Systemic lupus erythematosus in a multiethnic US cohort, XXXVII: Association of lymphopenia with clinical manifestations, serologic abnormalities, disease activity, and damage accrual
Article first published online: 29 SEP 2006
Copyright © 2006 by the American College of Rheumatology
Arthritis Care & Research
Volume 55, Issue 5, pages 799–806, 15 October 2006
How to Cite
Vilá, L. M., Alarcón, G. S., McGwin, G., Bastian, H. M., Fessler, B. J. and 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 & Rheumatism, 55: 799–806. doi: 10.1002/art.22224
- Issue published online: 29 SEP 2006
- Article first published online: 29 SEP 2006
- Manuscript Accepted: 13 JAN 2006
- Manuscript Received: 10 AUG 2005
- NIH (Institute of Arthritis and Musculoskeletal and Skin Diseases). Grant Number: R01-AR-42503
- General Clinical Research Centers to the University of Texas Health Science Center at Houston. Grant Number: M01-RR-02558
- University of Alabama at Birmingham. Grant Number: M01-RR-00032
- RCMI Clinical Research Infrastructure Initiative (award) from the National Center for Research Resources to the University of Puerto Rico Medical Sciences Campus. Grant Number: 1P20-RR-11126
- Systemic lupus erythematosus;
- Clinical manifestations;
- Disease activity;
- Disease damage
To determine if lymphopenia is associated with clinical/immunologic manifestations, disease activity, and disease damage in systemic lupus erythematosus (SLE).
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 (≥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.
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.
Lymphopenia is associated with several clinical/immunologic manifestations in SLE. Moderate and marked lymphopenia are associated with higher disease activity and damage accrual.