scholarly journals Risk and protective factors for thrombosis in systemic lupus erythematosus: results from a large, multi-ethnic cohort

2008 ◽  
Vol 68 (2) ◽  
pp. 238-241 ◽  
Author(s):  
R Kaiser ◽  
C M Cleveland ◽  
L A Criswell
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Asian Americans ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Medication Use ◽  
Small Sample ◽  
Antiphospholipid Antibody ◽  
Systemic Lupus ◽  
History Of

Objectives:Few studies have examined thrombosis in systemic lupus erythematosus (SLE), none have included Asian-Americans, and most have had small sample sizes. We analysed risk factors for thrombosis in a large, multi-ethnic SLE cohort.Methods:We studied 1930 SLE subjects, including Caucasians, African-Americans, Asian-Americans and Hispanics. Data were derived from questionnaires and medical records. Documented history of thrombosis was the primary outcome. Explanatory variables included age at SLE diagnosis, gender, ethnicity, disease duration, smoking, antiphospholipid antibody (aPL) status, nephritis and specific medications.Results:Smoking (OR 1.26, p = 0.011), longer disease duration (OR 1.26 per 5 years p = 0.027×10−7), nephritis (OR 1.35, p = 0.036), aPL positivity (OR 3.22, p<10−9) and immunomodulating medication use (OR 1.40, p = 0.011) were statistically significant risk factors for thrombosis. Younger age at SLE onset was protective (OR 0.52 for age ⩽20, p = 0.001). After adjusting for disease severity and incorporating propensity scores, hydroxychloroquine use remained significantly protective for thrombosis (OR 0.62, p = 4.91×10−4).Conclusions:This study confirms that older age at onset, longer disease duration, smoking, aPL positivity, history of nephritis and immunomodulating medication use are risk factors for thrombosis in SLE. These data are the first to confirm in a large and ethnically diverse SLE cohort that hydroxychloroquine use is protective for thrombosis.

scholarly journals Semiquantified Noncalcified Coronary Plaque in Systemic Lupus Erythematosus

2012 ◽  
Vol 39 (12) ◽  
pp. 2286-2293 ◽  
Author(s):  
ADNAN N. KIANI ◽  
JENS VOGEL-CLAUSSEN ◽  
ARMIN ARBAB-ZADEH ◽  
LAURENCE S. MAGDER ◽  
JOAO LIMA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Lupus Erythematosus ◽  
Univariate Analysis ◽  
Coronary Plaque ◽  
Systemic Lupus ◽  
History Of ◽  
Noncalcified Plaque

Objective.A major cause of morbidity and mortality in systemic lupus erythematosus (SLE) is accelerated coronary atherosclerosis. New technology (computed tomographic angiography) can measure noncalcified coronary plaque (NCP), which is more prone to rupture. We report on a study of semiquantified NCP in SLE.Methods.Patients with SLE (n = 147) with no history of cardiovascular disease underwent 64-slice coronary multidetector computed tomography (MDCT). The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software.Results.The group of 147 patients with SLE was 86% female, 70% white, 29% African American, and 3% other ethnicity. The mean age was 51 years. In our univariate analysis, the major traditional cardiovascular risk factors associated with noncalcified plaque were age (p = 0.007), obesity (p = 0.03; measured as body mass index), homocysteine (p = 0.05), and hypertension (p = 0.04). Anticardiolipin (p = 0.026; but not lupus anticoagulant) and anti-dsDNA (p = 0.03) were associated with higher noncalcified plaque. Prednisone and hydroxychloroquine therapy had no effect, but methotrexate (MTX) use was associated with higher noncalcified plaque (p = 0.0001). In the best multivariate model, age, current MTX use, and history of anti-dsDNA remained significant.Conclusion.Our results suggest that serologic SLE (anti-dsDNA) and traditional cardiovascular risk factors contribute to semiquantified noncalcified plaque in SLE. The association with MTX is not understood, but should be replicated in larger studies and in multiple centers.

