Features associated with hematologic abnormalities and their impact in patients with systemic lupus erythematosus: Data from a multiethnic Latin American cohort

Semin Arthritis Rheum. 2016 Jun;45(6):675-83. doi: 10.1016/j.semarthrit.2015.11.003. Epub 2015 Nov 12.

Abstract

Objective: To examine hematological manifestations' correlates and their impact on damage accrual and mortality in SLE patients from the multiethnic, Latin American, GLADEL cohort.

Methods: In patients with recent SLE diagnosis (≤2 years), the association between follow-up hematological manifestations (per ACR criteria) and socio-demographic and clinical variables was examined by univariable and multivariable logistic regressions; their impact on damage accrual and mortality was examined by Poisson and Cox proportional-hazards regression analyses, respectively.

Results: Of 1437 patients, 948 (66.0%) developed ≥1 hematological manifestation [5.5% hemolytic anemia (AHA), 16.3% thrombocytopenia, and 56.4% lymphopenia] over 4.3 (3.3) follow-up years. Younger age, Mestizo ethnicity, hematologic disorder (at/or before SLE diagnosis), and first damage recorded were associated with hematological manifestations while antimalarials were negatively associated. AHA (at/or before SLE diagnosis), anti-Sm, and anti-RNP antibodies were associated with subsequent AHA occurrence while musculoskeletal involvement was negatively associated. Thrombocytopenia (at/or before SLE diagnosis), AHA, anti-phospholipid antibodies (aPLs), anti-SSA/Ro, anti-SSB/La antibodies, and first damage recorded were associated with later thrombocytopenia occurrence. Lymphopenia (at/or before SLE diagnosis), younger age at diagnosis, Mestizo ethnicity, having medical insurance, and first damage recorded were associated with subsequent lymphopenia occurrence while antimalarials and azathioprine treatment were negatively associated. AHA was associated with damage accrual and mortality after adjusting for variables known to affect these outcomes.

Conclusions: Mestizo ethnicity and early hematological manifestations are risk factors for their subsequent occurrence while antimalarials have a protective effect. The associations between AHA and aPLs and thrombocytopenia were corroborated. AHA contributes independently to damage accrual and diminished survival.

Keywords: Autoimmune hemolytic anemia; Hematologic manifestations; Lymphopenia; Systemic lupus erythematosus; Thrombocytopenia.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • African Continental Ancestry Group
  • Age Factors
  • Anemia, Hemolytic / blood*
  • Anemia, Hemolytic / ethnology
  • Anemia, Hemolytic / etiology
  • Antibodies, Antinuclear / immunology
  • Antibodies, Antiphospholipid / immunology
  • Antimalarials / therapeutic use
  • Autoantibodies / immunology
  • Azathioprine / therapeutic use
  • Ethnic Groups
  • European Continental Ancestry Group
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Indians, South American
  • Insurance, Health
  • Latin America
  • Logistic Models
  • Longitudinal Studies
  • Lupus Erythematosus, Systemic / blood*
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / drug therapy
  • Lupus Erythematosus, Systemic / immunology
  • Lymphopenia / blood*
  • Lymphopenia / ethnology
  • Lymphopenia / etiology
  • Male
  • Multivariate Analysis
  • Proportional Hazards Models
  • Ribonucleoproteins / immunology
  • Thrombocytopenia / blood*
  • Thrombocytopenia / ethnology
  • Thrombocytopenia / etiology
  • Young Adult

Substances

  • Antibodies, Antinuclear
  • Antibodies, Antiphospholipid
  • Antimalarials
  • Autoantibodies
  • Immunosuppressive Agents
  • Ribonucleoproteins
  • SS-A antibodies
  • SS-B antibodies
  • Azathioprine