Peripheral vascular disease in systemic lupus erythematosus

Abstract

With increasing longevity of lupus patients, peripheral vascular disease (PVD) has become an important cause of morbidity. With no systematic study of PVD in systemic lupus erythematosus (SLE), this study was undertaken to define the frequency and spectrum of PVD in SLE and factors affecting such an occurrence. All medium-sized peripheral arteries of bilateral upper and lower extremities were studied in 50 SLE patients using Doppler ultrasonography. PVD was defined clinically as one or more of intermittent claudication, absent/unequal pulses, gangrene or ischemic ulcers and sub-clinically as asymptomatic patients with Doppler abnormalities, with ≥50% reduction in diameter considered hemodynamically significant. Mean (SD) age of the patients was 31.6 (10.1) years. Forty-one percent were hypertensive. Dyslipidemia was found in 62%. Fifteen (30%) had Raynaud's phenomenon. Fourteen (28%) patients had PVD, of whom three had positive markers for antiphospholipid antibody (aPL) and six were asymptomatic. Ischemic ulcers were seen in eight (16%), gangrene in three (6%), femoral artery plaques in two (4%), stenosis in four (8%) and intermittent claudication in none. Dyslipidemia was found to independently affect occurrence of PVD (OR = 5.37, [95% CI 1.05—27.5], P = 0.05). The causes of PVD overlap significantly and further studies are needed to ascertain the relative contribution of each. Lupus (2007) 16, 720—723.

Keywords

atherosclerosis Doppler lupus peripheral vascular

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References

Ansari A. , Larson PH , Bates HD Vascular manifestations of systemic lupus erythematosus. Angiology 1986; 37: 423—432.

Kao AH , Sabatine JM , Manzi S. Update on vascular disease in systemic lupus erythematosus. Curr Opin Rheumatol 2003; 15: 519—527.

Manzi S.

Systemic lupus erythematosus: a model for atherogenesis?

Rheumatology 2000; 39: 353—359.

Misra A. , Vikram NK Insulin resistance syndrome (metabolic syndrome) and Asian Indians. Current Science 2002; 83:1483—1496.

Hochberg MC Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40: 1725

Bhatt SP , Handa R. , Gulati GS , et al. Atherosclerosis in Asian Indians with systemic lupus erythematosus . Scand J Rheumatol 2006; 35: 128—132.

Bombardier C. , Gladman DD , Urowitz M. , Caron D. , Chang C. and the Committee on prognosis studies in SLE. Derivation of the SLEDAI: a diseases activity index for lupus patients. Arthritis Rheum 1992; 35: 630—640.

Gladman DD , Ginzler E. , Goldsmith C. et al. The development and validation of the Systemic Lupus International Colloborating Clinics/ Ameriacn College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 1996; 39: 363—369.

Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults, Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) . J Am Med Assoc 2001; 285: 2486—2497.

10.

Jager KA , Rciketts HJ , Strandness DE Jr.Duplex scanning for the evaluation of lower limb arterial disease . In Bernstein EF ed. Noninvasive Diagnostic Techniques in Vascular Disease, St.Louis: Mosby, 1985: 619—631.

11.

Urowitz MB , Gladman DD Accelerated atheroma in lupus—background. Lupus. 2000; 9: 161—165.

12.

Manzi S. , Selzer F. , Sutton-Tyrrell K. et al. Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. Arthritis Rheum 1999; 42: 51—60.

13.

Rahman P. , Aguero S. , Gladman DD , Hallett D. , Urowitz MB Vascular events in hypertensive patients with systemic lupus erythematosus . Lupus 2000; 9: 672—675.

14.

Toloza SM , Uribe AG , McGwin G. Jr et al. LUMINA Study Group. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXIII. Baseline predictors of vascular events. Arthritis Rheum 2004; 50: 3947—3957.

15.

Svenungsson E. , Jensen-Urstad K. , Heimburger M. et al. Risk factors for cardiovascular disease in systemic lupus erythematosus. Circulation 2001; 104: 1887—1893.

16.

Doria A. , Shoenfeld Y. , Wu R. et al. Risk factors for subclinical atherosclerosis in a prospective cohort of patients with systemic lupus erythematosus. Ann Rheum Dis 2003; 62:1071—1077.

17.

Vlachoyiannopoulos PG , Kanellopoulos PG , Ioannidis JP , Tektonidou MG , Mastorakou I. , Moutsopoulos HM Atherosclerosis in pre-menopausal women with antiphospholipid syndrome and systemic lupus erythematosus: a controlled study . Rheumatology (Oxford) 2003; 42: 645—651.

18.

Bruce IN , Urowitz MB , Gladman DD , Ibanez D. , Steiner G. Risk factors for coronary heart disease in women with systemic lupus erythematosus: the Toronto Risk Factor Study. Arthritis Rheum 2003; 48: 3159—3167.

19.

Roman MJ , Beth-Ann Shanker , Davis A. et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. NEJM 2003; 349: 2399—2406.

20.

Wolak T. , Todosoui E. , Szendro G. et al. Duplex study of the carotid and femoral arteries of patients with systemic lupus erythematosus: a controlled study. J Rheumatol 2004; 31: 909—914.

21.

Bessant R. , Hingorani A. , Patel L. , MacGregor A. , Isenberg DA , Rahman A. Risk of coronary heart disease and stroke in a large British cohort of patients with systemic lupus erythematosus. Rheumatology ( Oxford) 2004; 43: 924—929.

22.

McDonald J. , Stewart J. , Urowitz MB , Gladman DD Peripheral vascular disease in patients with systemic lupus erythematosus. Ann Rheum Dis 1992; 51: 56—60.

23.

Theodoridou A. , Bento L. , D'Cruz DP, Khamashta MA, Hughes GR. Prevalence and associations of an abnormal ankle-brachial index in systemic lupus erythematosus: a pilot study. Ann Rheum Dis 2003; 62: 1199—1203.

24.

Lin CC , Ding HJ , Chen YW , Wang JJ , Ho ST , Kao A. High prevalence of asymptomatically poor muscle perfusion of lower extremities measured in systemic lupus erythematosus patients with abnormal myocardial perfusion. Rheumatol 2004; 24: 227—229.

25.

Hsu HB , Sun SS , Chen JJ et al. Usefulness of thallium-201 muscle scan to investigate perfusion reserve in the lower limbs of patients with systemic lupus erythematusus. Rheumatol Int 2004; 24: 291—293.

26.

Wang CR , Chou CC , Hsieh KH , Chuang CY , Chen CY Lupus patients with peripheral vascular thrombosis: the significance of measuring anticardiolipin antibody. J Emerg Med 1993 ; 11: 468—470.