spain, ²³Rheumatology, Hospital Universitario Virgen Macarena, Sevilla, Spain, ²⁴Rheumatology, Hospital Miguel Servet, Zaragoza, Spain, ²⁵Rheumatology, Hospital Virgen de la Arrixaca, Murcia, Spain, ²⁶Rheumatology Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain, ²⁷HOSPITAL RAMÓN Y CAJAL, Madrid, Spain, ²⁸Hospital de dia Baix de LLobregat, LLobregat, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Juvenile SLE and morbidity and mortality

Session Information

Date: Tuesday, October 23, 2018

Session Title: Systemic Lupus Erythematosus – Clinical Poster III: Treatment

Session Type: ACR Poster Session C

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

Background/Purpose: To identify patterns (clusters) of damage manifestation within a large cohort of juvenile SLE (jSLE) patients and evaluate their possible association with mortality.

Methods: This is a multicentre, descriptive, cross-sectional study of a cohort of 345 jSLE patients from the Spanish Society of Rheumatology Lupus Registry (RELESSER). Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestation were identified and compared.

Results: Mean age (years) ± S.D. at diagnosis was 14.2 ± 2.89; 88.7% were female and 93.4% were Caucasian. Mean SLICC/ACR DI ± S.D. was 1.27 ± 1.63. A total of 12 (3.5%) patients died. Three damage clusters were identified: Cluster 1 (72.7% of patients) presented a lower number of individuals with damage (22.3% vs. 100% in Clusters 2 and 3, P<0.001); Cluster 2 (14.5% of patients) was characterized by renal damage in 60% of patients, significantly more than Clusters 1 and 3 (P<0.001), in addition to increased more ocular, cardiovascular and gonadal damage; Cluster 3 (12.7%) was practically the only group with musculoskeletal damage (100%), significantly higher than in Clusters 1 and 2 (P<0.001). The overall mortality rate in Cluster 2 was 2.2 times higher than that in Cluster 3 and 5 times higher than that in Cluster 1 (p<0.017 for both comparisons).

Conclusion: In a large cohort of jSLE patients, renal and musculoskeletal damage manifestations were the two dominant forms of damage by which patients were sorted into clinically meaningful clusters. We found two clusters of jSLE with important clinical damage that were associated with higher rates of mortality, especially for the cluster of patients with predominant renal damage. Physicians should be particularly vigilant to the early prevention of damage in this subset of jSLE patients with kidney involvement.

Disclosure: J. Pego-Reigosa, None; T. Salman-Monte, None; I. Altabás-González, None; I. Rúa-Figueroa, None; J. de Uña, None; V. Balboa-Barreiro, None; F. J. López Longo, None; M. Galindo, None; J. Calvo-Alen, None; A. Olivé-Marqués, None; C. Mouriño-Rodriguez, None; E. Tomero, None; M. L. Horcada, None; A. Sánchez Atrio, None; C. A. Montilla-Morales, None; E. Salgado, None; E. Diez Alvarez, None; R. Blanco, None; J. L. Andreu, None; O. Fernández-Berrizbeitia, None; J. Hernández Beiraín, None; M. Gantes, None; B. Hernández-Cruz, None; A. Pecondon-Español, None; C. Marras Fernandez-Cid, None; M. G. Bonilla Hernán, None; J. García-Villanueva, None; V. Torrente, None.

To cite this abstract in AMA style:

Pego-Reigosa J, Salman-Monte T, Altabás-González I, Rúa-Figueroa I, de Uña J, Balboa-Barreiro V, López Longo FJ, Galindo M, Calvo-Alen J, Olivé-Marqués A, Mouriño-Rodriguez C, Tomero E, Horcada ML, Sánchez Atrio A, Montilla-Morales CA, Salgado E, Diez Alvarez E, Blanco R, Andreu JL, Fernández-Berrizbeitia O, Hernández Beiraín J, Gantes M, Hernández-Cruz B, Pecondon-Español A, Marras Fernandez-Cid C, Bonilla Hernán MG, García-Villanueva J, Torrente V. Relationship between Damage and Mortality in Juvenile-Onset Systemic Lupus Erythematosus: Cluster Analyses in a Large Cohort from the Spanish Society of Rheumatology Lupus Registry [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/relationship-between-damage-and-mortality-in-juvenile-onset-systemic-lupus-erythematosus-cluster-analyses-in-a-large-cohort-from-the-spanish-society-of-rheumatology-lupus-registry/. Accessed December 10, 2019.

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