Pyoderma Gangrenosum Mimicking Antiphospholipid Antibody Syndrome in a Child With Juvenile Systemic Lupus Erythematosus

2020 ◽  
Author(s):  
metin kaya gürgöze ◽  
Aslıhan Kara ◽  
Mehmet yusuf sarı ◽  
İlknur Çalık ◽  
Saadet Akarsu
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Skin Biopsy ◽  
Pyoderma Gangrenosum ◽  
Lupus Erythematosus ◽  
Anticoagulation Therapy ◽  
Anticardiolipin Antibody ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Systemic Lupus ◽  
History Of

Abstract Background: Although pyoderma gangrenosum (PG) -like lesions have been rarely described in adults with the antiphospholipid antibody syndrome (APS) and systemic lupus erythematosus (SLE), the occurrence of PG as a preceding manifestation of APS in children with SLE has not been reported until. We present a young girl with SLE and APS who developed progressive extstensive ulcerations that were consistent with PG.Case presentation: A 14-year-old girl with a 2-year history of SLE was admitted to our department, complaining painful crusted ulcerations on her legs. Skin biopsy was reported as PG. However, she did not respond to immunosuppressive therapy administered. When her skin biopsy findings is reassessed in keeping with the positive anticardiolipin antibody results, superficial small vessel microthrombosis was observed. Diagnosis of APS and PG developing secondary to SLE were made. It was resulted in marked clinical improvement with anticoagulation therapy in addition to immunosuppressives as is recommended in APS. Conclusions: Based in clinical, pathological and response to proposed treatment, we can state that PG -like lesions in children with SLE could be considered as a secondary form of APS.

scholarly journals Atherosclerotic plaque in carotid arteries in systemic lupus erythematosus: frequency and associated risk factors

2005 ◽  
Vol 123 (3) ◽  
pp. 137-142 ◽  
Author(s):  
Alexandre Wagner Silva de Souza ◽  
Francisca Satomi Hatta ◽  
Fausto Miranda Jr. ◽  
Emília Inoue Sato
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Atherosclerotic Plaque ◽  
Lupus Erythematosus ◽  
Carotid Plaque ◽  
Carotid Arteries ◽  
Disease Duration ◽  
Significant Risk ◽  
Older Age ◽  
Systemic Lupus

CONTEXT AND OBJECTIVE: Atherosclerotic disease is an important cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. No previous study has estimated carotid disease prevalence in such patients in Brazil. The aim was to evaluate the prevalence of atherosclerotic plaque in carotid arteries, in SLE patients and controls, and to verify possible associations between risk factors and carotid plaque. DESIGN AND SETTING: Cross-sectional study, at Universidade Federal de São Paulo - Escola Paulista de Medicina. METHODS: Carotid plaque prevalence was assessed by B-mode ultrasound in 82 female SLE patients of mean age 34.0 years and 62 controls of mean age 35.7 years. Plaque was defined as a distinct area of hyperechogenicity and/or focal protrusion of the vessel wall into the lumen. Risk factors for coronary disease and SLE-related variables were determined. RESULTS: 50% of patients and 29% of controls presented carotid plaque. Older age, longer disease duration, higher Systemic Lupus International Collaborating Clinics (SLICC) score, higher levels of low-density lipoprotein and greater diabetes, obesity, premature ovarian failure and family history of coronary artery disease were found in patients with carotid plaque than in those without plaque. Patients with plaque were younger than controls with plaque. SLE diagnosis, obesity, older age, higher SLICC score and longer disease duration were independent risk factors for carotid plaque. CONCLUSION: Young patients with SLE present higher prevalence of carotid plaque than controls. SLE diagnosis was a significant risk factor for carotid atherosclerosis.

scholarly journals Genetic Risk Factors for Thrombosis in Systemic Lupus Erythematosus

