Peripheral vascular damage in systemic lupus erythematosus: data from LUMINA,a large multi-ethnic U.S. cohort (LXIX)

Abstract

To determine the factors associated with peripheral vascular damage in systemic lupus erythematosus patients and its impact on survival from Lupus in Minorities, Nature versus Nurture, a longitudinal US multi-ethnic cohort. Peripheral vascular damage was defined by the Systemic Lupus International Collaborating Clinics Damage Index (SDI). Factors associated with peripheral vascular damage were examined by univariable and multi-variable logistic regression models and its impact on survival by a Cox multi-variable regression. Thirty-four (5.3%) of 637 patients (90% women, mean [SD] age 36.5 [12.6] [16—87] years) developed peripheral vascular damage. Age and the SDI (without peripheral vascular damage) were statistically significant (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.01—1.08; P = 0.0107 and OR = 1.30, 95% CI 0.09—1.56; P = 0.0043, respectively) in multi-variable analyses. Azathioprine, warfarin and statins were also statistically significant, and glucocorticoid use was borderline statistically significant (OR = 1.03, 95% CI 0.10—1.06; P = 0.0975). In the survival analysis, peripheral vascular damage was independently associated with a diminished survival (hazard ratio = 2.36; 95% CI 1.07—5.19; P = 0.0334). In short, age was independently associated with peripheral vascular damage, but so was the presence of damage in other organs (ocular, neuropsychiatric, renal, cardiovascular, pulmonary, musculoskeletal and integument) and some medications (probably reflecting more severe disease). Peripheral vascular damage also negatively affected survival. Lupus (2009) 18, 1303—1308.

Keywords

damage LUMINA peripheral vascular systemic lupus erythematosus

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References

Bernatsky S. , Boivin JF , Joseph L. , et al. Mortality in systemic lupus erythematosus. Arthritis Rheum 2006; 54: 2550-2557.

Urowitz MB , Bookman AA , Koehler BE , Gordon DA , Smythe HA , Ogryzlo MA The bimodal mortality pattern of systemic lupus erythematosus. Am J Med 1976; 60: 221-225.

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

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

Gladman DD , Urowitz MB , Goldsmith CH , et al. The reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index in patients with systemic lupus erythematosus. Arthritis Rheum 1997; 40: 809-813.

Alarcon GS , Friedman AW , Straaton KV , et al. Systemic lupus erythematosus in three ethnic groups: III. A comparison of characteristics early in the natural history of the LUMINA cohort . LUpus in MInority populations: NAture vs. Nurture. Lupus 1999; 8: 197-209.

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

Reveille JD , Moulds JM , Ahn C. , et al. Systemic lupus erythematosus in three ethnic groups: I. The effects of HLA class II, C4, and CR1 alleles, socioeconomic factors, and ethnicity at disease onset. LUMINA Study Group. Lupus in minority populations, nature versus nurture. Arthritis Rheum 1998; 41: 1161-1172.

U.S. Department of Commerce, Bureau of the Census. ( 1995). Current population reports, Series P-23, No. 28 and Series P-60, No. 68 and subsequent years. Washington, DC: Housing and Household Economic Statistics Division; 1995 .

10.

Liang MH , Socher SA , Larson MG , Schur PH Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. Arthritis Rheum 1989; 32: 1107-1118.

11.

Alarcon GS , McGwin Jr G. , Bastian HM , et al. Systemic lupus erythematosus in three ethnic groups. VII [correction of VIII]. Predictors of early mortality in the LUMINA cohort. LUMINA Study Group. Arthritis Rheum 2001; 45: 191-202.

12.

Duran S. , Apte M. , Alarcon GS Poverty, not ethnicity, accounts for the differential mortality rates among lupus patients of various ethnic groups. J Natl Med Assoc 2007; 99: 1196-1198.

13.

Urowitz MB , Ibanez D. , Gladman DD Atherosclerotic vascular events in a single large lupus cohort: prevalence and risk factors. J Rheumatol 2007; 34: 70-75.

14.

Gladman DD , Urowitz MB , Rahman P. , Ibanez D. , Tam LS Accrual of organ damage over time in patients with systemic lupus erythematosus . J Rheumatol 2003; 30: 1955-1959.

15.

Zonana-Nacach A. , Camargo-Coronel A. , Yanez P. , et al. Measurement of damage in 210 Mexican patients with systemic lupus erythematosus: relationship with disease duration. Lupus 1998; 7: 119-123.

16.

Cassano G. , Roverano S. , Paira S. , et al. Accrual of organ damage over time in Argentine patients with systemic lupus erythematosus: a multi-centre study. Clin Rheumatol 2007; 26: 2017-2022.

17.

Bhatt SP , Handa R. , Gulati GS , et al. Peripheral vascular disease in systemic lupus erythematosus . Lupus 2007; 16: 720-723.

18.

Alarcon GS , McGwin Jr G. , Bartolucci AA , et al. Systemic lupus erythematosus in three ethnic groups. IX. Differences in damage accrual. Arthritis Rheum 2001; 44: 2797-2806.

19.

Toloza SM , Uribe A. , McGwin G. , et al. Systemic Lupus erythematosus in a multiethnic US cohort (LUMINA) XXIII. Baseline predictors of vascular events. Arthritis Rheum 2004; 50: 3947-57.

20.

Bruce IN. Cardiovascular disease in lupus patients: should all patients be treated with statins and aspirin?

Best Pract Res Clin Rheumatol 2005; 19: 823-838.