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. 2021 Mar 20;19(1):35.
doi: 10.1186/s12969-021-00513-5.

Disease activity index is associated with subclinical atherosclerosis in childhood-onset systemic lupus erythematosus

Priscila B S Medeiros  1   2 , Roberta G Salomão  3 , Sara R Teixeira  4 , Diane M Rassi  5 , Luciana Rodrigues  1 , Davi C Aragon  1 , Priscila G Fassini  6 , Fábio V Ued  3 , Rita C Tostes  5 , Jacqueline P Monteiro  1   3 , Virgínia P L Ferriani  1   2 , Luciana M de Carvalho  7   8   9
Affiliations

Disease activity index is associated with subclinical atherosclerosis in childhood-onset systemic lupus erythematosus

Priscila B S Medeiros et al. Pediatr Rheumatol Online J. .

Abstract

Background: Systemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular events. The present study determined the prevalence of subclinical atherosclerosis in childhood-onset SLE using the carotid intima-media thickness (CIMT) measurement and investigated associations between traditional and nontraditional risk factors for atherosclerosis, such as medications, SLE Disease Activity Index - SLEDAI-2 K and SLICC-ACR damage index and CIMT.

Methods: Cross-sectional prospective study between 2017 and 2018. CIMT was assessed by ultrasonography. Data were collected by chart review, nutritional evaluation and laboratory tests and analyzed by Fisher, Wilcoxon-Mann-Whitney tests, multiple linear and log binomial regression.

Results: Twenty-eight patients (mean age 13.9 years, SD 3) were enrolled. The prevalence of subclinical atherosclerosis was 32% (95% CI 14.8, 49.4). The mean CIMT was 0.43 ± 0.035 mm. The most common traditional risk factors observed were dyslipidemia (82.1%), uncontrolled hypertension (14.2%), obesity (14.3%), and poor diet (78.6%). Uncontrolled hypertension (p = 0.04), proteinuria (p = 0.02), estimated glomerular filtration rate < 75 ml /min/1.73 m2 (p = 0.02) and SLEDAI-2 K > 5 (P = 0.04) were associated with subclinical atherosclerosis. SLEDAI-2 K > 5 maintained association with CIMT after adjusting for control variables.

Conclusion: Subclinical atherosclerosis is frequently observed in cSLE, mainly in patients with moderate to severe disease activity.

Keywords: Atherosclerosis; Carotid intima-media thickness; Lupus Erythematosus, systemic, childhood; Nutritional assessment.

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Conflict of interest statement

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Fig. 1
Fig. 1
Example of carotid intima-media thickness (CIMT) of the far wall of the common carotid artery. a Patient with mean CIMT of 0.47 mm above the 90th percentile for age and sex controls (Doyon et al, Hypertension, 2013), which is considered subclinical atherosclerosis. b Another patient with a mean CIMT of 0.36 mm within the normal range for age
Fig. 2
Fig. 2
Carotid intima-media thickness (CIMT) measures in mm in cSLE patients according to SLEDAI-2 k score (≤5 ou > 5), Estimate CrCl < 75 ml/min/1,73 m2, protein to creatinine ratio in cSLE patients. Value distribution is shown by boxplot (Whiskers 5–95 percentile). Data were analyzed with Mann-Whitney non-parametric test (*P = 0.04 ** P = 0.04 and #P = 0.02)
See this image and copyright information in PMC

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