Rheumatology Advance Access originally published online on July 19, 2005
Rheumatology 2005 44(10):1303-1307; doi:10.1093/rheumatology/kei014
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Systemic lupus erythematosus in a multiethnic cohort (LUMINA): XXVIII. Factors predictive of thrombotic events
Department of Medicine (Division of Rheumatology), School of Medicine, University of Texas Health Science Center at Houston, Houston, TX, 1 Departments of Medicine (Division of Clinical Immunology and Rheumatology), Epidemiology, Biostatistics (Section of Statistical Genetics) and Surgery (Section of Trauma, Burns, and Critical Care), Schools of Medicine and Public Health, University of Alabama at Birmingham, Birmingham AL, 2 Department of Medicine (Division of Rheumatology), School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX and 3 Department of Medicine (Division of Rheumatology), School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
Correspondence to: G. S. Alarcón, 830 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294-3408, USA. E-mail: graciela.alarcon{at}ccc.uab.edu
Objective. To determine the relationship between the presence of antiphospholipid (aPL) antibodies, hydroxychloroquine use and the occurrence of thrombotic events in patients with systemic lupus erythematosus (SLE).
Methods: Four hundred and forty-two SLE patients from the LUMINA (Lupus in Minorities: Nature vs Nurture) cohort, a multiethnic (Hispanics from Texas, n = 99 and Puerto Rico, n = 36; African Americans, n = 172; and Caucasians, n = 135) cohort, were studied by generalized estimating equation (GEE) to determine the relationship between antiphospholipid (aPL) antibodies (measured as IgG and IgM aPL antibodies and/or the lupus anticoagulant) at enrolment or historically prior to enrolment, hydroxychloroquine use (ever) and the occurrence of thrombotic (central and/or peripheral, arterial and/or venous) events after adjusting for known and possible confounders [socioeconomic–demographic features, smoking, disease activity and damage, serum cholesterol levels, anti-oxidized low-density lipoprotein IgG and IgM antibodies, and high-sensitivity (hs) C-reactive protein]. Postanalysis correlation between aPL and anticardiolipin (aCL) assays was attempted by performing aCL assays on random samples of patients whose aPL status was known.
Results. A number of clinical variables were significant in the univariable analyses; however, in the multivariable GEE analyses, only smoking [odds ratio (OR) 2.777, 95% confidence interval (CI) 1.317–5.852] and disease activity as measured by the SLAM (Systemic Lupus Activity Measure) (OR 1.099; 95% CI 1.053–1.147) were significant. In particular, hydroxychloroquine use, which appeared to be protective against thrombotic events in the univariable analyses, was not retained in the multivariable analyses. aPL antibodies were not significant in either analysis. Few additional aPL-positive patients emerged from the validation study.
Conclusions. Smoking and disease activity emerged as important determinants in the occurrence of thrombotic events in our patients. Comprehensive treatment strategies should be directed to both smoking cessation and control of disease activity in patients with SLE.
KEY WORDS: Systemic lupus erythematosus, Thrombosis, Hydroxychloroquine, Antiphospholipid antibodies, LUMINA
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