PT  - JOURNAL ARTICLE
AU  - Andrea Hinojosa-Azaola
AU  - Juanita Romero-Diaz
AU  - Angel Gabriel  Vargas-Ruiz
AU  - Carlos A.  Nuñez-Alvarez
AU  - Alba Cicero-Casarrubias
AU  - Mario C.  Ocampo-Torres
AU  - Jorge Sanchez-Guerrero
TI  - Venous and Arterial Thrombotic Events in Systemic Lupus Erythematosus
AID  - 10.3899/jrheum.150506
DP  - 2016 Jan 15
TA  - The Journal of Rheumatology
PG  - jrheum.150506
4099  - http://www.jrheum.org/content/early/2016/01/02/jrheum.150506.short
4100  - http://www.jrheum.org/content/early/2016/01/02/jrheum.150506.full
AB  - Objective The incidence of thrombosis in patients with systemic lupus erythematosus (SLE) is 25 to 50-fold higher than in the general population; we aimed to define the characteristics of venous thrombotic events (VTE) and arterial thrombotic events (ATE) to identify the patients at highest risk. Methods The study included 219 patients with recent-onset SLE. At baseline, standardized medical history and laboratory tests were done. Followup visits occurred quarterly, and information about damage accrual, comorbidities, and cardiovascular risk factors was updated annually. Main outcome was development of TE after SLE diagnosis. Results Thirty-five patients (16%) developed TE (27 VTE, 8 ATE) during 5.21 years of followup; incidence rate 31/1000 patient-years. Most events (57%) developed within the first year of diagnosis, and 69% were not associated with lupus anticoagulant (LAC), determined with 1 method. VTE developed earlier than ATE (2.0 vs 57.5 mos, p = 0.02). In the multivariate analysis, variables preceding VTE included cutaneous vasculitis, nephrotic syndrome, dose of prednisone, and LAC in combination with anti-RNP/Sm antibodies (p < 0.03). Patients with ATE were older (median age 44 vs 29 yrs, p = 0.04), smokers, and had hypertension, diabetes mellitus, dyslipidemia, at least 2 traditional risk factors, nephrotic syndrome, chronic damage, and a higher cumulative dose of prednisone (p < 0.05). LAC in combination with anti-RNP/Sm antibodies was associated with VTE and improved the accuracy for predicting it. Conclusion Our study suggests that in SLE, VTE and ATE have different risk factors. Understanding these differences is helpful for identifying patients at highest risk. The use of LAC plus anti-RNP/Sm for predicting VTE deserves further study.