Systemic lupus erythematosus as a cause and prognostic factor of acute pancreatitis

To perform a systematic analysis and case-control study of our patients with systemic lupus erythematosus (SLE) to determine the prevalence of acute pancreatitis (AP).

All episodes of AP in SLE patients were identified (July 1984-July 2001). Prevalence was calculated. Etiology for each AP event was classified into mechanical, toxic-metabolic, or idiopathic. AP severity was defined based on Atlanta criteria. SLE disease activity was scored using Mex-SLEDAI index. A control group of non-SLE patients with AP was designed to establish the risk of developing severe or fatal idiopathic AP in patients with SLE.

Forty-nine AP episodes were identified in 35 SLE patients (30 +/- 14 yrs old, 94% female). Prevalence was 3.5%. A single episode was present in 26 patients. Identified AP causes were mechanical in 14 and toxic-metabolic in 10. Seventeen episodes were considered idiopathic. At least one drug related to AP was administered in 13 episodes. Corticosteroids were in use in 32 episodes, and as the only drug in 16. Mex-SLEDAI scores were significantly higher in idiopathic events. In the case-control analysis, idiopathic AP was more frequent in SLE cases (46% vs 14%). The strength of association of AP severity and related mortality was higher in SLE patients (OR 8.6 and 7.5, respectively).

AP is not a highly prevalent manifestation of SLE. Idiopathic cases predominate and show increased SLE activity. Drug consumption does not seem to participate in AP development. SLE episodes are more severe and frequently fatal.