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Systemic lupus erythematosus in a multiethnic US cohort, XXXVII: association of lymphopenia with clinical manifestations, serologic abnormalities, disease activity, and damage accrual.
Arthritis Rheum 2006; 55(5):799-806AR

Abstract

OBJECTIVE

To determine if lymphopenia is associated with clinical/immunologic manifestations, disease activity, and disease damage in systemic lupus erythematosus (SLE).

METHODS

The study group comprised 591 patients with SLE participating in a multiethnic, longitudinal outcome study. Cumulative clinical/immunologic (per American College of Rheumatology criteria) and pharmacologic treatment variables were obtained at enrollment (T0) and last visit (TL). Lymphopenia (<1,500/mm3) was scored only when clinically attributable to SLE and not to medications or other causes. Lymphocyte counts were expressed in 4 categories per the Systemic Lupus Activity Measure (SLAM): normal (> or =1,500/mm3), mild (1,000-1,499/mm3), moderate (500-999/mm3), and marked (<500/mm3). Disease activity was assessed with the SLAM and the Physician's Global Assessment (PGA). Disease damage was determined with the Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI). The relationship of lymphopenia with cumulative clinical/immunologic and pharmacologic treatment variables was first examined, then the association between the SLAM, PGA, and SLICC-DI scores with different categories of lymphopenia was examined by generalized estimating equation (GEE) regression analyses. Ethnicity, age, and sex were entered into all regression models.

RESULTS

At T0 and TL, lymphopenia was found to be positively associated with renal involvement, leukopenia, anti-double-stranded DNA antibodies, anti-Ro antibodies, and the use of glucocorticoids, azathioprine, and methotrexate, but was negatively associated with photosensitivity. On GEE analyses, marked lymphopenia at T0 and moderate and marked lymphopenia for all visits were independently associated with higher SLAM, PGA, and SLICC-DI scores.

CONCLUSION

Lymphopenia is associated with several clinical/immunologic manifestations in SLE. Moderate and marked lymphopenia are associated with higher disease activity and damage accrual.

Authors+Show Affiliations

Division of Rheumatology, Department of Internal Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico. lvila@rcm.upr.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17013840

Citation

Vilá, Luis M., et al. "Systemic Lupus Erythematosus in a Multiethnic US Cohort, XXXVII: Association of Lymphopenia With Clinical Manifestations, Serologic Abnormalities, Disease Activity, and Damage Accrual." Arthritis and Rheumatism, vol. 55, no. 5, 2006, pp. 799-806.
Vilá LM, Alarcón GS, McGwin G, et al. Systemic lupus erythematosus in a multiethnic US cohort, XXXVII: association of lymphopenia with clinical manifestations, serologic abnormalities, disease activity, and damage accrual. Arthritis Rheum. 2006;55(5):799-806.
Vilá, L. M., Alarcón, G. S., McGwin, G., Bastian, H. M., Fessler, B. J., & Reveille, J. D. (2006). Systemic lupus erythematosus in a multiethnic US cohort, XXXVII: association of lymphopenia with clinical manifestations, serologic abnormalities, disease activity, and damage accrual. Arthritis and Rheumatism, 55(5), pp. 799-806.
Vilá LM, et al. Systemic Lupus Erythematosus in a Multiethnic US Cohort, XXXVII: Association of Lymphopenia With Clinical Manifestations, Serologic Abnormalities, Disease Activity, and Damage Accrual. Arthritis Rheum. 2006 Oct 15;55(5):799-806. PubMed PMID: 17013840.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systemic lupus erythematosus in a multiethnic US cohort, XXXVII: association of lymphopenia with clinical manifestations, serologic abnormalities, disease activity, and damage accrual. AU - Vilá,Luis M, AU - Alarcón,Graciela S, AU - McGwin,Gerald,Jr AU - Bastian,Holly M, AU - Fessler,Barri J, AU - Reveille,John D, AU - ,, PY - 2006/10/3/pubmed PY - 2006/11/15/medline PY - 2006/10/3/entrez SP - 799 EP - 806 JF - Arthritis and rheumatism JO - Arthritis Rheum. VL - 55 IS - 5 N2 - OBJECTIVE: To determine if lymphopenia is associated with clinical/immunologic manifestations, disease activity, and disease damage in systemic lupus erythematosus (SLE). METHODS: The study group comprised 591 patients with SLE participating in a multiethnic, longitudinal outcome study. Cumulative clinical/immunologic (per American College of Rheumatology criteria) and pharmacologic treatment variables were obtained at enrollment (T0) and last visit (TL). Lymphopenia (<1,500/mm3) was scored only when clinically attributable to SLE and not to medications or other causes. Lymphocyte counts were expressed in 4 categories per the Systemic Lupus Activity Measure (SLAM): normal (> or =1,500/mm3), mild (1,000-1,499/mm3), moderate (500-999/mm3), and marked (<500/mm3). Disease activity was assessed with the SLAM and the Physician's Global Assessment (PGA). Disease damage was determined with the Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI). The relationship of lymphopenia with cumulative clinical/immunologic and pharmacologic treatment variables was first examined, then the association between the SLAM, PGA, and SLICC-DI scores with different categories of lymphopenia was examined by generalized estimating equation (GEE) regression analyses. Ethnicity, age, and sex were entered into all regression models. RESULTS: At T0 and TL, lymphopenia was found to be positively associated with renal involvement, leukopenia, anti-double-stranded DNA antibodies, anti-Ro antibodies, and the use of glucocorticoids, azathioprine, and methotrexate, but was negatively associated with photosensitivity. On GEE analyses, marked lymphopenia at T0 and moderate and marked lymphopenia for all visits were independently associated with higher SLAM, PGA, and SLICC-DI scores. CONCLUSION: Lymphopenia is associated with several clinical/immunologic manifestations in SLE. Moderate and marked lymphopenia are associated with higher disease activity and damage accrual. SN - 0004-3591 UR - https://www.unboundmedicine.com/medline/citation/17013840/Systemic_lupus_erythematosus_in_a_multiethnic_US_cohort_XXXVII:_association_of_lymphopenia_with_clinical_manifestations_serologic_abnormalities_disease_activity_and_damage_accrual_ L2 - https://doi.org/10.1002/art.22224 DB - PRIME DP - Unbound Medicine ER -