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Prevalence, clinical features, risk factors, and outcomes of SLE patients with aortic aneurysm: a cross-sectional retrospective study in a Chinese single center

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Abstract

Objectives

The prevalence, clinical features, and outcomes of patients with systemic lupus erythematosus (SLE) complicated with or without aortic aneurysm (AA) were compared in a Chinese single-center cohort.

Methods

Included in this study were SLE patients who received treatment at Shanghai Changhai Hospital between 2000 and 2020. The prevalence, clinical features, and outcomes of these SLE patients with or without AA were compared by Student’s t-tests or Fisher’s exact tests as appropriate. Risk factors associated with AA occurrence in SLE were evaluated by univariable and multivariable logistic regression analyses. The survival analysis between SLE patients with or without AA was conducted by the Kaplan–Meier method.

Results

Of the 1843 SLE patients included in this study, 16 (0.86%) were identified as having AA, and 160 of the remaining 1825 SLE patients without AA were selected as a simple random sample for comparison. The SLE patients with AA showed a higher proportion of smoking and hypertension as compared with those with no AA. Multivariable logistic regression analysis showed that a long SLE duration and anti-RNP positivity were two independent risk factors associated with AA occurrence in SLE patients. The log rank test showed that SLE patients with AA had a significantly higher risk of progression to death. Renal disorder was associated with an even poorer outcome in SLE patients with AA.

Conclusion

The incidence of AA in SLE patients may be underestimated. The association between AA and SLE, especially in patients with multiple risk factors, should not be ignored.

Key Points

• The risk of SLE patients developing AA may be higher than that previously estimated.

• The risk of SLE patients especially with multiple risk factors developing AA should not be ignored.

• The diagnosis of AA should not be forgot when SLE patients present with chest, back, or abdominal symptoms with unexplained causes.

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Availability of data and material

The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

References

  1. Urowitz MB, Ibañez D, Gladman DD (2007) Atherosclerotic vascular events in a single large lupus cohort: prevalence and risk factors. J Rheumatol 34:70–75

    PubMed  Google Scholar 

  2. Durcan L, O’Dwyer T, Petri M (2019) Management strategies and future directions for systemic lupus erythematosus in adults. Lancet 393:2332–2343

    Article  Google Scholar 

  3. Dörner T, Furie R (2019) Novel paradigms in systemic lupus erythematosus. Lancet 393:2344–2358

    Article  Google Scholar 

  4. Urowitz MB, Gladman DD, Farewell V, Su J, Romero-Diaz J, Bae SC, Fortin PR, Sanchez-Guerrero J, Clarke AE, Bernatsky S, Gordon C, Hanly JG, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Ginzler E, Alarcón GS, Chatham WW, Petri MA, Bruce IN, Khamashta MA, Aranow C, Dooley MA, Manzi S, Ramsey-Goldman R, Nived O, Jönsen A, Steinsson K, Zoma AA, Ruiz-Irastorza G, Lim SS, Kalunian KC, Ỉnanç M, van Vollenhoven R, Ramos-Casals M, Kamen DL, Jacobsen S, Peschken CA, Askanase A, Stoll T (2020) Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort. Arthritis Rheumatol 72:1734–1740

    Article  CAS  Google Scholar 

  5. Tselios K, Gladman DD, Su J, Urowitz M (2020) Impact of the new American College of Cardiology/American Heart Association definition of hypertension on atherosclerotic vascular events in systemic lupus erythematosus. Ann Rheum Dis 79:612–617

    Article  CAS  Google Scholar 

  6. Nienaber CA, Clough RE, Sakalihasan N, Suzuki T, Gibbs R, Mussa F, Jenkins MP, Thompson MM, Evangelista A, Yeh JS, Cheshire N, Rosendahl U, Pepper J (2016) Aortic dissection Nat Rev Dis Primers 2:16053

    Article  Google Scholar 

  7. Nordon IM, Hinchliffe RJ, Loftus IM, Thompson MM (2011) Pathophysiology and epidemiology of abdominal aortic aneurysms. Nat Rev Cardiol 8:92–102

    Article  Google Scholar 

  8. Li Y, Yang N, Duan W, Liu S, Yu S, Yi D (2012) Acute aortic dissection in China. Am J Cardiol 110:1056–1061

    Article  Google Scholar 

  9. Guy A, Tiosano S, Comaneshter D, Tekes-Manova D, Shovman O, Cohen AD, Amital H (2016) Aortic aneurysm association with SLE - a case-control study. Lupus 25:959–963

    Article  CAS  Google Scholar 

  10. Kermani TA, Warrington KJ, Crowson CS, Hunder GG, Ytterberg SR, Gabriel SE, Matteson EL (2016) Predictors of dissection in aortic aneurysms from giant cell arteritis. J Clin Rheumatol 22:184–187

    Article  Google Scholar 

  11. Gonzalez-Gay MA, Garcia-Porrua C, Pineiro A, Pego-Reigosa R, Llorca J, Hunder GG (2004) Aortic aneurysm and dissection in patients with biopsy-proven giant cell arteritis from northwestern Spain: a population-based study. Medicine (Baltimore) 83:335–341

    Article  Google Scholar 

  12. Silvestri V, Simonte G. 2017. Aortic Pathology in Systemic Lupus Erythematosus: A Case Report and Review of Literature. Ann Vasc Surg 43:312 e5–312 e12.