2012 ◽  
Vol 39 (8) ◽  
pp. 1603-1610 ◽  
Author(s):  
RACHEL KAISER ◽  
YONGHONG LI ◽  
MONICA CHANG ◽  
JOSEPH CATANESE ◽  
ANN B. BEGOVICH ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Venous Thrombosis ◽  
Lupus Erythematosus ◽  
Genetic Risk ◽  
Genetic Risk Factors ◽  
Antiphospholipid Antibody ◽  
Systemic Lupus ◽  
Discovery Cohort ◽  
Thrombosis Risk

Objective.Thrombosis is a serious complication of systemic lupus erythematosus (SLE). We investigated whether genetic variants implicated in thrombosis pathways are associated with thrombosis among 2 ethnically diverse SLE cohorts.Methods.Our discovery cohort consisted of 1698 patients with SLE enrolled in the University of California, San Francisco, Lupus Genetics Project and our replication cohort included 1361 patients with SLE enrolled in the PROFILE cohort. Patients fulfilled American College of Rheumatology SLE criteria, and data relevant to thrombosis were available. Thirty-three single nucleotide polymorphisms (SNP) previously shown to be associated with risk of deep venous thrombosis in the general population or implicated in thrombosis pathways were genotyped and tested for association with thrombosis in bivariate allelic analyses. SNP with p < 0.1 in the bivariate analyses were further tested in multivariable logistic regression models adjusted for age, sex, disease duration, antiphospholipid antibody status, smoking, nephritis, and medications.Results.In the discovery cohort, 23% of patients with SLE experienced a thrombotic event. SNP in the following genes demonstrated association with thrombosis risk overall in the discovery or replication cohorts and were assessed using metaanalytic methods: factor V Leiden (FVL) rs6025 (OR 1.85, p = 0.02) and methylenetetrahydrofolate reductase (MTHFR) rs1801133 (OR 0.75, p = 0.04) in whites, and fibrinogen gamma (FGG) rs2066865 (OR 1.91, p = 0.01) in Hispanic Americans. SNP in these genes showed association with venous thrombosis risk in whites: MTHFR rs1801131 (OR 1.51, p = 0.01), MTHFR rs1801133 (OR 0.70, p = 0.04), FVL rs6025 (OR 2.69, p = 0.002), and FGG rs2066865 (OR 1.49, p = 0.02) in whites. A SNP in FGG rs2066865 (OR 2.19, p = 0.003) demonstrated association with arterial thrombosis risk in Hispanics.Conclusion.Our results implicate specific genetic risk factors for thrombosis in patients with SLE and suggest that genetic risk for thrombosis differs across ethnic groups.

Predictors of Incident Seizure in Systemic Lupus Erythematosus

2016 ◽  
Vol 43 (3) ◽  
pp. 565-575 ◽  
Author(s):  
XiangYang Huang ◽  
Laurence S. Magder ◽  
Michelle Petri
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Renal Involvement ◽  
Multivariable Analysis ◽  
Clinical Manifestations ◽  
Systemic Lupus ◽  
Malar Rash ◽  
History Of

Objective.The risk factors for incident seizures in systemic lupus erythematosus (SLE) were prospectively determined in a cohort study.Methods.A total of 2203 patients with SLE followed longitudinally in the Hopkins Lupus Cohort were analyzed. Demographic variables, clinical manifestations, laboratory tests, and SLE disease activity were recorded at each quarterly visit. Adjusted estimates of association of risk factors for onset of seizure were derived using pooled logistic regression. We examined incident seizures in 3 ways: at the time of diagnosis, more than 45 days after the diagnosis of SLE, and after cohort entry.Results.Of 2203 patients with no history of seizure prior to SLE diagnosis, 157 (7.13%) had the first seizure occurrence at the time of (37 patients, 1.68%) or after diagnosis (120 patients, 5.45%) of SLE. The risk of seizure occurring around the time of SLE diagnosis was higher in patients with a history of malar rash (p = 0.002), proteinuria (p = 0.004), and psychosis (p < 0.001). Multivariable analysis of the first seizure occurring after the diagnosis of SLE showed that history of low C3 (p = 0.0078), psychosis (p < 0.0001), cranial or peripheral neuropathy (p = 0.0043), anti-Sm antibody (p = 0.0551), renal involvement (p = 0.0177), and current corticosteroid dose (p < 0.0001) were independently associated with a higher incidence of seizure. Disease activity was not predictive after adjusting for corticosteroids.Conclusion.Risk of seizure after diagnosis of SLE is increased in those patients with prior psychosis, neuropathy, proteinuria, anti-Sm, low C3, and use of corticosteroids.

