Background/Purpose:

Serositis is one of the ACR classification criteria for SLE.  Its incidence is variable in studies varying from 12 to 60%.

The aim of this study is to determine the prevalence of serositis, its recurrence, management and complications in a large longitudinal cohort study.

Methods:

Patients studied were seen in a long term single center observational cohort study. Pleurisy and pericarditis were diagnosed according to SLEDAI-2K Disease Activity Index criteria, which require objective measures to classify the serositis.

Demographic and clinical data collected at the time of serositis onset included age, gender, age at diagnosis, disease duration, medication used, damage index and SLEDAI assessment. Patients were divided into two groups: 1) patients with no recurrence and 2) those with recurrence. Those patients who had serositis features for more than six months despite appropriate treatment were considered to have refractory disease.  Recovery was defined as resolution of pain attributed to the serositis. Descriptive statistics were used.

Results:

214 patients out of 1678 patients in the cohort (12.8%), had serositis during their disease course.  This group was made up of 83% Female, 67% Caucasian, 14% Black, 8% Asian and 10% Other. Age at SLE diagnosis was 33 ± 12 years. At onset of serositis, disease duration was 4.6 ± 6.1 years; SLEDAI-2K (excluding serositis items) was 11.3 ± 9.7 and 61 (36%) patients had some damage.

174 patients had no recurrence and 40 patients (18.7%)had recurrence – 31 patients had 2 episodes, 5 patients had 3 episodes and 4 patients had 4 episodes.  12 (0.7%) patients had complications including pleural fibrosis and thickening and pericardial thickening.

202 (94.4%) patients went on to complete recovery and 12 (5.6%) were refractory.  Average time to recovery was 8.6 ± 9.6 weeks. Refractory patients had serositis for an average of 1.2 ± 0.5 year.

Excluding refractory patients and comparing patients with recurrence to those without recurrence, there was no difference in sex, age at SLE diagnosis, age and disease duration at serositis onset, SLEDAI-2K or percent of patients with damage. More patients with recurrences had steroids and immunosuppressives compared to the non-recurrence group (100% vs 89% for steroids p=0.05; 36% vs 11% for immunosuppressives, p=0.0002).

Conclusion:

Serositis occurs in 12.8% of our patients as defined by SLEDAI-2K. They responded well to corticosteroid but approximately 1 in 5 had a recurrence.  Refractory disease is rare.  There were no predictive variables for recurrence.

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« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/serositis-in-systemic-lupus-erythematosus-prevalence-recurrence-treatment-and-outcome/