Objective: To determine the features associated with acute-onset systemic lupus erythematosus (SLE).
Methods: Six hundred thirty-one SLE patients from LUMINA, a multiethnic (Hispanics, African Americans and Caucasians) cohort, were studied. Acute disease-onset was defined as the accrual of ≥ 4 American College of Rheumatology criteria for the classification of SLE in ≤ 4 weeks. Socioeconomic-demographic features, clinical manifestations, disease activity, damage accrual, mortality, autoantibodies, HLA class II and FCGR alleles, behavioral/ psychological variables were compared between patients with acute and insidious disease-onset by univariable (Chi square and Student's t test) and multivariable (stepwise logistic regression) analyses.
Results: Ninety-four (15%) patients had acute disease-onset. In the multivariable analysis, patients with acute-onset lupus had more renal involvement (OR= 1.845, 95% CI 1.076-3.162; p= 0.026] and higher disease activity (OR= 1.057, 95% CI 1.005-1.112; p= 0.030). In contrast, age (OR= 0.976, 95% CI 0.956-0.997; p= 0.025), education (OR= 0.901, 95% CI 0.827-0.983, p= 0.019), health insurance (OR= 0.423, 95% CI 0.249-0.718; p= 0.001) and skin involvement (OR= 0.346, 95% CI 0.142-0.843; p= 0.019) were negatively associated with acute-onset lupus. No differences were found regarding the serologic, genetic and behavioral/psychological features; that was also the case for damage accrual and mortality.
Conclusions: Patients with acute-onset lupus seem to be younger, have a lower socio-economic status and display a more severe disease in terms of clinical manifestations and disease activity. However, intermediate (damage) and long term (mortality) outcomes appear not to be influenced by the disease-onset type in SLE.
- acute onset lupus
- disease activity
- systemic lupus erythematosus