Lupus mesenteric vasculitis: Clinical features and associated factors for the recurrence and prognosis of disease

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Abstract

Objective

To evaluate the clinical characteristics of lupus mesenteric vasculitis (LMV) and identify the potential factors and appropriate treatments that are associated with disease relapse and prognosis in LMV.

Methods

A retrospective cohort study was performed among patients admitted to the First Affiliated Hospital of Sun Yet-sen University between 2002 and 2011. Demographic information, clinical symptoms, laboratory findings, imaging characteristics like abdominal CT scan, ultrasonography, medications including corticosteroid, cyclophosphamide, and other immunosuppressive agents, and outcomes were documented. The endpoints of the study were defined as occurrence of severe complications that needed surgical intervention, disease recurrence, or death.

Results

Out of 3823 systemic lupus erythematosus (SLE) patients, 97 were diagnosed with mesenteric vasculitis with the overall prevalence of 2.5%. Among these 97 LMV patients, 13 died because of serious complications (13/97, 13.4%) and 2 presented intestinal perforation during the induction therapy stage. The logistic regression multivariate analysis indicated that leukopenia [peripheral WBC, odds ratio (OR) = 0.640, 95% confidence interval (CI): 0.456–0.896, P = 0.009], hypoalbuminemia (serum albumin, OR = 0.891, 95% CI: 0.798–0.994, P = 0.039) and elevated serum amylase (OR = 7.719, 95% CI: 1.795–33.185, P = 0.006) were positively associated with the occurrence of serious complications, while intravenous cyclophosphamide (CYC) therapy inhibited the occurrence of serious complications (OR = 0.220, 95% CI: 0.053–0.903, P = 0.036). A total of 79 patients who achieved remission were followed-up for 2–96 months and 18 cases experienced disease relapse (18/79, 22.8%). The statistical analysis adjusted by Cox proportional hazards models indicated that high-dose CYC therapy (≥1.0 g/m2/month) was a protective factor for disease relapse and led to better outcomes [hazard ratio (HR) = 0.209, 95% CI: 0.049–0.887, P = 0.034], while the severe thickness of the bowel wall (>8 mm) was a risk factor (HR = 7.308, 95% CI: 1.740–30.696, P = 0.007). LMV and lupus cystitis occurred concurrently in 22 (22/97, 22.7%) patients, and the symptoms of urinary tract resolved after treatment with corticosteroid and immunosupressants.

Conclusion

LMV is one of the serious complications of SLE with high mortality. The current study demonstrated that leukopenia, hypoalbuminemia, and elevated serum amylase were associated with severe adverse events, while CYC therapy led to better outcomes during remission-induction stage. Severe thickness of the bowel was a risk factor while high-dose CYC therapy was a protective factor for disease relapse in intensification therapy stage. It is necessary to evaluate the urinary tract involvement once LMV is diagnosed due to the frequent coexistence of these 2 diseases.

Section snippets

Patients

A retrospective review of the medical records between January 2002 and December 2011 was performed at the First Affiliated Hospital of Sun Yat-sen University. All together, 3823 patients were classified as having SLE who fulfilled at least 4 of the 1997 American College of Rheumatology (ACR) revised classification criteria for SLE [7]. Among these SLE patients, 97 had a dual simultaneous diagnosis of LMV according to the following inclusion criteria [8], [9]: (1) clinical evidence of

Clinical and demographic characteristics

Table 1 shows the clinical and demographic characteristics of the patients. Among the 97 patients with LMV, 47 (48.5%) presented with acute abdominal pain as the initial symptom of SLE. The median time between the onset of SLE and LMV was 0.5 months (ranging from 0 to 240 months). Abdominal pain was the most common symptom (88/97, 90.7%) and abdominal distension was the most common physical sign (68/97, 70.1%). CT scans indicated enteritis, and cystitis occurred concomitantly with lupus in 22

Discussion

The manifestation of LMV varies from mild, nonspecific symptoms to severe abdominal pain mimicking acute surgical abdomen. Its prevalence ranges from 0.2% to 9.7% in SLE patients and from 29% to 65% in patients presenting with acute abdominal pain [4]. In the current study, the prevalence of LMV was 2.5% of hospitalized lupus patients and 49.5% among those initially presented with acute abdominal pain, which was in accordance with other reports [2], [3], [6], [24]. The median SLE duration was

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    This work was supported by the Guangdong Provincial Science and Technology Foundations, China (2009B030801098, 2011B050300009, 2008B080703015, 2005B30701001, and 2007B031500007); Guangdong Natural Science Foundation (S2012010009075); and National Natural Science Foundations of China (81102270 and 81102270).

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