Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Thrombotic events (TE) cause great morbidity and mortality in SLE patients. Studies of TE in SLE focus on early-onset TE. While the incidence of TE remains increased during later-stage disease, no study has assessed the risk factors for late-onset TE. The purpose of this study is to: a) assess the characteristics and risk factors associated with late-onset TE (> 5 years after diagnosis) in SLE; and b) compare these with early-onset TE (< 5 years after diagnosis).
Methods: One hundred and fifty-one SLE patients who developed TE after enrolment in a prospective lupus cohort from 1970 to 2014 were identified. They were matched for age, sex and disease duration with non-TE SLE patients (early-onset TE controls: n=151; and late- onset TE controls: n=77). The demographic (age, ethnicity), clinical (disease duration, ACR criteria, SLE manifestations), lab (anti-dsDNA antibody, C3, C4, nuclear antigens, lupus anticoagulant, anti-cardiolipin antibody), disease activity (SLEDAI-2K), disease damage [SLICC Damage Index with cardiovascular items removed (mod-SDI)] and treatment (prednisone, immunosuppressants, antimalarials, anti-inflammatories), as well as TE type [arterial (ATE), venous (VTE)] and traditional TE risk factor (smoking, cholesterol levels and hypertension) variables were recorded.
Results: Fifty (33%) patients developed late-onset and 101 (67%) early-onset TE. In comparison with early- onsetTE, late-onset TE were predominantly ATE (62.0% vs 45%, P=0.02). In univariate analysis, significant variables associated with late-onset TE were hypertension (OR 3.97, P<0.01), oral/nasal ulcers (OR 2.56, P=0.03), CNS manifestations (OR 5.40, P=0.01), vasculitis (OR 3.48, P<0.01), elevated total cholesterol (OR 2.58, p<0.01), and prednisone dose within 3 years of TE (OR 1.07, P=0.02).
In multivariate analysis, significant predictors of late-onset TE were hypertension (OR 2.85, P=0.03), CNS manifestations (OR = 6.66, P=0.04), vasculitis (OR = 2.96, P=0.049), lupus anti-coagulant (OR = 4.73, P=0.02). Risk factors associated with late ATE included a combination of traditional TE risk factor and lupus-related factors; whereas in late VTE risk factors included predominantly lupus-related factors. Variables associated with early-onset TE were also a mixture of traditional and lupus-related risk-factors.
Conclusion: Late-onset TE in SLE is predominantly arterial, and result from both traditional and SLE-related risk factors. The risk of thrombosis remains elevated throughout the course of SLE, resulting from the combination of traditional and SLE-related risk factors. In order to reduce the burden of TE, these risk factors need to be continuously evaluated and controlled throughout the disease course.
To cite this abstract in AMA style:Al-Ghanim K, Su J, Morrison SE, Alharbi S, Attar M, Gladman D, Urowitz M, Sánchez-Guerrero J. Risk Factors for Late-Onset Thrombosis in Systemic Lupus Erythematosus (SLE) [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/risk-factors-for-late-onset-thrombosis-in-systemic-lupus-erythematosus-sle/. Accessed October 1, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-for-late-onset-thrombosis-in-systemic-lupus-erythematosus-sle/