RESEARCH - SLE in a multiethnic US cohort (LUMINA) LIII: disease expression and outcome in acute onset lupus

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ls of the Rheumatic Diseases 2008;67:500-504

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EXTENDED REPORTS

Systemic lupus erythaematosus in a multiethnic US cohort (LUMINA)

LIII: disease expression and outcome in acute onset lupus

A M Bertoli 1, L M Vilá 1, J D Reveille 2, G S Alarcón 3, for the

LUMINA study group

1 Department of Medicine (Division of Rheumatology), University of

Puerto Rico Medical Sciences Campus, San , Puerto Rico

2 Department of Medicine (Division of Rheumatology), University of

Texas Health Science Center at Houston, Houston, Texas, USA

3 Department of Medicine (Division of Clinical Immunology and

Rheumatology), School of Medicine, University of Alabama at

Birmingham, Birmingham, Alabama, USA

Objective: To determine the features associated with acute onset

systemic lupus erythaematosus (SLE).

Methods: A total of 631 SLE patients from LUMINA (for " lupus in

minority populations: nature vs nurture " ), a multiethnic (Hispanics,

African–Americans and Caucasians) cohort, were studied. Acute disease

onset was defined as the accrual of 4 American College of Rheumatology

(ACR) 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, behavioural/psychological variables were compared between

patients with acute and insidious disease onset by univariable (2 and

Student t test) and multivariable (stepwise logistic regression)

analyses.

Results: A total of 94 (15%) patients had acute disease onset. In the

multivariable analysis, patients with acute onset lupus had more renal

involvement (odds ratio (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). By 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 serological, genetic and behavioural/psychological

features; this 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 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 type of disease onset in SLE.

http://ard.bmj.com/cgi/content/abstract/67/4/500

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