Predictors of Vasculitis in Patients With Systemic Lupus Erythematosus in Bangladesh

Abstract

Introduction Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. Sometimes vasculitis may complicate the disease. Among the manifestations of SLE, vasculitis presentation is common. This study aimed to identify the predictors of vasculitis in SLE patients. Methods This is a cross-sectional study in a single center conducted in the Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from December 2019 to January 2021. The disease activity and damage were assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SLICC/ACR DI). Study subjects were grouped into vasculitis and no vasculitis groups. The multivariate logistic regression analysis was done to determine the independent predictors of vasculitis in SLE. The p-value <0.05 was considered significant. Results The rate of lupus vasculitis was 14.3%. The significant difference in vasculitis features between vasculitis and no vasculitis groups were: acute cutaneous lupus erythematosus (ACLE) (p<0.001), oral ulcer (p<0.001), alopecia (p<0.001), Raynaud's phenomenon (p=0.011), fever (p=0.002), arthritis (p<0.001), pregnancy loss (p=0.003), lupus nephritis (p=0.032), seizure (p=0.027), pleurisy (p=0.027), leucopenia (p=0.049), anti-dsDNA positivity (p=0.008), hypocomplementemia (p=0.003), higher mean SLEDAI (p<0.001) and SLICC/ACR DI score (p<0.001). 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 The vasculitis flare of lupus is associated with Raynaud's phenomenon and pregnancy loss. Mucocutaneous flare, fever, arthritis, seizure, pleurisy, and lupus nephritis were also associated with vasculitis.

Keywords: cutaneous vasculitis; flare of lupus; lupus flare; lupus vasculitis; rheumatoid arthritis; sle; sle and lupus nephritis; vasculitis; vasculitis and disease activity.