  13. Li J, Wang X, Zhang H, Wang W, Pei Y, Xie T, Lin W, Zuo X, Zhang W (2019) Aorta coarctation and systemic lupus erythematosus: a case report. Medicine (Baltimore) 98:e16397

    Article  Google Scholar 

  14. Yuan SM (2019) Aortic aneurysm and dissection in systemic lupus erythematosus. Z Rheumatol 78:287–294

    Article  Google Scholar 

  15. Petri M, Genovese M, Engle E, Hochberg M (1991) Definition, incidence, and clinical description of flare in systemic lupus erythematosus. A prospective cohort study Arthritis Rheum 34:937–944

    CAS  PubMed  Google Scholar 

  16. Griffiths B, Mosca M, Gordon C (2005) Assessment of patients with systemic lupus erythematosus and the use of lupus disease activity indices. Best Pract Res Clin Rheumatol 19:685–708

    Article  Google Scholar 

  17. Cook RJ, Gladman DD, Pericak D, Urowitz MB (2000) Prediction of short term mortality in systemic lupus erythematosus with time dependent measures of disease activity. J Rheumatol 27:1892–1895

    CAS  PubMed  Google Scholar 

  18. Gladman DD, Urowitz MB, Kagal A, Hallett D (2000) Accurately describing changes in disease activity in systemic lupus erythematosus. J Rheumatol 27:377–379

    CAS  PubMed  Google Scholar 

  19. Bennett SJ, Dill KE, Hanley M, Ahmed O, Desjardins B, Gage KL, Ginsburg M, Khoynezhad A, Oliva IB, Steigner ML, Strax R, Verma N, Rybicki FJ (2018) ACR Appropriateness Criteria(®) suspected thoracic aortic aneurysm. J Am Coll Radiol 15:S208-s214

    Article  Google Scholar 

  20. Barile-Fabris L, Hernández-Cabrera MF, Barragan-Garfias JA (2014) Vasculitis in systemic lupus erythematosus. Curr Rheumatol Rep 16:440

    Article  CAS  Google Scholar 

  21. Wang SH, Chang YS, Liu CJ, Lai CC, Chen TJ, Chen WS (2014) Incidence and risk analysis of aortic aneurysm and aortic dissection among patients with systemic lupus erythematosus: a nationwide population-based study in Taiwan. Lupus 23:665–671

    Article  Google Scholar 

  22. Roldan PC, Ratliff M, Snider R, Macias L, Rodriguez R, Sibbitt W, Roldan CA. 2014. Aortic atherosclerosis in systemic lupus erythematosus. Rheumatology (Sunnyvale) Suppl 5.

  23. Wang W, Duan W, Xue Y, Wang L, Liu J, Yu S, Yi D, Registry of Aortic Dissection in China Sino RADI. (2014) Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China. J Thorac Cardiovasc Surg 148:2995–3000

    Article  Google Scholar 

  24. Kurata A, Kawakami T, Sato J, Sakamoto A, Muramatsu T, Nakabayashi K (2011) Aortic aneurysms in systemic lupus erythematosus: a meta-analysis of 35 cases in the literature and two different pathogeneses. Cardiovasc Pathol 20:e1-7

    Article  Google Scholar 

  25. Ohara N, Miyata T, Kurata A, Oshiro H, Sato O, Shigematsu H (2000) Ten years’ experience of aortic aneurysm associated with systemic lupus erythematosus. Eur J Vasc Endovasc Surg 19:288–293

    Article  CAS  Google Scholar 

  26. Di Battista M, Tani C, Elefante E, Chimera D, Carli L, Ferro F, Stagnaro C, Mosca M (2020) Framingham, ACC/AHA or QRISK3: which is the best in systemic lupus erythematosus cardiovascular risk estimation? Clin Exp Rheumatol 38:602–608

    PubMed  Google Scholar 

  27. Dima A, Jurcut C, Baicus C (2018) The impact of anti-U1-RNP positivity: systemic lupus erythematosus versus mixed connective tissue disease. Rheumatol Int 38:1169–1178

    Article  CAS  Google Scholar 

  28. Quintana RA, Taylor WR (2019) Cellular mechanisms of aortic aneurysm formation. Circ Res 124:607–618

    Article  CAS  Google Scholar 

  29. Xia L, Huang L, Feng X, Xiao J, Wei X, Yu X (2020) Chronobiological patterns of acute aortic dissection in central China. Heart. https://doi.org/10.1136/heartjnl-2020-317009

    Article  PubMed  Google Scholar 

  30. Golledge J (2019) Abdominal aortic aneurysm: update on pathogenesis and medical treatments. Nat Rev Cardiol 16:225–242

    Article  Google Scholar 

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Funding

The work was funded by the Shanghai Pujiang Young Rheumatologists Training Program (SPROG), Grant/Award Number: SPROG201707 and Climbing Plan of Changhai hospital, Grant/Award Number: 2020YXK047.

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Author notes

  1. Ju Zhang, Jie Gao and Ruina Kong equally contributed to this work.

Authors and Affiliations

  1. Department of Rheumatology and Immunology, Changhai Hospital, Second Military Medical University, Shanghai, China

    Ju Zhang, Jie Gao, Ruina Kong, Qian Chen, Yunxia Xia, Xiaofang Li & Qing Cai

  2. National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China

    Ti Zhang

  3. Department of Health Statistics, Second Military Medical University, Shanghai, China

    Chenxin Cheng

Authors
  1. Ju Zhang
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  2. Jie Gao
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Correspondence to Ti Zhang or Qing Cai.

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Zhang, J., Gao, J., Kong, R. et al. Prevalence, clinical features, risk factors, and outcomes of SLE patients with aortic aneurysm: a cross-sectional retrospective study in a Chinese single center. Clin Rheumatol 41, 377–386 (2022). https://doi.org/10.1007/s10067-021-05927-w

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