Neuromyelitis optica spectrum disorder in a patient with systemic lupus erythematosus and anti-phospholipid antibody syndrome

2008 ◽  
Vol 14 (3) ◽  
pp. 425-427 ◽  
Author(s):  
Lahar R Mehta ◽  
Melissa K Samuelsson ◽  
Anatole K Kleiner ◽  
Andrew D Goodman ◽  
Jennifer H Anolik ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Neuromyelitis Optica ◽  
Lupus Erythematosus ◽  
Transverse Myelitis ◽  
Specific Marker ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Systemic Lupus ◽  
History Of ◽  
Recurrent Transverse Myelitis

Neuromyelitis optica (NMO) is a demyelinating disease of the central nervous system characterized by severe episodes of optic nerve and spinal cord inflammation. NMO-IgG (anti-aquaporin-4) has been recently described as a sensitive and specific marker for NMO. As there have been prior published reports of an association between NMO and systemic autoimmune diseases, the prognostic value of the antibody test in these cases is uncertain. We describe a 47-year old woman with recurrent transverse myelitis and a long-standing history of systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLS). While she did not have a history of optic neuritis, serological testing for the NMO-IgG was positive when she was admitted for her second episode of transverse myelitis. Testing for the NMO-IgG in cases of isolated or recurrent transverse myelitis attributed to current SLE and APLS may help clarify the diagnosis of a distinct disease process likely to cause recurrent and severe disability, warranting more aggressive immunotherapy. Multiple Sclerosis 2008; 14: 425—427. http://msj.sagepub.com

scholarly journals POS0723 HERPES ZOSTER IN A MULTI-ETHNIC SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) COHORT: CLINICAL FEATURES AND RISK FACTORS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 611.2-612
Author(s):  
S. S. Shaharir ◽  
S. Rajalingham ◽  
R. Mohd ◽  
N. Kori ◽  
A. Jamil
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Mycophenolate Mofetil ◽  
Herpes Zoster ◽  
Lupus Erythematosus ◽  
Lower Risk ◽  
The Other ◽  
Systemic Lupus ◽  
History Of ◽  
Time Of Infection

