Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Influenza Humoral Immune Responses in Patients with Systemic Lupus Erythematosus.

Vista3,  Evan Glenn, Crowe2,  Sherry, Thompson2,  Linda, Air4,  Gillian, James1,  Judith A.

Oklahoma Med Research Foundation, Oklahoma City, OK
Oklahoma Medical Research Foundation
Oklahoma Medical Research Foundation, Oklahoma City, OK
University of Oklahoma Health Science Center

Background:

Annual seasonal flu vaccination has been the standard of care among the general population. Controversy still exists as to whether flu vaccination is effective among systemic lupus erythematosus (SLE) patients, who are identified by the United States Centers for Disease Control as a high risk group as part of the immunocompromised population. Select clinical and demographic factors may influence the response to influenza infection and vaccination among SLE patients. Flu vaccine is given at a particular period of the year in the clinical setting; however, nearly all previous studies have been limited in sample size, racial composition and focused on patients with relatively quiescent disease. This study assessed a large cadre of ethnically diverse SLE patients to identify clinical, demographic and therapeutic features associated with poor influenza vaccination responses.

Methods:

A total of 201 SLE patients who fulfilled the American College of Rheumatology (ACR) criteria provided informed consent. Influenza antibody titers were tested at up to five-fold dilutions. A very low and a very high titer were defined as an endpoint titer of 1:200 and 1:10,000 respectively. Patient demographics and clinical profiles, including current medications, were collected. Antinuclear antibodies (ANA), anti-dsDNA, anti-Ro, anti-La, anti-Sm, anti-RNP, anti-Ribo P, anti-cardiolipin IgG were measured. Test for proportions and modified Wald method were used to compute for the 95% confidence interval of each influenza humoral immune endpoint titer.

Results:

The sample population was comprised of 92 African Americans (45%), 98 Caucasians (48%) and 17 belongs to other or mixed races (7%). The median age of all subjects from this study is 43.5 years (range 17 to 87) and 87% are females. The mean influenza antibody endpoint titers were computed at 1:2146 (SD 2.48, CI 1802 to 2492), 17 subjects (8.5%, CI 0.05 to 0.13) were very low and 15 subjects (7.5%, CI 0.45 to 0.12) were very high. The majority (78 subjects) had an endpoint titer of 1:1000 (38.8%, CI 0.32 to 0.46). Endpoint titers for the others are as follows: 27 subjects (13.4%, CI 0.09 to 0.19) with 1:300 and 64 subjects (31.8%, 0.26 to 0.39) with 1:3000. Comparing the very low and very high endpoint titers, no significant differences in terms of sex, age and race were seen. In terms of their ACR criteria, patients with very high endpoint titers have higher incidence of discoid rash (30% vs 10%), photosensitivity (70% vs 50%) and serositis (60% vs 30%), while patients with very low endpoint titers fulfilled more immunologic criteria (80% vs 20%). Among the autoantibodies, no difference were seen in the ANA titers and the presence of anti-nRNP was significantly higher for those with very low endpoint titers (7/17 vs 1/15, OR 9.9 p <0.04). More patients with very low endpoint titers have concomitant prednisone medication than those with very high endpoint titers (12/17 vs 4/15, OR 6.6 p< 0.03).

Conclusions:

Humoral immune responses to influenza were seen among patients with SLE. The variability of flu antibody titers could be influenced by factors that include current medications with steroids and select autoantibody production such as anti-RNP.

To cite this abstract, please use the following information:
Vista, Evan Glenn, Crowe, Sherry, Thompson, Linda, Air, Gillian, James, Judith A.; Influenza Humoral Immune Responses in Patients with Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :466
DOI: 10.1002/art.28235

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