AB1020 DISEASE ACTIVITY INDEX IS ASSOCIATED WITH SUBCLINICAL ATHEROSCLEROSIS IN CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract

Background Systemic lupus erythematosus (SLE) is considered an independent risk factor for cardiovascular events in association with traditional risk factors. Therefore, it is important to recognize and to identify the specific risk factors for atherosclerotic disease in these patients for the prevention and early treatment of cardiovascular diseases, aiming to provide a better quality of life with long-term morbidity reduction. Objectives To determine the prevalence of subclinical atherosclerosis by the measurement of carotid intima-media thickness (CIMT) in patients with childhood-onset systemic lupus erythematosus (cSLE) younger than 21 years. To check for associations between sex, age, race, body mass index, medications in use, cumulative dose of corticosteroid, traditional and nontraditional risk factors for atherosclerosis, laboratory tests, including plasma cytokine levels, clinical disease activity score (SLE Disease Activity Index - SLEDAI-2K) and cumulative damage index (Cumulative Organ Damage of the SLE International Collaborating Clinics - SLICC/ACR damage index) with CIMT. Methods This was a cross-sectional study. Clinical and laboratory data were collected based on chart review and laboratory testing; present clinical and nutritional evaluation were performed during interviews and CIMT was evaluated by ultrasound carried out by an expert radiologist. Associations were estimated using univariate analysis (Fisher and Wilcoxon-Mann-Whitney tests) and multivariate analysis (linear and log binomial regression). Results Twenty-eight patients, aged 13.9 ± 3 years, were enrolled in the study. The prevalence of subclinical atherosclerosis was 32.14% (95% CI: 14.8, 49.4) and the mean carotid intima-media thickness (CIMT) was 0.43 ± 0.035 mm. Most common traditional risk factors observed were dyslipidemia in 89,3%; uncontrolled hypertension in 66,6%; overweight or obesity in 32% and poor diet in 78,6%. Nontraditional risk factors observed were duration of disease of 2.4 ± 2.12 years; mean SLEDAI-2K of 7.8 ± 6.0; SLICC/ACR damage index scored ≥ 1 in 25%; high levels of ultra-sensitive C-reactive protein in 25% and nephritis and neuropsychiatric involvement in 75% and 28.5% of the patients, respectively. Cumulative dose of corticosteroids was 0.48 ± 0.83 mg/kg/day and 60.7% of patients were using immunosuppressive drugs. Univariate analysis showed that uncontrolled hypertension, proteinuria, estimated glomerular filtration rate 5 were associated with subclinical atherosclerosis. The association of CIMT with SLEDAI-2K > 5 was maintained after adjusting for control variables (cumulative corticosteroid dose, duration of disease, levels of cholesterol fractions,hypertension and renal disease). Conclusion This study demonstrated that subclinical atherosclerosis was frequently observed in cSLE, mainly in patients with moderate to severe activity disease (SLEDAI-2K greater than 5) Financial Suport: CNPq# 400913/2016-0 Disclosure of Interests None declared