Session Information
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment: Treatment and Management Studies
Session Type: Abstract Submissions (ACR)
Background/Purpose: Thrombosis is increased in SLE due to disease activity and co-morbid factors including antiphospholipid antibodies. We separately investigated the natural history of venous vs. arterial thrombosis.
Methods: 2250 patients were enrolled in a prospective cohort; 334 had a thrombotic event before cohort entry or diagnosis of SLE. For ALL thrombosis, age over 60 yrs, male gender, African-American ethnicity, SLEDAI greater than 3, and prednisone greater than 0 were risk factors.
Results: In general, rates of venous thrombosis were fairly constant, while rates of arterial thrombosis increased with age. The figure below shows that initially the venous thrombosis rate is higher (including before diagnosis) and later the arterial thrombosis rate is higher.
Figure SEQ Figure * ARABIC 1: Probability of remaining thrombosis free, by age
Table 1: Incidence rates (per 1000 patient-years) of thromboses
|
All Thromboses |
Arterial Thromboses |
Venous Thromboses |
||||
|
Characteristic of Person-Month |
Rate Ratios (95% CI) |
P-values |
Rate Ratios (95% CI) |
P-values |
Rate Ratios (95% CI) |
P-values |
|
Age 18-39 40-49 50-59 60+
|
1.0 (Ref Group) 1.1 (0.8, 1.6) 1.2 (0.8, 1.7) 2.2 (1.4, 3.3) |
0.47 0.46 0.0002 |
1.0 (Ref. Group) 1.3 (0.8, 2.1) 1.5 (0.9, 2.4) 3.0 (1.8, 4.9) |
0.22 0.13 0.0001 |
1.0 0.9 (0.6, 1.5) 0.8 (0.5, 1.5) 1.1 (0.6, 2.2) |
0.66 0.53 0.70 |
|
Sex Female Male
|
1.0 (Ref. Group) 1.7 (1.1, 2.7) |
0.024 |
1.0 (Ref. Group) 1.7 (1.0, 3.0) |
0.070 |
1.0 (Ref. Group) 1.5 (0.7, 2.9) |
0.27 |
|
Race Caucasian African Amer. Other
|
1.0 (Ref. Group) 1.5 (1.1, 2.0) 1.0 (0.5, 1.9) |
0.0051 0.91 |
1.0 (Ref. Group) 1.5 (1.0, 2.1) 0.3 (0.1, 1.3) |
0.031 0.11 |
1.0 (Ref. Group) 1.5 (1.0, 2.2) 1.6 (0.7, 3.6) |
0.068 0.24 |
|
Most Recent SLEDAI 0 1-2 3-4 5+
|
1.0 (Ref. Group) 1.3 (0.9, 2.0) 1.6 (1.1, 2.5) 3.0 (2.0, 4.4) |
0.20 0.024 <0.0001 |
1.0 (Ref. Group) 1.9 (1.1, 3.2) 2.5 (1.5, 4.3) 3.5 (2.1, 6.0) |
0.021 0.0007 <0.0001 |
1.0 (Ref. Group) 0.8 (0.4, 1.4) 0.9 (0.4, 1.7) 2.8 (1.7, 4.6) |
0.42 0.69 <0.0001 |
|
Current Prednisone Dose 0 1-9 10-19 20+
|
1.0 (Ref Group) 1.5 (1.0, 2.3) 3.3 (2.2, 4.8) 6.7 (4.5, 10.0) |
0.038 <0.0001 <0.0001 |
1.0 (Ref. Group) 1.8 (1.1, 3.0) 3.5 (2.2, 5.7) 7.0 (4.2, 11.6) |
0.015 <0.0001 <0.0001 |
1.0 (Ref. Group) 1.3 (0.7, 2.4) 3.2 (1.9, 5.6) 7.2 (4.1, 12.7) |
0.33 <0.0001 <0.0001 |
Conclusion: Prevention of venous thrombosis remains important throughout the course of SLE. Prevention of arterial thrombosis becomes more important later in the disease course. Disease activity is a risk factor for arterial thrombosis while prednisone is a risk factor for both venous and arterial thrombosis.
Disclosure:
K. Hickman,
None;
L. S. Magder,
None;
M. Petri,
None.
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