Analysis of clinical features of lupus mesenteric vasculitis

This study aimed to identify the clinical characteristics of systemic lupus erythematosus (SLE) patients with complicated with lupus mesenteric vasculitis (LMV), and to determine the impacts of the first-visit department, the number and duration of digestive system symptoms on disease activity, and imaging features of LMV patients. We expected that our study would keep clinicians across specialties vigilant for SLE-LMV, enabling early diagnosis and prompt treatment, thereby improving prognosis and reducing mortality from this potentially fatal condition. Clinical data of 174 patients with LMV admitted to the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2023 were collected and analyzed. The baseline clinical characteristics and laboratory data were analyzed and compared by the first-admission department: either the Rheumatology Department or other departments. In addition, the impact of the numbers and durations of various digestive system symptoms in these patients, as well as laboratory results, disease activity, and imaging findings, was analyzed. The independent-samples t-test and Mann-Whitney U-test were used to compare differences in continuous variables. In contrast, the Kruskal-Wallis test, chi-square test, or Fisher's exact test was used to compare differences in disease activity-related indicators, imaging features, and treatment regimens. A total of 174 patients with an initial diagnosis of LMV were included in this study. Among these patients, 87 (50.0%) had a prior SLE diagnosis, 76 (43.7%) were first diagnosed in the Rheumatology Department, and 36 (20.7%) and 31 (17.8%) were first diagnosed in the Departments of Gastroenterology and Emergency Medicine, respectively. All patients had mild to severe digestive symptoms, including abdominal pain, diarrhea, nausea, vomiting, and abdominal distension. Multiple digestive symptoms occurred in 151 (86.8%) patients. The patients were divided into two groups based on whether they were first diagnosed in the rheumatology department or other departments. The results showed that patients who were not initially diagnosed in the rheumatology department had longer hospital stays and lower disease activity. The patients were further categorized into groups based on the number and time of various digestive symptoms. Compared with those with fewer flares, the proportions of leukopenia, hypocomplementemia, and abdominal effusion were higher in those with frequent LMV recurrences. The white blood cell (WBC) and neutrophil counts in patients with abdominal pain of less than 7 days were higher than those with abdominal pain of more than 7 days. However, statistical analysis did not reveal significant differences among other inflammatory markers and the indices of disease activity. In terms of imaging features obtained by contrast-enhanced CT, a statistical difference was detected in patients with abdominal pain over 7 days compared to those with less than 7 days with respect to thickening of both small and large bowel walls. Due to atypical clinical manifestations of SLE patients with concomitant LMV, only approximately 50% patients were first diagnosed at the Rheumatology Department, with the rest being first diagnosed in other departments, which resulted in delayed diagnosis and treatments, prolonged hospital stay, and potentially, poor prognosis. Evaluation of the impacts of the number and duration of digestive symptom flares on disease activity and imaging features demonstrated that patients with multiple symptoms had more severe radiological findings. Therefore, clinicians, particularly rheumatologists, should keep vigilant when patients have multiple digestive system symptoms and frequent recurrence, as early diagnosis of LMV with prompt and aggressive treatments may improve the prognosis of these patients.