IS THERE ANY INFLUENCE OF THE ANTIRHEUMATIC THERAPY ON HEART DAMAGE IN SYSTEMIC LUPUS ERYTHEMATOSUS?

Abstract

TOPIC: Cardiovascular Disease TYPE: Original Investigations PURPOSE: Cardiovascular involvement in systemic lupus erythematosus (SLE) patients can be associated with disease severity, activity and treatment-related factors. The goal is to determine possible differences in the structure and frequency of heart damage in SLE patients, with and without antirheumatic therapy. METHODS: This is a prospective cross-sectional study including 87pts (91% females, aged 32[28-41]years (median[interquartile range 25%-75%]) with SLE(SLICC 2012 criteria). All patients were divided into 2 groups: the 1st group was composed of “untreated” patients and the 2nd – of patients receiving antirheumatic therapy. The 1st group included 42pts(93% females) aged 31[27–40]years who were not receiving steroids, immunosuppressants and biological agents, 4(10%) of them were on hydroxychloroquine (HCQ) therapy 200 mg/day. The 2nd group is represented by 45pts(89% females) aged 34[28-45]years. Out of them 44(98%) patients were on prednisone therapy at 10[8-15]mg/day, 9(21%)- on cyclophosphamide, 6(13%)-azathioprine, 4(8%)-mycophenolate mofetil, 4(8%)-methotrexate, 32(71%)–HCQ, and 9(19%)–on biologic (rituximab, belimumab). Patients receiving antirheumatic therapy (group 2) had longer disease duration (96 vs 18 months, p<0,00001), lower disease activity (SLEDAI-2K 4 vs 12 scores,p<0,001), higher SLICC/DI (1 vs 0 score,p<0,001); lower percentage of them had skin lesions (11 vs 57%,p<0,0001), arthritis (22 vs 52%,p<0,05) and hematological disorders (24 vs 74%,p<0,0001) than “untreated” patients from the 1st group.Serum levels of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II(Roche Diagnostics, Switzerland). Normal NT-proBNP levels should vary within ≤125pg/ml. RESULTS: No differences in terms of pericarditis (43% and 47%) (both exudative and adhesive), endocarditis (26% and 33%), arrhythmias (19% and 18%) and cardiac conduction defect (2% each), coronary artery disease (2% and 9%), myocardial infarction (0 and 4%), and heart failure (7% and 15%) frequencies were found between the “treatment-na?v” SLE patients and patients receiving antirheumatic therapy (p>0,05 for all cases). NT-proBNP concentrations were higher in “treatment-na?v”patients (150,7 vs 32,6 pg/ml,p<0,01), exceeding normal values (>125,0pg/ml).Myocarditis diagnosed by based on clinical, laboratory and instrumental findings (without myocardial biopsy) were documented in “treatment-na?v” patients only, but difference did not reach statistical significance (10% vs 0,p=0,050).Hypertension was more common in patients from the 2ndgroup (62% and 29%,p<0,01), but no differences were found in the frequency of other traditional risk factors, although total cholesterol levels and body mass index (BMI) were higher than in 1stgroup: 5,7 vs 4,5 mmol/L,p<0,05; 22,66 and 22,10 kg/m2,p<0,01, respectively. CONCLUSIONS: Antirheumatic therapy does not seemingly aggravate the heart damage in SLE patients, yielding no statistical difference in both - variety or frequency of most common CV pathologies. But the therapy (mostly steroids) and longer disease duration is associated with hypertension, high cholesterol level and BMI. Higher disease activity (in “treatment-na?v” patients) is associated with the increased NT-proBNP level, and possibly, higher frequency of myocarditis. CLINICAL IMPLICATIONS: Antirheumatic therapy does not aggravate the heart damage in SLE DISCLOSURES: No relevant relationships by Elena Gerasimova, source=Web Response No relevant relationships by Yulia Gorbunova, source=Web Response No relevant relationships by Liubov Kondrateva, source=Web Response No relevant relationships by Tatiana Panafidina, source=Web Response No relevant relationships by Tatiana Popkova, source=Web Response