Assessment of premature atherosclerosis in systemic lupus erythematosus patients with and without nephritis

Abstract

Background Risk of subclinical atherosclerosis is increased in patients with systemic lupus erythematosus (SLE). We correlated carotid intima media thickness (CIMT) and endothelial dysfunction through flow-mediated dilation (FMD) in SLE patients with the SLE Disease Activity Index (SLEDAI). Methods This single-centre cross-sectional study recruited 100 consenting SLE outpatients (ACR 1997 criteria) out of which 50 had nephritis, with disease duration of ≥2 years for SLE and ≥6 months for lupus nephritis. We measured baseline laboratory levels, CIMT and FMD (after brachial BP cuff inflation up to 200 mmHg for five minutes), and calculated SLEDAI. Results Mean age was 29.88 ± 6.53 years; 95/100 were female. CIMT showed positive correlation ( p = 0.037; rho = 0.209), and FMD showed inverse correlation with patient’s age ( p = 0.011; rho = –0.252). CIMT and FMD were more deranged in patients aged ≥25 years ( p < 0.05). CIMT was not significantly different between SLE patients with and without nephritis ( p > 0.05), whereas SLEDAI and FMD were more deranged in nephritis patients ( p < 0.05). In patients without nephritis, FMD showed significant inverse correlation with disease duration ( p = 0.043; rho = –0.288) and urine albumin ( p = 0.045; rho = –0.285). In nephritis patients, the correlation between age of the patient was significantly positive with CIMT ( p = 0.001; rho = 0.441) and significantly inverse with FMD ( p = 0.028; rho = –0.312). Conclusion SLE patients with nephritis are at a higher risk to develop arterial stiffening, leading to early end-organ damage. Early aggressive treatment may prevent endothelial dysfunction. FMD using vascular ultrasonography on the brachial artery represents a non-invasive, repeatable and useful method for the assessment of endothelial dysfunction.