ObjectivesCardiovascular diseaseand heart failure (CHF) are leading causes of death in systemic lupus erythematosus (SLE). The underlying mechanisms for increased CHF in SLE are unclear but myocardial inflammation and lupus myocarditis (LM) may play a role. We propose that 18F-fluorodeoxyglucose–positron emission tomography (18F-FDG–PET)/CT can help diagnose LM.MethodsThis report describes eight patients with presumed LM; five patients were evaluated due to active cardiorespiratory symptoms and three patients were participating in a pilot study to determine the prevalence of subclinical myocarditis in SLE. Clinical characteristics, laboratory and cardiac testing including electrocardiography (ECG), transthoracic echocardiogram (TTE), coronary artery evaluation as well as 18F-FDG–PET/CT imaging are discussed.ResultsFour patients were African American and the others were Hispanic. Half presented with chest pain; 37% had dyspnoea and 25% were asymptomatic. The median SLE Disease Activity Index (SLEDAI-2K) was 5 (2–18) and SLICC Damage Index (SDI) 0.5 (0–5). The median troponin level was 0.08 ng/mL (0–0.9). The most common ECG findings were non-specific ST-T wave abnormalities (n=5). Fifty per cent of the patients had a decreased ejection fraction on TTE and all patients had diffuse myocardial FDG uptake on 18F-FDG–PET/CT consistent with myocardial inflammation.ConclusionThis case series is the first to describe the use of 18F-FDG–PET/CT in the diagnosis of LM and discuss the clinical characteristics and cardiac findings of eight patients with LM supporting the role for cardiac 18F-FDG–PET/CT in its diagnosis.

Background Hydroxychloroquine (HCQ) is a cornerstone therapy for systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However, reports of its use and subsequent fatal arrhythmias in patients with coronavirus disease 19 (COVID-19) have raised concern regarding its cardiovascular (CV) safety. Therefore, we examined the relationship between HCQ use and corrected QT (QTc) length in SLE and RA patients without clinical CV disease (CVD). Methods SLE patients from the Columbia University Lupus Cohort registry (n = 352) and two RA cohorts (n = 178; ESCAPE-RA and RHYTHM-RA) with electrocardiograms (ECGs) collected as part of study data were analyzed. RA cohort participants were recruited from tertiary referral centers with additional referrals from community rheumatologists, while SLE subjects originated from the Columbia University Lupus Cohort. All patients met American College of Rheumatology (ACR) classification criteria for SLE or RA and lacked known CVD. The exposure of interest was HCQ use and main outcome measure was QTc length [continuous or categorical (≥ 440 ms and ≥ 500 ms)]. Results Of the combined SLE and RA cohorts (n = 530), 70% were HCQ users and 44% had a QTc ≥ 440 ms. The adjusted mean QTc length was comparable between HCQ users vs non-users (438 ms vs 437 ms). In multivariable logistic models, HCQ use was not a significant predictor of a QTc ≥ 440 ms for the entire cohort (OR 0.77; 95% CI 0.48–1.23; p = 0.27). Importantly, a QTc ≥ 500 ms was inversely associated with HCQ use and not associated with arrhythmias or deaths. A significant interaction was found between HCQ use and use of anti-psychotics. Ultimately, the use of HCQ combined with any QTc prolonging medication as a group was associated with a QTc length (434 ms; 95% CI 430, 439) which was comparable to that of use of HCQ alone (433 ms; 95% CI 429-437). Conclusion In a combined cohort of SLE and RA patients without clinical CVD, adjusted QTc length was comparable between HCQ and non-HCQ users, supporting its CV safety in patients with rheumatic diseases.

BackgroundHydroxychloroquine (HCQ) is a cornerstone therapy for systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However, reports of its use and subsequent fatal arrhythmias in patients with Coronavirus disease 19 (COVID-19) have raised concern regarding its cardiovascular (CV) safety. Therefore, we examined the relationship between HCQ use and corrected QT (QTc) length in SLE and RA patients without clinical CV disease (CVD).MethodsOne SLE (n=352) and two RA cohorts (n=178) with electrocardiograms (ECGs) collected as part of study data were analyzed. RA cohort participants were recruited from tertiary referral centers with additional referrals from community rheumatologists, while SLE subjects originated from the Columbia University Lupus Cohort. All patients met American College of Rheumatology (ACR) classification criteria for SLE or RA, and lacked known CVD. The exposure of interest was HCQ use and main outcome measure was QTc length [continuous or categorical (≥440 ms and ≥500 ms)]. ResultsOf the combined SLE and RA cohorts (n=530), 70% were HCQ users and 44% had a QTc≥ 440 ms. The adjusted mean QTc length was comparable between HCQ users vs non-users (438 ms vs 437 ms). In multivariable logistic models, HCQ use was not a significant predictor of a QTc≥440 ms for the entire cohort (OR 0.77; 95% CI 0.48-1.23; p=0.27). Importantly, a QTc≥500 ms was inversely associated with HCQ use and not associated with arrhythmias or deaths. A significant interaction was found between HCQ use and use of anti-psychotics. Ultimately, the use of HCQ combined with any QTc prolonging medication as a group was associated with a QTc length (434 ms; 95%CI 430, 439) which was comparable to that of use of HCQ alone (433 ms; 95% CI 429, 437). ConclusionIn a combined cohort of SLE and RA patients without clinical CVD, adjusted QTc length was comparable between HCQ and non-HCQ users, supporting its CV safety in patients with rheumatic diseases.

