Systemic Lupus Erythematosus
Features associated with, and the impact of, hemolytic anemia in patients with systemic lupus erythematosus: LX, results from a multiethnic cohort
Article first published online: 29 AUG 2008
Copyright © 2008 by the American College of Rheumatology
Arthritis Care & Research
Volume 59, Issue 9, pages 1332–1340, 15 September 2008
How to Cite
Durán, S., Apte, M., Alarcón, G. S., Marion, M. C., Edberg, J. C., Kimberly, R. P., Zhang, J., Langefeld, C. D., ViLá, L. M. and Reveille, J. D. (2008), Features associated with, and the impact of, hemolytic anemia in patients with systemic lupus erythematosus: LX, results from a multiethnic cohort. Arthritis & Rheumatism, 59: 1332–1340. doi: 10.1002/art.24020
- Issue published online: 29 AUG 2008
- Article first published online: 29 AUG 2008
- Manuscript Accepted: 22 MAY 2008
- Manuscript Received: 17 DEC 2007
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Numbers: P01-AR-49084, R01-AR-42503
- General Clinical Research Centers. Grant Number: M01-RR-02558
- University of Texas Health Science Center at Houston. Grant Number: M01-RR-00032 to the University of Alabama at Birmingham [UAB]
- National Center for Research Resources (NIH) RCMI Clinical Research Infrastructure Initiative. Grant Number: 1P20-RR-11126 to the University of Puerto Rico Medical Sciences Campus
- Supporting Training Efforts in Lupus for Latin American Rheumatologists program, funded by Rheuminations, Inc. (UAB)
To examine the clinical and genetic correlates of hemolytic anemia and its impact on damage accrual and mortality in systemic lupus erythematosus (SLE) patients.
SLE patients (American College of Rheumatology [ACR] criteria) of Hispanic (Texan or Puerto Rican), African American, and Caucasian ethnicity from the LUMINA (LUpus in MInorities, NAture versus nurture) cohort were studied. Hemolytic anemia was defined as anemia with reticulocytosis (ACR criterion). The association between degrees of hemolytic anemia and socioeconomic/demographic, clinical, pharmacologic, immunologic, psychological, and behavioral variables was examined by univariable and multivariable (proportional odds model) analyses. Genetic variables (FCGR and Fas/Fas ligand polymorphisms) were examined by 2 degrees of freedom test of association and Cochran-Armitage trend tests. The impact of hemolytic anemia on damage accrual and mortality was examined by multivariable linear and Cox regression analyses, respectively.
Of 628 patients studied, 90% were women, 19% were Texan Hispanic, 16% were Puerto Rican Hispanic, 37% were African American, and 28% were Caucasian. Sixty-five (10%) patients developed hemolytic anemia at some time during the disease course, 83% at or before diagnosis. Variables independently associated with degrees of hemolytic anemia were African American ethnicity, thrombocytopenia, and the use of azathioprine. Hemolytic anemia was associated with damage accrual after adjusting for variables known to affect this outcome; however, hemolytic anemia was not associated with mortality.
The association of hemolytic anemia with thrombocytopenia suggests a common mechanism in their pathophysiology. Hemolytic anemia is an early disease manifestation and is associated with African American ethnicity and the use of azathioprine; it appears to exert an impact on damage but not on mortality.