Gastrointestinal Damage Linked to Worse Prognosis in Patients With Systemic Lupus Erythematosus

Gastrointestinal damage is associated with increased risk for involvement of other target organs and a worse prognosis for patients with systemic lupus erythematosus (SLE), according to study results presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.

The objective of the study was to explore the gastrointestinal manifestations among the Registry of SLE Patients of the Spanish Society of Rheumatology (RELESSER) cohort and determine whether gastrointestinal damage may predict worse outcomes for patients with lupus.

The nationwide, retrospective, multicenter, cross-sectional study included 3654 patients with lupus who met 4 or more of the ACR-97 criteria. Of the total cohort, gastrointestinal damage was reported in 131 patients (3.7%), including infarction or bowel resection in 101 (2.8%), pancreatic insufficiency in 6 (0.2%), stricture or upper gastrointestinal tract surgery in 12 (0.3%), chronic peritonitis in 6 (0.2%), and mesenteric insufficiency in 6 (0.2%).

Compared with patients without gastrointestinal damage, those with gastrointestinal damage were older (53.1 vs 46.0 years, respectively; P <.001) and had longer disease duration (16.4 vs 11.7 years, respectively; P =.001). Several disease manifestations were more common among the group with vs without gastrointestinal damage, including vasculitis (14.1% vs 8.7%, respectively; P =.056), renal disease (56.1% vs 42.4%, respectively; P =.003), and serositis (40.5% vs 28.5%, respectively; P =.005). 

Patients with vs without gastrointestinal damage more commonly received certain treatment options, including glucocorticoids (96.9% vs 88.6%; P =.001), azathioprine (44.2% vs 33.9%; P =.01), mycophenolate mofetil (23.7% vs 14.9%; P =.009), and cyclophosphamide (37.4% vs 21.8%; P <.001). However, patients without vs with gastrointestinal damage received hydroxychloroquine more frequently (83.4% vs 75.2%; P =.022).

Gastrointestinal damage was associated with a worse prognosis, including higher modified Systemic Lupus International Collaborating Clinics Damage Index (SDI) score (2 vs 1, P <.001), increased risk for hospitalizations (71.5% vs 54.2%; P <.001), and mortality (17.6% vs 5.2%; P <.001).

Multivariable analysis showed that older age (odds ratio [OR], 1.02; P <.001), high daily dose of prednisone (10-30 mg/d, OR, 2.61; P =.074; >30-60 mg/d, OR, 3.04; P =.035; >60 mg/d, OR, 4.14; P =.008), and higher modified SDI score (OR, 1.26; P <.001) remained statistically significant. Researchers noted that the presence of oral ulcers reduced the risk of developing gastrointestinal damage in 30% of patients (OR, 0.67; P =.044).

“Having GI damage is associated with clinical involvement of other target organs in lupus and with a worse prognosis. Patients on high dose of glucocorticoids are at higher risk of developing GI damage which reinforces the strategy of minimizing glucocorticoids,” the researchers concluded.

Reference

Segura TB, González AI, Rúa-Figueroa I, et al. Gastrointestinal disease in SLE: does it indicate a worse prognosis? Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0267.