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Background: Among the manifestations of SLE, vasculitic presentation is common. This study was aimed to identify the predictors of vasculitis in SLE patients.
Objectives: To identify the determinants of vasculitis in SLE patients.
Methods: The study was conducted in the Department of Rheumatology, BSMMU, Dhaka from December 2019 to January 2021. A total 168 consecutive confirmed cases of SLE patients were enrolled. The patients were evaluated for the features of vasculitic rashes, digital gangrene, mesenteric vasculitis, mononeuritis multiplex. The cutaneous vasculitis was confirmed by a dermatologist. Study subjects were grouped into vasculitic and no vasculitic groups. The disease activity and damage were assessed using SLEDAI and SLICC/ACR DI. The rate of vasculitis was expressed in percentage. The multivariate logistic regression analysis was done to determine the independent predictors of vasculitis in SLE. P value <0.05 was considered significant.
Results: Rate of lupus vasculitis was 14.3%. The features shown significant difference between vasculitic and no vasculitic groups were: ACLE (79.2% vs. 18.8%, p<0.001), oral ulcer (70.8% vs. 13.2%, p<0.001), alopecia (83.3% vs. 27.1%, p<0.001), Raynaud’s phenomenon (20.8% vs. 5.6%, p=0.011), fever (54.2% vs. 25.0%, p=0.002), arthritis (70.8% vs. 29.9%, p<0.001), pregnancy loss (68.8% vs. 32.7%, p=0.003), lupus nephritis (25.0% vs. 45.1%, p=0.032), seizure (8.3% vs. 0.7%, p=0.027), pleurisy (8.3% vs. 0.7%, p=0.027), leucopenia (8.3% vs. 1.4%, p=0.049), anti ds-DNA positivity (87.5% vs. 62.5%, p=0.008), hypocomplementemia (87.5% vs. 59%, p=0.003), higher mean SLEDAI (p<0.001) and SLICC/ACR damage index score (p<0.001). Though not significant the rate of antiphospholipid antibody positivity was high (69.2% vs. 42.9%, p=0.052) in vasculitis group. In multivariate logistic regression analysis, higher SLEDAI score (OR = 1.296, 95% CI =1.114-1.508) was positively and lupus nephritis (OR= 0.055, 95% CI =0.007-0.413) was negatively associated with lupus vasculitis.
Conclusion: In SLE, vasculitic presentation is common. Higher the SLEDAI score greater the chance of lupus vasculitis.
REFERENCES:
[1]Aringer, M., Costenbader, K., Daikh, D., Brinks, R., Mosca, M., Ramsey-Goldman, R., et al., (2019). 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis & Rheumatology , 71(9), pp.1400-1412.
[2]Drenkard, C., Villa, A., Reyes, E., Abello, M. and Alarcón-Segovia, D. (1997). Vasculitis in systemic lupus erythematosus. Lupus , 6(3), pp.235-242.
[3]Ramos-Casals, M., Nardi, N., Lagrutta, M., Brito-Zerón, P., Bové, A., Delgado, et al., (2006). Vasculitis in Systemic Lupus Erythematosus. Medicine , 85(2), pp.95-104.
Comparison of clinical features of Lupus vasculitis and without vasculitis (n=168 )
| Clinical features | Lupus vasculitis (n=24) n (%) | Without vasculitis (n=144) n (%) | p-value |
|---|---|---|---|
| Fever | 13 (54.2) | 36 (25.0) | 0.002 γ |
| SLE specific skin lesions | |||
| ACLE | 19 (79.2) | 27(18.8) | <0.001 γ |
| SCLE | 1 (4.2) | 6(4.2) | 0.500 * |
| SLE non-specific skin lesions | |||
| Oral ulcer | 17 (70.8) | 19 (13.2) | <0.001 γ |
| Alopecia | 20 (83.3) | 39 (27.1) | <0.001 γ |
| Raynaud’s | 5 (20.8) | 8 (5.6) | 0.011* |
| Arthritis | 17 (70.8) | 43 29.9) | <0.001 γ |
| Lupus nephritis a | 6 (25.0) | 65 (45.1) | 0.032 γ |
| Neuro psychiatric | |||
| Seizure | 2 (8.3) | 1 (0.7) | 0.027 * |
| Psychosis | 1 (4.2) | 2 (1.4) | 0.186 * |
| Serositis | |||
| PleurisyPericarditis | 2 (8.3)1 (4.2) | 1 (0.7)3 (2.1) | 0.027 * 0.231 * |
| Pregnancy loss | 11/16 (68.8) | 32/98 (32.7) | 0.003 γ |
| DVT | 1 (4.2) | 6 (4.2) | 0.500 * |
| APS | 3 (12.5) | 11 (7.6) | 0.213 * |
| AVN | 1 (4.2) | 2 (1.4) | 0.186 * |
| Pulmonary HTN | 2 (8.3) | 3 (2.1) | 0.074 * |
* Fisherʼs eхact test; γ chi-Square test, p < 0.05 is considered statistically significant, n: Number, %: Percent.
ACLE: Acute Cutaneous Lupus Erythematosus, SCLE: Sub-acute Cutaneous Lupus Erythematosus, DVT: Deep Vein Thrombosis, APS: Anti Phospholipid Antibody Syndrome, AVN: Avascular necrosis, HTN: Hypertension,
a: all diagnosed cases of lupus nephritis, presented with or without flare
Acknowledgements: We acknowledge all of our patients for their kind participation in this study. We also acknowledge Prof. Syed Atiqul Haq, Prof. Minhaj Rahim Choudhury, Prof. Abu Shahin, Dr. Md. Masudul Hasaan, Dr. Shamim Ahmed, Dr. Abul Kalam Azad, Department of rheumatology, BSMMU for their support and kind help during the work. At the end we acknowledge BSMMU authority for their support in conducting the study.
Disclosure of Interests: None declared