Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Accrual Damage Assessment In Juvenile-Onset Systemic Lupus Erythematosus.
Ovalles, Juan G., Martinez-Barrio, Julia, Lopez-Longo, Francisco J., de la Torre, Inmaculada, Martinez-Estupinan, Lina, Nieto, Juan C., Carreno, Luis
Background/Purpose:
Several studies have shown that patients with juvenile-onset systemic lupus erythematosus (JOSLE) develop more organ involvement and accrue irreversible damage at faster rates than adult SLE patients1–4. To investigate the frequency of cumulative organ damage in JOSLE and its association with demographic, clinical and immunological variables.
Methods:
Data was obtained from a single-center inception cohort of 92 cases diagnosed at 18 years old or less between 1986 and 2006. Demographic, clinical and laboratory features were collected at disease onset and every 12 months with a minimum follow-up time of 1 year (median 12, 1–20). Damage was scored at the end of the study using SLICC/ACR Damage Index. Sera samples were tested for autoantibodies, complement and immunoglobulins. Student's T, Chi-square or Fisher's exact test was applied for bivariate analysis and multiple logistic regression for multivariate analysis.
Results:
Overall, 68% patients had organ damage (SLICC/ACR>=1) with a mean score of 1.8. At disease onset renal involvement was associated with the presence of damage (p<0.002). Developing irreversible system damage was related to anaemia (p=0.006), thrombocytopenia (p=0.001), arthritis (p=0.01), neurologic (p<0.001), renal (p=0.002), hypertension (p=0.001) and musculoskeletal (p=0.02) manifestations during the follow-up. Also the accrual damage has shown relation with evolution time (p=0.009). The genre and mortality was no related to SLICC/ACR score (p>0.05). In logistic regression models, the occurrence of anaemia, arthritis, renal manifestations during follow-up and longer disease duration showed the strongest association with the presence of damage.
| CHARACTERISTICS n=92 | SLICC/ACR = 0 (n=29) | SLICC/ACR >= 1 (n=63) | p |
|---|---|---|---|
| At Disease Onset | |||
| DEMOGRAPHIC FEATURES | |||
| Sex Ratio (Female/Male) | 8.6 (26/3) | 5.2 (53/10) | NS |
| Age, Mean±SD | 12.1±4.5 | 13.3±3.1 | NS |
| CLINICAL MANIFESTATIONS (%) | |||
| Renal | 0 (0) | 16 (25.4) | 0.002 |
| During Follow-Up | |||
| Arthritis | 20 (69) | 57 (92) | 0.01 |
| Neuropsychiatric | 2 (6.9) | 35 (55.6) | <0.001 |
| Renal | 12 (41.4) | 46 (73) | 0.002 |
| Hypertension | 4 (13.8) | 31 (49.2) | 0.001 |
| Musculoskeletal | 3 (10.3) | 21 (33.3) | 0.02 |
| Anaemia | 12 (41.4) | 45 (71.4) | 0.006 |
| Thrombocytopenia | 1 (3.4) | 21 (33.3%) | 0.001 |
| Disease Duration, Mean±SD | 9.7 ± 5.6 | 14.8 ± 9.6 | 0.009 |
| Exitus Letalis | 0 (0) | 7 (11.3) | NS |
Best Predictor Logistic Regression Model for JOSLE patients with cumulative organ damage vs. patients without damage
| Odds Ratio | 95% CI | p | |
|---|---|---|---|
| Renal manifestations during follow-up | 6.4 | 1.9–21.5 | 0.003 |
| Anaemia | 3.2 | 1.1–9.5 | 0.036 |
| Arthritits | 8 | 1.7–37.5 | 0.008 |
| Evolution time | 1.1 | 1.1–1.2 | 0.005 |
Conclusion:
We found evidence of cumulative organ damage in 68% of the JOSLE cases. Damage was significantly more likely in patients who had experienced renal manifestations at diagnosis, had longer disease duration, anaemia, arthritis and renal manifestations during follow-up. Autoantibodies, in spite of being helpful for the diagnosis and prediction of SLE's activity, are not useful to predict damage.
Reference:
1–Carreño, L, et al. Lupus. 1999;8(4):287–92.
2–Brunner, HI, et al. Arthritis Rheum. 2002;46:436–44.
3–Hiraki, LT, et al. J Pediatr. 2008;152(4):550–6.
4–Descloux, E, et al. Rheumatology (Oxford). 2009;48(7):779–84.
To cite this abstract, please use the following information:
Ovalles, Juan G., Martinez-Barrio, Julia, Lopez-Longo, Francisco J., de la Torre, Inmaculada, Martinez-Estupinan, Lina, Nieto, Juan C., et al; Accrual Damage Assessment In Juvenile-Onset Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2036
DOI:
