Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-24T02:58:52.810Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk factors of pulmonary arterial hypertension in patients with systemic lupus erythematosus

Part of: Surgery

Published online by Cambridge University Press:  08 March 2021

Yunxia Lei ,
Xiao Zhang Open the ORCID record for Xiao Zhang [Opens in a new window] ,
Yuan Feng ,
Jieying Wang  and
Riqiang Luo
Yunxia Lei
Affiliation:
Department of Rheumatology and Clinical Immunology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province510080, China
Xiao Zhang*
Affiliation:
Department of Rheumatology and Clinical Immunology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province510080, China
Yuan Feng
Affiliation:
Department of Rheumatology and Clinical Immunology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province510080, China
Jieying Wang
Affiliation:
Department of Rheumatology and Clinical Immunology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province510080, China
Riqiang Luo
Affiliation:
Department of Rheumatology and Clinical Immunology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province510080, China
*
Author for correspondence: Xiao Zhang, Department of Rheumatology and Clinical Immunology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, 22nd Floor, Main Building, No. 106 Zhongshan 2nd Road, Guangzhou, Guangdong Province510080, China. Tel: +86 020 83883539; Fax: 86-020-83883539. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Pulmonary arterial hypertension symptoms in systemic lupus erythematosus patients are non-specific and early diagnosis and intervention are challenging. It remains essential to explore risk factors for pulmonary arterial hypertension in systemic lupus erythematosus patients to identify high risk patients and allow intensive monitoring.

Methods:

From January 2010 to December 2018, 84 patients with systemic lupus erythematosus and pulmonary arterial hypertension and 160 patients with systemic lupus erythematosus but without pulmonary arterial hypertension were enrolled. Clinical manifestations and laboratory test results were compared between the two groups to identify predictors of pulmonary arterial hypertension. Candidate pulmonary arterial hypertension risk factors were further compared among systemic lupus erythematosus-pulmonary arterial hypertension patients with different characteristics.

Results:

Among collected patient characteristics, Raynaud’s phenomenon (OR 2.32, 95% CI: 1.17–4.61), digital vasculitis (OR 4.12, 95% CI: 1.48–11.49), pericardial effusion, pulmonary interstitial lesions, positive anti-u1 ribonucleoprotein antibodies, and positive anticardiolipin antibodies immunoglobulin G were associated with significantly higher risk of pulmonary arterial hypertension in systemic lupus erythematosus patients. Among these candidate risk factors, positive anti-u1 ribonucleoprotein antibody was independently associated with severe pulmonary arterial hypertension and more active disease. Digital vasculitis was independently associated with systemic lupus erythematosus alleviation, while pericardial effusion was associated with systemic lupus erythematosus deterioration. Pericardial effusion was associated with longer pulmonary arterial hypertension duration.

Conclusion:

The significant association between studied clinical and laboratory indicators and risk of pulmonary arterial hypertension, pulmonary arterial hypertension and systemic lupus erythematosus characteristics suggested that these factors can be used to identify patients at higher risk of pulmonary arterial hypertension and adverse outcomes. Close monitoring may be indicated in patients with these risk factors, especially with more than one risk factor.

Keywords

Pulmonary arterial hypertensionsystemic lupus erythematosusrisk stratification
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 10 , October 2021 , pp. 1619 - 1624
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Pons-Estel, GJ, Ugarte-Gil, MF, Alarcón, GS. Epidemiology of systemic lupus erythematosus. Expert Rev Clin Immunol 2017; 13: 799–814.CrossRefGoogle ScholarPubMed
Huang, C, Li, MT, Liu, YT, et al. Baseline characteristics and risk factors of pulmonary arterial hypertension in systemic lupus erythematosus patients. Medicine 2016; 95: e2761.CrossRefGoogle ScholarPubMed
Chow, S, Chandran, V, Fazelzad, R, Johnson, S. Prognostic factors for survival in systemic lupus erythematosus associated pulmonary hypertension. Lupus 2012; 21: 353–364.CrossRefGoogle ScholarPubMed
Gaine, SP, Rubin, LJ. Primary pulmonary hypertension. Lancet. 1998; 352: 719–725.CrossRefGoogle ScholarPubMed
Rubin, LJ. Primary pulmonary hypertension. N Engl J Med 1997; 336: 111–117.CrossRefGoogle ScholarPubMed
Humbert, M, Sitbon, O, Simonneau, G. Treatment of pulmonary arterial hypertension. N Engl J Med 2004; 351: 1425–1436.CrossRefGoogle ScholarPubMed
Dhala, A. Pulmonary arterial hypertension in systemic lupus erythematosus: current status and future direction. Clin Dev Immunol 2012; 2012: 854941.CrossRefGoogle ScholarPubMed
Li, M, Wang, Q, Zhao, J, et al. Chinese SLE Treatment and Research group (CSTAR) registry: II. Prevalence and risk factors of pulmonary arterial hypertension in Chinese patients with systemic lupus erythematosus. Lupus 2014; 23: 1085–1091.CrossRefGoogle Scholar
O’callaghan, DS, Savale, L, Montani, D, et al. Treatment of pulmonary arterial hypertension with targeted therapies. Nat Rev Cardiol 2011; 8: 526–538.CrossRefGoogle ScholarPubMed
Fisher, MR, Mathai, SC, Champion, HC, et al. Clinical differences between idiopathic and scleroderma-related pulmonary hypertension. Arthritis Rheum 2006; 54: 3043–3050.CrossRefGoogle ScholarPubMed
Jais, X, Launay, D, Yaici, A, et al. Immunosuppressive therapy in lupus-and mixed connective tissue disease–associated pulmonary arterial hypertension: a retrospective analysis of twenty-three cases. Arthritis Rheum 2008; 58: 521–531.CrossRefGoogle Scholar
McLaughlin, VV, Gaine, SP, Howard, LS, et al. Treatment goals of pulmonary hypertension. J Am Coll Cardiol 2013; 62: D73–D81.CrossRefGoogle ScholarPubMed
Sanchez, O, Sitbon, O, Jaïs, X, Simonneau, G, Humbert, M. Immunosuppressive therapy in connective tissue diseases-associated pulmonary arterial hypertension. Chest 2006; 130: 182–189.CrossRefGoogle ScholarPubMed
Tselios, K, Gladman, DD, Urowitz, MB. Systemic lupus erythematosus and pulmonary arterial hypertension: links, risks, and management strategies. Open Access Rheumatol 2017; 9: 1.Google ScholarPubMed
Chen, XF, Que, WZ, Zheng, XX, Zou, S, Pin, L, Xuwei, Y. Clinical features and risk factors of pulmonary hypertension in Chinese patients with systemic lupus erythematosus. Arch Rheumatol 2019; 34: 88.CrossRefGoogle Scholar
Hochberg, MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Autoimmun Rev 1997; 40: 1725–1725.Google ScholarPubMed
Simonneau, G, Galie, N, Rubin, LJ, et al. Clinical classification of pulmonary hypertension. J Am Coll Cardiol 2004; 43: S5–S12.CrossRefGoogle ScholarPubMed
Bombardier, C, Gladman, DD, Urowitz, MB, Caron, D, Chang, CH. Derivation of the SLEDAI. A disease activity index for lupus patients. Arthritis Rheum 1992; 35: 630–640.CrossRefGoogle ScholarPubMed
Galiè, N, Humbert, M, Vachiery, J-L, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) endorsed by: association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2015; 46: 903–975.Google Scholar
Kasparian, A, Floros, A, Gialafos, E, et al. Raynaud’s phenomenon is correlated with elevated systolic pulmonary arterial pressure in patients with systemic lupus erythematosus. Lupus 2007; 16: 505–508.CrossRefGoogle ScholarPubMed
Luo, YF, Robbins, IM, Karatas, M, Brixey, AG, Rice, TW, Light, RW. Frequency of pleural effusions in patients with pulmonary arterial hypertension associated with connective tissue diseases. Chest 2011; 140: 42–47.CrossRefGoogle ScholarPubMed
Prete, M, Fatone, M, Vacca, A, Racanelli, V, Perosa, F. Severe pulmonary hypertension as the initial manifestation of systemic lupus erythematosus: a case report and review of the literature. Clin Exp Rheumatol 2014; 32: 267–274.Google ScholarPubMed
Prabu, A, Patel, K, Yee, CS, et al. Prevalence and risk factors for pulmonary arterial hypertension in patients with lupus. Rheumatology 2009; 48: 1506–1511.CrossRefGoogle ScholarPubMed
Xia, Y, Tu, S, Hu, Y, et al. Pulmonary hypertension in systemic lupus erythematosus: a systematic review and analysis of 642 cases in Chinese population. Rheumatol Int 2013; 33: 1211–1217.10.1007/s00296-012-2525-yCrossRefGoogle ScholarPubMed
Sharp, GC, Irvin, WS, Tan, EM, Gould, RG, Holman, HR. Mixed connective tissue disease-an apparently distinct rheumatic disease syndrome associated with a specific antibody to an extractable nuclear antigen (ENA). Am J Med 1972; 52: 148–159.CrossRefGoogle Scholar
Okawa-Takatsuji, M, Aotsuka, S, Fujinami, M, Uwatoko, S, Kinoshita, M, Sumiya, M. Up-regulation of intercellular adhesion molecule-1 (ICAM-1), endothelial leucocyte adhesion molecule-1 (ELAM-1) and class II MHC molecules on pulmonary artery endothelial cells by antibodies against U1-ribonucleoprotein. Clin Exp Immunol 1999; 116: 174–180.CrossRefGoogle ScholarPubMed
Farzaneh-Far, A, Roman, MJ, Lockshin, MD, et al. Relationship of antiphospholipid antibodies to cardiovascular manifestations of systemic lupus erythematosus. Arthritis Rheum 2006; 54: 3918–3925.CrossRefGoogle ScholarPubMed
Pope, J. An update in pulmonary hypertension in systemic lupus erythematosus–do we need to know about it? Lupus 2008; 17: 274–277.CrossRefGoogle Scholar