Osteopontin and Disease Activity in Patients with Recent-onset Systemic Lupus Erythematosus: Results from the SLICC Inception Cohort

OBJECTIVE

In cross-sectional studies, elevated osteopontin (OPN) levels have been proposed to reflect, and/or precede, progressive organ damage and disease severity in systemic lupus erythematosus (SLE). We aimed, in a cohort of patients with recent-onset SLE, to determine whether raised serum OPN levels precede damage and/or are associated with disease activity or certain disease phenotypes.

METHODS

We included 344 patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort who had 5 years of followup data available. All patients fulfilled the 1997 American College of Rheumatology (ACR) criteria. Baseline sera from patients and from age- and sex-matched population-based controls were analyzed for OPN using ELISA. Disease activity and damage were assessed at each annual followup visit using the SLE Disease Activity Index 2000 (SLEDAI-2K) and the SLICC/ACR damage index (SDI), respectively.

RESULTS

Compared to controls, baseline OPN was raised 4-fold in SLE cases (p < 0.0001). After relevant adjustments in a binary logistic regression model, OPN levels failed to significantly predict global damage accrual defined as SDI ≥ 1 at 5 years. However, baseline OPN correlated with SLEDAI-2K at enrollment into the cohort (r = 0.27, p < 0.0001), and patients with high disease activity (SLEDAI-2K ≥ 5) had raised serum OPN (p < 0.0001). In addition, higher OPN levels were found in patients with persistent disease activity (p = 0.0006), in cases with renal involvement (p < 0.0001) and impaired estimated glomerular filtration rate (p = 0.01).

CONCLUSION

The performance of OPN to predict development of organ damage was not impressive. However, OPN associated significantly with lupus nephritis and with raised disease activity at enrollment, as well as over time.

Longterm Outcome of Patients with Primary Antiphospholipid Syndrome: A Retrospective Multicenter Study

OBJECTIVE

To assess the longterm frequency of thrombotic recurrences, obstetrical complications, organ damage, severe comorbidities, and evolution toward connective tissue disease (CTD) in primary antiphospholipid syndrome (PAPS).

METHODS

Medical records of patients with PAPS followed in 6 centers for ≥ 15 years were retrospectively reviewed.

RESULTS

One hundred fifteen patients were studied: 88% women, followed between 1983 and 2014 with a mean (± SD) age at diagnosis of 33 (± 10) years. During a median followup of 18 years (range 15-30), 50 patients (44%) had at least a thrombotic event for a total of 75 events and an annual incidence of 3.5%. Thromboses were more frequent in patients with previous thrombotic history (p = 0.002). A catastrophic antiphospholipid syndrome occurred in 6 patients (5%). The use of oral anticoagulants in patients with thrombotic onset did not appear to be protective against recurrences (p = 0.26). Fifty-two women had 87 pregnancies, successful in 78%. Twenty-nine percent of patients accrued functional damage. Damage was significantly associated with a thrombotic history (p = 0.004) and with arterial events (p < 0.001), especially stroke, but not with demographics, serology, or treatment. Twenty-four major bleeding episodes were recorded in 18 patients, all receiving anticoagulants. Severe infections affected 6 patients (5%), with 1 fatality. A solid cancer was diagnosed in 8 patients (7%). Altogether, 16 patients (14%) developed an autoimmune disease and 13 (11%) a full-blown picture of CTD.

CONCLUSION

Despite therapy, a high proportion of patients experienced new thrombotic events and organ damage, while evolution toward CTD was infrequent.

Bone mineral density change in systemic lupus erythematosus: a 5-year followup study

OBJECTIVE

To determine changes of bone mineral density (BMD) over a 5-year period in a cohort of female patients with systemic lupus erythematosus (SLE) and to identify factors predictive of BMD loss.

METHODS

Our longitudinal study involved 125 female patients with SLE with a mean (SD) age of 46.5 years (10.1) and a median disease duration of 10.4 years. Demographics and clinical data were collected and BMD at the femoral neck, total hip, and lumbar spine (L1-4) was performed by using dual-energy x-ray absorptiometry at baseline and followup.

RESULTS

Average percentage changes of BMD over a mean followup of 5 years were -2.41% at the femoral neck, -1.63% at the total hip, and -0.62% at the lumbar spine, with significant changes at both the femoral neck (p < 0.0001) and total hip (p < 0.0005), but not at the lumbar spine (p = 0.128). Disease flare, new organ damage, and use of glucocorticoids during followup were significantly associated with larger decreases in BMD. BMD loss was arrested at the femoral neck and BMD increased at the total hip and lumbar spine in patients receiving antiosteoporosis therapy. In multivariate analyses, use of antiosteoporosis therapy was independently associated with increased BMD at any site and new organ damage was an independent predictor of BMD loss at the femoral neck.

CONCLUSION

Significant BMD loss at the hip over a period of 5 years was found in patients with SLE. Disease activity, disease damage, and use of glucocorticoids are the disease-specific variables that contribute to bone loss in SLE.