ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 612

Thrombosis Recurrence in Systemic Lupus Erythematosus Patients with and without Antiphospholipid Antibodies

Ibrahim AlHomood1, D. D. Gladman2, Dominique Ibanez3 and Murray B. Urowitz3, 1Rheumatology, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada, 2Division of Rheumatology, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada, 3Division of Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Systemic Lupus Erythematosus: Clinical Aspects

Session Type: Abstract Submissions (ACR)

Background/Purpose:   To determine the outcome of thrombotic events in the presence and absence of antiphospholipid antibodies (aPL) in patients with systemic lupus erythematosus (SLE).

Methods:   Patients with SLE and thrombotic events followed prospectively at the Lupus clinic were divided into two groups: 1) those with one event (no recurrence) and 2) those with recurrent events.

Demographic and clinical data collected at time of thrombosis included age, race, gender, aPL status (anticardiolipin antibodies &/or lupus anticoagulant), disease duration, disease activity (SLEDAI-2K), hypertension, diabetes mellitus (DM), hypercholesterolemia, smoking and use of aspirin (ASA). Thrombotic events (TE) were divided into arterial TE (ATE) and venous TE (VTE).ATE was defined as angina, myocardial infarction, stroke, or peripheral arterial thrombosis, and VTE was defined as deep vein thrombosis or pulmonary emboli. Comparison between patients with and without recurrence was done using descriptive statistics. Time to recurrence was compared using Kaplan-Meier curves and stepwise Proportional hazard models

Results: 613 TE were identified in 400 patients. 213 recurrences were observed in 132 patients. The aPL status is known in 367 patients of whom118 (32.2%) have had a recurrence. The mean time to recurrence in these 118 patients is 5.0 ± 5.1 years.

 

Patients with Recurrence

Patients with no Recurrence

p value

No.

118

249

 

Sex(F)

94 (79.7%)

219 (88.0%)

0.04

Age at SLE Dx

Age at 1st TE

35.9 ± 14.1

46.7 ± 14.4

33.2 ± 15.3

42.9 ± 14.7

0.11

0.02

SLE Disease Duration at 1st TE

10.8 ± 10.0

9.7 ± 8.8

0.28

Race     Caucasian

              Black

              Asian

              Other

96 (81.4%)

13 (11.0%)

1 (0.8%)

8 (6.8%)

187 (75.1%)

25 (10.0%)

16 (6.4%)

21 (8.4%)

0.18*

aPL +ve

(ever at 1st TE)

82 (69.5%)

143 (57.4%)

0.03

Hypertension

       Ever to 1st TE

       At 1st TE

78 (66.7%)

52 (45.2%)

157 (63.1%)

124 (50.0%)

0.50

0.40

Cholesterolemia†

       Ever to 1st TE

       At 1st TE

84 (77.1%)

63 / 101 (62.4%)

170 (70.5%)

116 / 235 (49.4%)

0.21

0.03

Diabetes Mellitus

       Ever to 1st TE

       At 1st TE

14 (12.0%)

12 (10.3%)

17 (6.9%)

14 (5.7%)

0.10

0.11

SLEDAI-2K at 1st TE

9.3 ± 9.1

8.8 ± 8.4

0.64

Smoker

       Ever to 1st TE

       At 1st TE

40 (34.8%)

29 (25.2%)

62 (25.3%)

42 (17.1%)

0.06

0.07

ASA ever in the 5 years following 1st TE (or until recurrence if within 5 years)

39 / 110 (35.5%)

60 / 231 (26.0%)

0.07

Venous TE

Arterial TE

43 (36.4%)

80 (67.8%)

117 (47.0%)

141 (56.6%)

0.06

0.04

Kaplan-Meier curve for the prediction of Recurrence

by aPL +ve ever at time of 1st TE

Conclusion:

Recurrent TE occurs in 32.2% of lupus patients with TE. ATE recurred more often than VTE. Patients with high cholesterol level at time of thrombosis or antiphospholipid antibodies have an increased the risk of recurrence.

Disclosure:

I. AlHomood,
None;

D. D. Gladman,
None;

D. Ibanez,
None;

M. B. Urowitz,
None.

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