Background Systemic lupus erythematosus (SLE) is an autoimmune multisystemic disease with a wide variety of clinical manifestations. One of its symptoms, associated to high morbidity, is serositis. Its prevalence ranges between 11% and 54%, and little is known about factors associated to this manifestation. The aim of this study is to determine the prevalence of serositis in SLE patients visited at the outpatient Lupus Unit of the Hospital del Mar and identify risk factors that can be used as predictors of this manifestation. Methods A retrospective case-control study was performed based on the review of 297 medical records of SLE patients. Twenty-eight patients were identified to have suffered serositis (cases) and were age- and sex-matched with 2 controls with SLE without serositis. Results The overall prevalence of serositis in our cohort was 9.42%, being higher in men than in women, 30% versus 7.9% ( p = 0.001, 95% CI: 1.7–42.4%). In 40.7%, it was the first manifestation of the disease. When looking for serositis-associated factors, an association was found with anti-dsDNA antibodies measured by the Crithidia method ( p = 0.016), and different measures of corticosteroids, where cases had required higher maximum doses and more pulses than controls throughout the disease, although this last correlation was lost when adjusting for confounding variables as nephritis and arthritis. Cases also received more mycophenolic acid ( p = 0.021) and, marginally, more belimumab ( p = 0.056). Conclusion The overall prevalence of serositis was 9.42%, being significantly higher in men (30%). Therefore, male gender constitutes a risk factor for serositis, and almost one third of men will develop this manifestation, so greater awareness is required in SLE men. CrithidiaDNA+ was also identified as a risk factor, and it should be determined in all SLE patients. Cases significantly received more corticosteroid pulses and higher maximum doses in relation to other SLE severe manifestations, which could imply a more aggressive form of SLE in patients with serositis.
Background:Systemic lupus erythematosus (SLE) is an autoimmune multisystemic disease with a wide variety of clinical manifestations, being one of them serositis, which includes pericarditis, pleuritis and peritonitis [1]. Incidence of serositis ranges between 11-54% [2].Objectives:To determine the prevalence of serositis in patients (pt) with SLE attended at the outpatient Lupus Unit and identify factors that could be used as predictors of this manifestation.Methods:Retrospective case-control study. 297 medical records of SLE pt were reviewed: 28 pt were diagnosed with serositis (cases) and were age- and sex-matched with 2 controls with SLE without serositis. Differences between cases and controls were analyzed as well as factors associated with serositis.Results:Patient’s characteristics are described in Table 1. The prevalence of serositis in our cohort was 9.42%. The difference between the prevalence of serositis in men and women was statistically higher in men, 30% vs 7.9% (p=0.001, CI 95%: 1.7%-42.4%). Serositis was diagnosed at an age of 41 ±14 years (y) and in 40.7% it was the first symptom. Time from SLE diagnosis to serositis was 4±5.3 y. 10 pt had recurrences: 6 had 2, and 4 had 3. Incidence of pericarditis and pleuritis was 78.6% and 82.1% respectively. 2 pt suffered from pericardial tamponade. Mean prednisone dose received during the serositis was 44.6±26.6mg. At the moment of serositis 100% were ANA+, 85.7% antidsDNA+, 80% CrithidiaDNA+, 57.9% antiRo60+, 52.6% antiRo52+, 15.9% antiLa+, 47.4% antiRNP+, 21.1% antiSm+, and 77.8% had low C3.When looking for serositis-associated factors we only found association with antidsDNA measured by Crithidia (p=0.016) and different measures of glucocorticosteroids (GC), having cases needed higher doses than controls (Table 1). Those with serositis had significantly received more mycophenolic acid (p=0.021) and marginally, more belimumab (p=0.056).Table 1.Comparison between groups of adverse maternal-fetal outcome.VARIABLESCASES (28)CONTROLS (54)p-value Female22 (33.3%)44 (66.7%)0.775 Male6 (37.5%)10 (62.5%) Caucasian20 (32.8%)41 (67.2%)0.693 Hispanic American7 (38.9%)11 (61.1%) Others1(33.3%)2 (66.6%)Arthritis22 (38.6%)35 (61.4%)0.219Leukopenia17 (34.0%)33 (66.0%)1.000Lymphopenia25 (33.8%)49 (66.2%)1.000Thrombocytopenia5 (20.8%)19 (79.2%)0.128Nephritis8 (50.0%)8 (50.0%)0.152Raynaud’s phenomenon6 (42.9%)8 (57.1%)0.263Haemolytic anaemia3 (42.9%)4 (57.1%)0.686Antinuclear antibodies28 (34.6%)53 (65.4%)1.000AntidsDNA23 (37.7%)38 (62.3%)0.295AntiSm9 (42.9%)12 (57.1%)0.425AntiRo5210 (41.7%)14 (58.3%)0.444AntiRo6013 (37.1%)22 (62.9%)0.645AntiRNP14 (43.8%)18 (56.3%)0.159CrithidiaDNA19 (47.5%)21 (52.5%)0.016Low C321 (39.6%)32 (60.4%)0.224Low C413 (38.2%)21 (61.8%)0.637Low CH5013 (39.4%)20 (60.6%)0.480SLICC*0.54 (±0.9)0.49 (±1.1)0.717SLEDAI*3.1 (±3.1)2.98 (±3.2) 0.844CorticosteroidsEver27 (38.6%)43 (61.4%)0,051Pulses ever9 (60.0%)6 (40.0%)0.033Maximum prednisone dose ever:<10mg18 (85.7%)3 (14.3%)0.00310-29mg14 (87.5%)2 (12.5%)30-60mg11 (45.8%)13 (54.2%)>60mg8 (47.1%)9 (52.9%)Conclusion:The prevalence of serositis was 9.42%. Serositis is significantly more frequent in SLE men than in women: almost ⅓ will develop serositis, so we need greater awareness of serositis in SLE men.CrithidiaDNA+ was identified as an associated factor of serositis. Furthermore, pt with serositis significantly received more pulses of GC and a higher maximum dose throughout the disease, which could imply a more aggressive form of SLE than in those without serositis. No correlation was found between serositis and any other characteristic.References:[1]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997;40:1725[2]Ryu S, Fu W, Petri MA: Associates and predictors of pleurisy or pericarditis in SLE. Lupus. Science. 2017, 4(1):e000221.Disclosure of Interests:None declared
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