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.


Risk Factors Associated with the Presence of Pneumonia in Patients with Lupus Erythematosus (SLE): A Nested Case-Control Study.

Rua-Figueroa1,  Iñigo, Novoa2,  Francisco J., Erausquin2,  Celia, Garcia-Bello2,  Miguel, de Castro2,  Felipe Rodríguez, Quevedo2,  Juan C., Garcia-Laorden2,  Isabel

Hospital Dr Negrin, Las Palmas GC, Spain
Hospital Dr Negrin

Purpose:

To determine the incidence of pneumonia and the associated risks factors in a monocentric SLE cohort.

Methods:

We included SLE patients (1997 criteria) with pneumonia and 196 age and sex-matched SLE controls. Clinical data, comorbidity and risk factors for pneumonia were retrospectively collected. Katz severity index (SI) and weighted SLICC/ACR damage index (wDI) were recorded. The standardized incidence ratio (SIR) of pneumonia was estimated. MBL, FCgR IIA, MASP-2, C2, IL6–174, SPD y SPA1 y 2 single nucleotide polymorphisms (SNP) were studied based on previous evidence of association with pulmonary infection. Differences were analysed using Pearson's c2 or Fisher's exact test as appropriate, and Student's t-test or Wilcoxon for qualitative variables.

Results:

Mean age at diagnosis: 31 years (p25-p75: 24–40); mean disease duration: 12 years (6–18); 92% were women; mean follow up: 6.7 (2.2–11.5). Leukopenia 48%; SLE criteria: 6 (5–7); SI 3 (2–5); wDI: 2 (0–5); exitus 14 (6%). 36 patients presented one or more pneumonia (29 defined, 7 probable); 9 patients suffered from pneumonia before SLE onset. 58% had received steroids, 16% at high doses, and 44% immunosuppressors at any time. Only 13% of patients were taking immunosuppressors at the moment of pneumonia. The SIR for pneumonia was 7.2. Excluding pneumonia cases after SLE onset, we also found an increased ratio (1.3). An association with a SNP of SPA2 1A1/1A0 gene, a protein crucial in pulmonary innate immunity, was found but the significance disappeared after Bonferroni correction. Excluding patients with immunosuppressors at the time of pneumonia, associations were found with SI (OR 1.2; 95% CI 1–1.4; p=0.016), wDI: p=0.044, number of SLE criteria (p=0.04), number of hospital admissions: (OR 17; 95%CI 2.4–130; p<0.01), and a strong trend for exitus (OR 3.2; 95% IC: 9–11.1; p=0.07) in univariate analysis. We found also association with high doses steroids treatment any time (OR 2; 95% CI 0.9–4.6; p= 0.087), immunosuppressors (OR 2.2; 95% IC: 1–4.9; p=0.049), cutaneous ulcers (OR 6.7; 95% IC: 2.1–21; p<0.01) and vasculitis (OR 3; 95% IC: 1.3–7.2; p =0.008). Furthermore, a trend was found for other infections (p=0.130) and admissions for non-pulmonary infections (p=0.087). In the multivariate analysis, adjusting for immunosuppressor treatment, the single statistically significant risk factor was SI (p=0.023).

Conclusions:

The incidence of pneumonia in patients with SLE is higher than in the general population and this probably also happens before the onset of SLE. Most patients were not receiving immunosupressive therapy at the moment of the pneumonia. Pneumonia is more frequent in severe SLE, independently of immunosupressive therapy.As suggested by current literature, infections - pneumonia in our study -, could be a severity marker in SLE.

To cite this abstract, please use the following information:
Rua-Figueroa, Iñigo, Novoa, Francisco J., Erausquin, Celia, Garcia-Bello, Miguel, de Castro, Felipe Rodríguez, Quevedo, Juan C., et al; Risk Factors Associated with the Presence of Pneumonia in Patients with Lupus Erythematosus (SLE): A Nested Case-Control Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1876
DOI: 10.1002/art.29641

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