Background:Systemic Lupus Erythematosus (SLE) patients are at risk of Herpes Zoster (HZ) infection due to the underlying immunosuppressed state. The reported incidence of HZ in SLE is 6 to 10-times higher than the general population.Objectives:To determine the clinical characteristics of SLE patients who develop Herpes Zoster (HZ) infection and their associated risk factors.Methods:Medical records review was performed on consecutive SLE patients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from 2018 until 2019. Previous history of HZ and their demographic characteristics, clinical and medications used at the time of infection were recorded. Univariate and multivariate analyses were performed to compare the clinical and treatment characteristics between SLE patients with history of HZ and patients who had never had experienced HZ.Results:A total of 229 patients with predominantly Malay patients (n=123, 53.7%), followed by Chinese (n=90, 39.3%) and others (n=16, 7.0%) were included. A total of 37 patients had history of HZ (16.2%). Their mean age during HZ episode was 34.4 ± 13.8 years and their SLE disease duration was 68.7 ±57.1 months. More than half of them (n=21, 56.8%) developed HZ when the SLE disease was active with the mean dose of prednisolone at the time of infection was 20.7 ± 9.2 mg daily. A total of 21 HZ patients (56.8%) had ever received cyclophosphamide with the median interval of the last infusion was 6 (0.2-84) months. Almost half of the HZ patients (n=18, 48.6%) developed the infection while on cyclosporine A. Meanwhile, 4 (10.8%) were on azathioprine and mycophenolate mofetil respectively. Chinese patients tend to have HZ as compared to other ethnics (27% vs 41.7%), p=0.07. HZ occurred in a higher proportion among male patients (29%) as compared to female patients (14.1%), p=0.05. The use of azathioprine (10.8% vs 55.2%, p<0.01) and mycophenolate mofetil (10.8% vs 31.8%, p=0.009) were less associated with HZ. On the other hand, the use of cyclosporine A (48.6% vs 32.3%, p=0.05) and prednisolone ≥ 60mg daily (44.4% vs 28%, p=0.04) were associated with HZ. Higher HZ patients had hematological manifestation (81.1% vs 62.5%, p=0.04) and positive lupus anticoagulant (LA), 32.4% vs 14.6%, p=0.02. A forward logistic regression which included all factors with p<0.1 in the univariate analyses revealed that the use of prednisolone ≥ 60mg daily and hematological manifestation were the independent predictors of HZ with OR= 2.28 (95% C.I = 1.01-5.17), p=0.049 and OR= 2.78 (95% C.I = 1.09-7.04), p=0.03 respectively. The use of azathioprine was associated with a lower risk of HZ with OR 0.08 (95% C. I= 0.03-0.25), p=<0.01.Conclusion:Our study demonstrated the possible influence of male gender, Chinese ethnicity and disease characteristics such as hematological manifestation and lupus anticoagulant positivity with the occurrence of HZ. In addition, the use high dose oral prednisolone ≥ 60mg daily was the independent predictor of HZ while on the other hand, the use of azathioprine was associated with a lower risk of developing HZ as compared to other immunosuppressive agents. Further larger studies are needed to confirm these associations.References:[1]Chen D, Li H, Xie J, Zhan Z, Liang L, Yang X. Herpes zoster in patients with systemic lupus erythematosus: Clinical features, complications and risk factors. Exp Ther Med. 2017;14(6):6222-6228.Disclosure of Interests:None declared

scholarly journals AB0339 PREVALENCE AND ASSOCIATED FACTORS OF LOW BONE MINERAL DENSITY IN ADULTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1194.2-1195
Author(s):  
M. Ardhaoui ◽  
M. Brahem ◽  
S. Arfa ◽  
H. Hachfi ◽  
B. Ben Rejeb ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Mineral Density ◽  
Systemic Lupus ◽  
Sledai Score ◽  
T Score ◽  
History Of ◽  
The Mean ◽  
Post Menopausal

