Determining Elevated Thrombotic Risk in Systemic Lupus Erythematosus

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Recent data from EULAR 2018 highlight the existence of thrombotic factors in systemic lupus erythematosus.
The following article is part of conference coverage from the European League Against Rheumatism (EULAR) Congress 2018 in Amsterdam, The Netherlands. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from EULAR 2018.

Thrombotic risk factors are prevalent among patients with systemic lupus erythematosus (SLE), and this risk is elevated when another autoimmune disease is present, according to data presented at the European League Against Rheumatism (EULAR) Congress held in Amsterdam, June 13 to 16, 2018.

Investigators sought to determine the role of thrombotic risk factors in patients with SLE, considering cardiovascular (CV) risk factors and antiphospholipid (aPL) antibodies, and to access the application of different thrombotic risk scales. They conducted a retrospective cohort study including 84 patients with SLE from an outpatient Portuguese central hospital.

The researchers evaluated patient sex, age, age at diagnosis, duration of illness, presence of another autoimmune disease, CV risk factors, presence of aPL antibodies, treatment, dose, and duration of steroids. The Framingham, Systemic Coronary Risk Evaluation (SCORE) and adjusted Global Antiphospholipid Syndrome Score (aGAPSS) scores were calculated to determine thrombotic risk.

Results showed that male patients with SLE had a higher prevalence of arterial hypertension (P =.022), dyslipidemia (P =.047), and smoking (P =.001), with an 11% to 20% risk on the Framingham scale and a 5% to 14% risk on the SCORE scale (P =.000). Female patients had a higher prevalence of another autoimmune disease (P =.014) and were more likely to be treated with disease-modifying antirheumatic drugs (P =.014). Framingham scale scores showed a risk of 11% to 20% in the presence of arterial hypertension and >20% in patients who smoked (P =.001). The SCORE scale showed a risk of 5% to 9% in the presence of arterial hypertension (P =.003) and a risk of 10% to 14% in dyslipidemia (P =.024). When the risk was between 6% and 20% on the Framingham scale, the risk was lower on the SCORE scale (P =.000).

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The investigators found that aPL antibodies did not correlate with an increased CV risk, but note that all aPL antibodies are associated with the presence of another autoimmune disease, aPL syndrome, and persistently positive aPL antibodies.

The aGAPSS scale associates a score from 7 to 12 if another autoimmune disease is present (P =.000); 4 to 9 with aPL syndrome; >7 with persistently positive aPL antibodies (P =.000); 4 to 6 with diabetes (P =.039), dyslipidemia (P =.002), and arterial hypertension (P =.000); >7 with a lupus anticoagulant or with anticardiolipin antibodies; and >12 with anti-β-2glycoprotein-I antibody (P =.000).

The authors concluded that in patients with SLE, both the presence of CV risk factors and the presence of aPL antibodies must be evaluated. In addition, not only should the Framingham risk scale be calculated but the global thrombotic risk should also be assessed using aGAPSS.

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Mota AS, Cunha I, Andrade J, et al. Can the overall thrombotic risk in systemic lupus erythematosus be determined? The combined role of classic cardiovascular factors and antiphospholipid antibodies. Presented at: European League Against Rheumatism (EULAR) Congress 2018; June 13-16, 2018; Amsterdam, The Netherlands. Abstract AB0549.