Background Patients with incomplete Systemic Lupus Erythematosus may represent a group of patients who will later develop SLE or they may form a subset of SLE patients with mild disease.
Objectives To study the differences in clinical manifestations, damage, co-morbidity and disease severity between patients with defined SLE (dSLE) and those with incomplete SLE (iSLE), included in RELESSER registry.
Methods All patients included in the transversal phase of RELESSER were studied.
The registry includes demographic data, clinical manifestations, information about activity, damage, severity, comorbidity, treatments and mortality, collecting 359 variables per patient, with highly standardized definitions. SELENA-SLEDAI (S-SLEDAI) and SLICC/ACR/DI (SDI) scores and Katz index (IK) were calculated.
To compare both groups an analysis based on the estimation of simple and adjusted odds ratios (OR) by means of logistic regression, with 95% confidence intervals (95%CI) was done.
Results 4,024 SLE patients were included (91% females; mean age at diagnosis:35.4 years; disease duration: median 11.0 years). 3,679 (91.4%) were dSLE and 345 (8.6%) iSLE. dSLE were younger than iSLE at diagnosis (34.6 vs 42.9 years) (OR:0.92; CI95%: 0.90-0.96; p<0.001), with a longer disease duration (12 vs 8 years) (OR:1.05; CI95%: 1.03-1.07; p<0.001).
As it was supposed, most clinical manifestations were more frequent in dSLE patients. Every one of the ACR criteria was associated with dSLE condition and this association was extremely high in the cases of malar rash (OR:9.14; CI95%:6.20-13.46; p<0.001), oral ulcers (OR:9.37; CI95%:6.08-14.45; p<0.001) and renal disorder (OR:9.12; CI95%:5.18-16.07; p<0.001).
The analysis adjusted by gender, age at onset and disease duration showed higher S-SLEDAI (OR:1.14;CI95%:1.08-1.20;p<0.001), SDI (OR:1.29; CI95%:1.15-1.44; p<0.001), KI (OR:2.10; CI95%:1.83-2.42; p<0.001), number of hospitalizations due to SLE activity (OR:2.79; CI95%:2.15-3.63; p<0.001) and mortality (OR:2.25; CI95%:1.24-4.48; p=0.008) in dSLE patients than in iSLE ones.
Higher number of dSLE received glucocorticoids (OR:3.22; CI95%:2.43-4.25; p<0.001), cyclophosphamide (OR:3.47; CI95%:2.12-5.67; p<0.001), mycophenolate mofetil (OR: 3.45; CI95%:1.91-6.25; p<0.001) and rituximab (OR:3.34; CI95%:1.36-8.23; p=0.009).
Refractoriness were associated with the dSLE condition (OR:3.04; CI95%:1.98-4.68; p<0.001). Although there were differences in certain risk factors between both groups, it was not the case in cardiovascular events.
Conclusions These results, obtained from the largest iSLE patients cohort reported up to now, support the hypothesis that iSLE behaves as a relative stable and mild disease, with lower activity, severity and refractoriness than dSLE.
Disclosure of Interest : None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.