Highest Risk for Organ Damage in Patients With SLE With Intermittent Cachexia

Compared with patients with systemic lupus erythematosus (SLE) without cachexia and with persistent cachexia, those with intermittent cachexia are at increased risk for future organ damage, according to study results published in Arthritis Care and Research.

Cachexia, defined as involuntary weight loss and loss of homeostatic control of energy and protein balance, is common among inflammatory diseases, but limited data are available on cachexia in patients with SLE. The aim of the current study was to assess the prevalence and risk factors for cachexia in patients with SLE.

Researchers used the modified Fearon criteria to define cachexia: 5% stable weight loss in 6 months without starvation relative to the average weight in all prior visits and/or weight loss >2% without starvation relative to the average weight in all prior visits and a body mass index <20.

Of 2452 patients with SLE from the Hopkins Lupus Cohort study whose weight was assessed at each visit, the study cohort included 2286 patients. A total of 56.3% of patients met the modified Fearon criteria for cachexia within the first 5 years of cohort entry. About one-third of patients (34%) who developed cachexia recovered within 12 months and less than a half (45.6%) recovered their previous weight by the end of follow-up. However, 18% of patients with SLE remained cachectic throughout the study period.

There were several risk factors for cachexia development, including body mass index <20, current corticosteroid use, vasculitis, lupus nephritis, serositis, hematologic manifestations, positive anti-dsDNA, anti-Sm and anti-RNP. After adjustment for corticosteroid use, only patients with musculoskeletal, skin and neurologic manifestations were not at risk of developing cachexia, suggesting a broad association with different disease manifestations.

Patients with persistent cachexia were at increased risk for kidney damage, including estimated glomerular filtration rate <50 (P <.01), proteinuria >3.5 gr/day (P <.05), and end-stage kidney disease (P <.05). Intermittent cachexia was associated with an increased risk for damage in multiple organs, including cataracts, retinal change or optic atrophy, cognitive impairment, cerebrovascular accident, cranial or peripheral neuropathy, pulmonary hypertension, pleural fibrosis, angina or coronary artery bypass, infarction or resection of bowel, deforming or erosive arthritis, osteoporosis, avascular necrosis, and premature gonadal failure.

“Further studies are needed to elucidate the implications of cachexia in terms of the response to treatment, long term outcomes, quality of life, as well as its role as a potential cardiovascular risk factor in SLE,” the researchers concluded.

Reference

Stojan G, Li J, Wittmaack A, Petri M. Cachexia in systemic lupus erythematosus: risk factors and relation to disease activity and damage. Published online August 2, 2020. Arthritis Care Res (Hoboken). doi:10.1002/acr.24395