TY - JOUR
T1 - Systemic lupus erythematosus in a multiethnic cohort (LUMINA)
T2 - XXVIII. Factors predictive of thrombotic events
AU - Ho, K. T.
AU - Ahn, C. W.
AU - Alarcón, Graciela S.
AU - Baethge, B. A.
AU - Tan, F. K.
AU - Roseman, J.
AU - Bastian, H. M.
AU - Fessler, B. J.
AU - McGwin, G.
AU - Vilá, L. M.
AU - Calvo-Alén, J.
AU - Reveille, J. D.
N1 - Funding Information:
The authors would like to acknowledge all LUMINA patients, without whom this study would have not been possible, our supporting staff (Martha L. Sanchez and Ellen Sowell at UAB, Carmine Pinilla at UPR and Robert Sandoval and Li-Lu Wang at UTH) for their efforts in securing our patients’ follow-up and performing other LUMINA-related tasks, Drs Ruihua Wu and Yehuda Schonfield for determining anti-oxidized antibodies in all patients, and Ms Ella Henderson for her expert assistance in the preparation of this manuscript. Supported by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01-AR42503) and General Clinical Research Centers [M01-RR02558 (UTH), M01-RR00032 (UAB) and m01-rr00073 (UTMB)] and from the National Center for Research Resources (NCRR/NIH) RCMI Clinical Research Infrastructure Initiative (RCRII) award 1P20RR11126 (UPR) and the Mary Kirkland Scholars Award Program (J.C.-A., UAB).
PY - 2005/10/1
Y1 - 2005/10/1
N2 - 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.
AB - 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.
KW - Antiphospholipid antibodies
KW - Hydroxychloroquine
KW - LUMINA
KW - Systemic lupus erythematosus
KW - Thrombosis
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U2 - 10.1093/rheumatology/kei014
DO - 10.1093/rheumatology/kei014
M3 - Article
C2 - 16030085
AN - SCOPUS:27144483360
SN - 1462-0324
VL - 44
SP - 1303
EP - 1307
JO - Rheumatology
JF - Rheumatology
IS - 10
ER -