Related Experiment Videos
Vasculitis in systemic lupus erythematosus
C Drenkard1, A R Villa, E Reyes
1Department of Immunology, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico.
Insights
This study investigated vasculitis in systemic lupus erythematosus (SLE) patients, finding it affects nearly 40% over 10 years. Vasculitis, especially visceral, is linked to worse outcomes and other lupus manifestations.
Area of Science:
- Rheumatology
- Immunology
- Internal Medicine
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
- Vasculitis, inflammation of blood vessels, is a known but incompletely understood complication of SLE.
- Understanding the epidemiology and clinical impact of vasculitis in SLE is crucial for patient management.
Purpose of the Study:
- To determine the frequency, location, and clinical features of vasculitis in a large cohort of SLE patients.
- To identify associated clinical and histopathological manifestations and prognostic factors.
- To explore the relationship between vasculitis and other SLE manifestations, including antiphospholipid syndrome.
Main Methods:
- Retrospective analysis of 667 SLE patients, with 540 included after exclusions.
- Assessment of vasculitis incidence density, cumulative incidence, and types (cutaneous, visceral, or both).
- Clinical and histopathological data collection, including biopsy and arteriography for confirmation.
Main Results:
- The cumulative incidence of vasculitis in SLE patients reached 41.1% at 10 years.
- Cutaneous vasculitis (160 patients) was more common than visceral vasculitis (24 patients).
- Visceral vasculitis was associated with increased mortality, particularly when controlled for age of onset and nephropathy.
Conclusions:
- Vasculitis is a significant complication in SLE, impacting disease course and prognosis.
- Specific SLE manifestations like myocarditis, psychosis, and antiphospholipid syndrome are associated with vasculitis.
- Visceral vasculitis in SLE patients portends a poorer prognosis, highlighting the need for vigilant monitoring and management.
Abstract:
We studied the frequency, location, clinical and histopathological features, associated manifestations, and prognosis of vasculitides in a cohort of 667 SLE patients. Exclusion of patients with previous vasculitis or insufficient information left 540 patients, 194 of whom has vasculitis (incidence density: 0.053 new cases/person/year, cumulative incidence of 0.051 at one year, 0.232 at 5 years and 0.411 at 10 years). Vasculitis was confirmed by biopsy in 46 cases, by arteriography in five, and by both in three. A single episode of vasculitis occurred in 119 and two or more in 75 patients. Vasculitis was cutaneous in 160, visceral in 24, both in 10. In the first episode of cutaneous vasculitides, 111 had punctuate lesions, 32 palpable purpura, 6 urticaria, 6 ulcers, 8 papules, 5 erythematous plaques or macules confirmed with biopsy, 2 erythema with necrosis, and 1 panniculitis (plus small vessel vasculitis). Of 29 with visceral vasculitis in the first episode, 19 had mononeuritis multiplex, 5 digital necrosis, 3 large artery vasculitis of limbs, one mesenteric, and one coronary, more than one type could appear simultaneously or in subsequent episodes. Patients with vasculitis had longer disease duration and followup, younger age of onset of SLE, and were more frequently males than those without. Lupus manifestations associated with vasculitis in univariate logistic regression included myocarditis, psychosis, Raynaud's phenomenon, serositis, leukopenia, lymphopenia and pleuritis. Vasculitis also associated with the antiphospholipid syndrome. The strength of this association increased when patients with vasculitis confirmed by biopsy and/or arteriography were considered separately. Visceral vasculitis associated with increased mortality when controlled for age of onset and nephropathy.