Objectives Hispanics with systemic lupus erythematosus (SLE) in the United States have more severe disease and damage accrual compared with whites. Data on Hispanics of similar ancestry in geographically different locations is limited but essential in defining genetic and environmental factors for SLE. This study evaluates SLE disease burden in two Dominican communities, Washington Heights in New York City (NYC) and Santiago in the Dominican Republic (DR). Methods Disease activity (SLE Disease Activity Index 2000 (SLEDAI-2K)) and damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)) were cross-sectionally measured in 76 Dominican SLE patients from the Columbia University Lupus Cohort in NYC and compared with 75 Dominican SLE patients living in Santiago in the DR. Results Mean (±SD) age was 40 (±14) and 36 (±11) years for NYC and DR patients, respectively. Median disease duration was 8 years. Disease activity was mild in both groups (SLEDAI-2K of 3 in NYC versus 4 in the DR). NYC Dominicans had more discoid lesions, positive anti-dsDNA, and anti-SSB antibodies. Dominicans in the DR used more corticosteroids, had less medical insurance, lower educational level, and were more likely to be unemployed, whereas more Dominicans in NYC smoked. NYC patients had a higher SDI compared with SLE patients in the DR (0.96 versus 0.24, p < 0.0001). Statistical significance was maintained in adjusted analysis (1.26 versus 0.57, p < 0.0001). Conclusion SLE Dominican patients in NYC had a higher SDI than those in the DR. Longitudinal studies are needed to ascertain whether this difference is due to biological, environmental factors, immigration patterns or a survival bias.

BackgroundCardiovascular disease (CVD) is a leading cause of mortality in systemic lupus erythematosus (SLE). Traditional CVD risk scores underperform in SLE. Interestingly, a high prevalence of nonspecific ST-T changes (NST-T) has been recently reported in lupus patients1,2. These electrocardiographic findings are known to increase the risk for myocardial infarction, coronary artery disease, CVD, and all-cause mortality3 in the general population, but in SLE this association remains unknown. Therefore, we sought to define the association of NST-T with the modified Framingham Risk Score (mFRS) as a surrogate outcome for CVD4.ObjectivesTo evaluate if NST-T are associated with higher mFRS in SLE patients without clinical cardiovascular disease.MethodsAdult SLE patients without clinical CVD continuously seen at the Columbia University Lupus Center between April 2016 and January 2017, meeting 1997 American College of Rheumatology classification criteria for SLE were studied. Twelve-lead electrocardiogram (EKG), high sensitivity C-reactive Protein (hsCRP), demographics, disease-specific characteristics, medication use, and CVD risk factors were ascertained. Univariable and multivariable linear regression models were constructed to test the association of NST-T with the mFRS.ResultsSeventy-four lupus patients were studied (baseline characteristics in table 1). In univariable analysis, patients with NST-T had a significantly higher mFRS (0.44, p=0.018). There were no confounders identified in the analysis. However after adjusting for variables associated with the mFRS: smoking, diabetes, hsCRP, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI], aspirin use, this association remained statistically significant (0.38, p=0.05). Image 1 shows the association of mFRS with NST-T vs no NST-T.Age, years ± SD39±13Female, n (%)67 (90%)Hispanic, n (%)56 (77%)African American, n (%)14 (19%)Body mass index30±8.3Median Disease Duration, years (IQR)6.5 (4–12)Median SLEDAI (IQR)4 (2–8)Moderate-Severe Disease activity (SLEDAI ≥6), n (%)23 (31%)Median SDI, n (%)0 (0–1)hsCRP median (IQR)2.4 (1–6.5)ESR , Median (IQR)37 (23–51)Anti-DNA, n (%)44 (60%)Anti-SSA, n (%)42 (59%)Anti-Smith, n (%)21 (30%)Ever smoker, n (%)16 (22%)Hypertension, n (%)22 (30%)Diabetes, n (%)6 (8%)mFRS, median (IQR)0.5 (0–1.8)NST-T abnormalities, n (%)27 (38%)Figure 1ConclusionsNon Specific ST-T changes are independently associated with a higher mFRS in SLE patients without clinical CVD.References Bourré-Tessier J, Urowitz MB, Pineau CA. et al. Electrocardiographic findings in systemic lupus erythematosus: data from an international inception cohort.Arthritis Care Res (Hoboken). 2015 Jan;67(1):128–35.Geraldino-Pardilla L,Gartshteyn Y, Piña P, et al.ECG non-specific ST-T and QTc abnormalities in patients with systemic lupus erythematosus compared with rheumatoid arthritis. Lupus Sci Med. 2016 Dec 16;3(1):e000168.Daviglus ML, Liao Y, Stamler J, et al. Association of Nonspecific Minor ST-T Abnormalities With Cardiovascula...