Rheumatology Advance Access originally published online on July 24, 2007
Rheumatology 2007 46(9):1471-1476; doi:10.1093/rheumatology/kem153
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Systemic lupus erythematosus in a multiethnic US cohort LUMINA LI: Anaemia as a predictor of disease activity and damage accrual
Department of Medicine (Division of Rheumatology), The University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, 1Department of Medicine (Division of Clinical Immunology and Rheumatology), School of Medicine, The University of Alabama at Birmingham, Birmingham, AL and 2Department of Medicine (Division of Rheumatology), The University of Texas Health Science Center at Houston, Houston, TX.
Correspondence to: Luis M. Vilá, Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067. E-mail: lvila{at}rcm.upr.edu
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Abstract |
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Objective: To examine if anaemia (and its severity) is associated with disease activity and damage accrual in systemic lupus erythematosus (SLE).
Methods: Four thousand four-hundred study visits in 613 SLE patients enrolled in LUMINA were studied. Anaemia was expressed in four categories of haematocrit (Hct) as defined by the Systemic Lupus Activity Measure-Revised (SLAM-R): no anaemia (Hct >35%), mild (Hct = 30–35%), moderate (Hct = 25–29%) and severe (Hct <25%). Anti-dsDNA antibodies were measured at baseline. Disease activity was assessed with the SLAM-R and damage with the Systemic Lupus International Collaborating Clinics Damage Index (SDI). The relationship between anaemia and anti-dsDNA antibodies with the SLAM and SDI scores was examined by univariate (one-way ANOVA) and multivariate (generalized linear models and generalized estimating equation regression) analyses.
Results: All categories of anaemia and anti-ds DNA were significantly associated with the SLAM-R at baseline and over time. However, only moderate and severe anaemia were associated with the SDI at baseline and over time, while the presence of anti-ds DNA was only associated with the SDI over time but not at baseline. Several clinical domains of the SLAM-R and SDI were associated with anaemia at baseline and over time.
Conclusions: Mild, moderate and marked anaemia are strongly associated with disease activity in SLE. Moderate and marked anaemia are associated with damage accrual. These associations are observed both early and during the course of SLE. Different levels of anaemia could be used to monitor disease activity and predict organ/system damage in SLE.
KEY WORDS: Systemic lupus erythematosus, Anaemia, Disease activity, Disease damage, Clinical manifestations
Submitted 29 January 2007;
revised version accepted 20 May 2007.
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