Background:Patients with Systemic Lupus Erythematosus (SLE) are at risk of osteoporosis (OP) and fragility fractures (FFx) because of the disease or its treatments. We assessed the prevalence and risk factors for OP in patients with SLE.Objectives:Our objective is to determine the prevalence of bone mineral density (BMD) loss and fracture risk factors in SLE patients undergoing dual-energy X-ray absorptiometry (DXA).Methods:This is a cross sectional study conducted during the year 2020 in the Rheumatology and internal medicine departements in Taher Sfar hospital of Mahdia, Tunisia. We included patients aged ≥18 years with a diagnosis of SLE according to the 1997 ACR or 2012 SLICC criteria. Patients with renal or hepatic osteodystrophy, or receiving bisphosphonates were excluded from the study. The BMD values were measured by DXA. The T-score, Z-scores and BMD of the lumbar spine (LS) and femoral neck (FN) were determined. OP was defined as a value of the T-score less or equal to -2.5 SD for postmenopausal women and men aged more than 50 years old, and Z-scores less or equal to -2 for premenopausal women and men aged less than 50 years old.Results:Forty-six SLE patients were included. The mean age was 47.19±16.45 years [18-85], with a mean disease duration of 2.52±3.46 years [15days-15years]. The mean SLEDAI score was 5.34±4.82. As regards menstrual history of female patients: 56.5% were premenopausal, 43.5% were post-menopausal and 6% had premature menopause. 13% of our patients gave history of smoking. The mean BMI was 27.6 ± 6 kg/m2 [15-39.8]. FFx were diagnosed in 4 patients (9%) and the mean age of the first fracture was 45years. GCs were used in 65.2% of cases (30 patients). The mean daily dose of GCs was 10 mg/day and the mean cumulative dose was 20g. Calcium and Vitamin D intake was mentioned in 65.2% of cases (30 patients). The association of SLE with other rheumatic diseases was found in 14 of patients. The mean T-score at FN and LS were respectively 0.02±1.17 and -1.32±1.36. The mean Z-score at FN and LS were respectively 0.53±1.14 and -0.6±1.26. It was found that 17 patients (37% of cases) had OP, 12 had osteopenia (26%) and 17 patients (37%) had normal BMD. 37% of patients had OP at LS, 23.9% osteopenia at LS, 6.5% OP at FN and 21.7% osteopenia at FN. Low BMD was significantly correlated with increased age (p=0.01) and disease duration(p=0.05),post-menopausal status(p=0.04), higher BMI (p=0.004), musculoskeletal involvement (p=0.01), association to other rheumatic diseases (p=0.01), higher disease activity by SLEDAI score (p=0.05), higher Erythrocyte sedimentation Rate (p=0.01) and C-Reactive Protein (p=0.007), low serum complement C3 (p=0.009) and C4 (p=0.04) and cumulative doses of GCs (p=0.01).We found also that BMD at LS was mostly affected by GCs intake, BMI and CRP while BMD at FN was mostly affected by SLEDAI score, C3 and C4 (p<0.001 in all cases). Gender, history of smoking and cardiovascular comorbidities had no significant impact on BMD.Conclusion:OP is a common but unrecognised complication of SLE with increased frequency of both peripheral and vertebral FFx. Our study suggests a high risk profile for OP and FFx in SLE which seems to be associated with age, disease duration, post-menopausal status, BMI and GCs.References:[1]Dey, M., & Bukhari, M. (2018). Predictors of fracture risk in patients with systemic lupus erythematosus. Lupus, 27(9), 1547–1551.Disclosure of Interests:None declared

scholarly journals 1690. Risk Factors of Invasive Aspergillosis in Systemic Lupus Erythematosus Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S619-S619
Author(s):  
Sithichai Kunawathanakul ◽  
Atibordee Meesing ◽  
Chingching Foocharoen
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Invasive Aspergillosis ◽  
Lupus Erythematosus ◽  
Lymphocyte Count ◽  
Absolute Lymphocyte Count ◽  
Steroid Treatment ◽  
Systemic Lupus ◽  
History Of ◽  
Low Prevalence

Abstract Background Invasive aspergillosis (IA) has been reported in systemic lupus erythematosus (SLE) patients. We assessed the risk factors of invasive aspergillosis in SLE patients. Methods A retrospective age- and sex-matched case–control study with ratio 3:1 in adult SLE patients from January 2002- December 2017 at Srinagarind Hospital, Khon Kaen University, KhonKaen, Thailand has been conducted. We excluded the patients who were overlap with other immunocompromised condition. Results Of 1,585 SLE patients, 22 patients (1.4%) had invasive aspergillosis and 66 controls were included in the study. The mean age was 36.9 ± 11.8 years and 76 (86.4%) patients were female. SLE patients who developed IA had statistically significant lower median total absolute lymphocyte count than control (503 vs. 1342 cells/mm3, P = 0.05) and history of steroid treatment (adjusted OR 21.43, P = 0.006) were the risk factor of IA. Conclusion There was a low prevalence of IA in SLE patients. Low total lymphocyte count, renal impairment and history of steroid treatment were significantly associated with invasive aspergillosis in SLE patients. Disclosures All authors: No reported disclosures.

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