The Presence of Anti-ribonucleoprotein at Diagnosis Is Associated with the Flare during the First Follow-up Year in Korean Patients with Systemic Lupus Erythematosus

Dae Sik Kim; Jung Yoon Pyo; Se-Jin Byun; Sung Soo Ahn; Jungsik Song; Yong-Beom Park; Soo-Kon Lee; Sang-Won Lee

doi:10.4078/jrd.2016.23.3.154

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Kim, Pyo, Byun, Ahn, Song, Park, Lee, and Lee: The Presence of Anti-ribonucleoprotein at Diagnosis Is Associated with the Flare during the First Follow-up Year in Korean Patients with Systemic Lupus Erythematosus

Original Article

J Rheum Dis 2016;23(3):154-160.

Published online: 31 October 2016

DOI: https://doi.org/10.4078/jrd.2016.23.3.154

The Presence of Anti-ribonucleoprotein at Diagnosis Is Associated with the Flare during the First Follow-up Year in Korean Patients with Systemic Lupus Erythematosus

Dae Sik Kim, Jung Yoon Pyo, Se-Jin Byun, Sung Soo Ahn, Jungsik Song, Yong-Beom Park, Soo-Kon Lee, Sang-Won Lee

Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Corresponding to: Sang-Won Lee, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. E-mail: laza00@yuhs.ac

Received 27 October 20156 December 2015 Accepted 21 December 2015

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The aim of this study was to examine whether the presence of anti-ribonucleoprotein (anti-RNP) antibodies at diagnosis is associated with systemic lupus erythematosus (SLE) flares in newly diagnosed patients during the first year of follow-up.

Methods

The medical records of 71 newly diagnosed SLE patients without other concomitant autoimmune disease, serious infection, or malignancy were reviewed retrospectively. SLE flares were defined according to the SLE Disease Activity Index 2000. Patients were divided into 2 groups according to the presence or absence of anti-RNP, and variables were compared between the groups.

Results

During the first year of follow-up, SLE patients with anti-RNP at diagnosis more frequently presented with mucosal ulcers (p=0.003), rash (p=0.001), and arthritis (p=0.007), compared to those without anti-RNP. The SLE flare incidence was remarkably higher in patients with anti-RNP than in those without anti-RNP (62.5% vs. 23.1%, p=0.001). SLE patients with anti-RNP at diagnosis had a significantly higher risk of ever experiencing a SLE flare during the first year of follow-up, compared to those without anti-RNP (odds ratio=8.250).

Conclusion

In conclusion, SLE patients with anti-RNP at diagnosis were more than 8-fold more likely to experience an SLE flare during the first year of follow-up.

Keywords: Anti-ribonucleoprotein, Flare, Systemic lupus erythematosus, Systemic lupus erythematosus disease activity index

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Table 1.

Baseline characteristics of patients with systemic lupus erythematosus and comparison of variables between patients wit and without anti-RNP

Characteristic	Total (n=71)	Patient with anti-RNP (n=35)	Patient without anti-RNP (n=36)	p-value
Demographic data
Age (yr)	43.2 (37.0∼55.0)	43.0 (37.0∼53.0)	46.0 (35.0∼57.0)	0.328
Female gender	66 (93.0)	33 (94.3)	33 (91.7)	1.000
SLEDAI-2K
Clinical features
Seizure	1 (1.4)	0 (0)	1 (2.8)	1.000
Psychosis	0 (0)	0 (0)	0 (0)	1.000
Organic brain syndrome	0 (0)	0 (0)	0 (0)	1.000
Visual disturbance	0 (0)	0 (0)	0 (0)	1.000
Lupus headache	0 (0)	0 (0)	0 (0)	1.000
Cerebrovascular accident	0 (0)	0 (0)	0 (0)	1.000
Vasculitis	0 (0)	0 (0)	0 (0)	1.000
Arthritis	24 (33.8)	16 (45.7)	8 (22.2)	0.036
Myositis	0 (0)	0 (0)	0 (0)	1.000
Pleurisy	6 (8.5)	3 (8.6)	3 (8.3)	1.000
Pericarditis	2 (2.8)	2 (5.7)	0 (0)	0.239
Rash	28 (39.4)	18 (51.4)	10 (27.8)	0.041
Alopecia	3 (4.2)	1 (2.9)	2 (5.6)	1.000
Mucosal ulcers	6 (8.5)	5 (14.3)	1 (2.8)	0.107
Fever	9 (12.7)	5 (14.3)	4 (11.1)	0.735
Laboratory results
Urinary casts	1 (1.4)	1 (2.9)	0 (0)	0.493
Hematuria	14 (19.7)	10 (28.6)	4 (11.1)	0.065
Proteinuria	16 (22.5)	10 (28.6)	6 (16.7)	0.230
Pyuria	13 (18.3)	8 (22.9)	5 (13.9)	0.329
Low complements	31 (43.7)	14 (40.0)	17 (47.2)	0.540
Increased DNA binding	21 (29.6)	9 (25.7)	12 (33.3)	0.482
Thrombocytopenia	12 (16.9)	3 (8.6)	9 (25.0)	0.065
Leukopenia	17 (23.9)	9 (25.7)	8 (22.2)	0.730
Score	6.0 (4.0∼9.0)	8.0 (5.0∼11.0)	5.0 (3.0∼6.0)	0.002
Autoantibodies
Antinuclear antibody	66 (93.0)	34 (97.1)	32 (88.9)	0.357
Anti-double strand DNA	21 (29.6)	9 (25.7)	12 (33.3)	0.482
Anti-Smith	11 (15.5)	11 (31.4)	0 (0)	<0.001
Anti-SSA/Ro	35 (49.3)	20 (57.1)	15 (41.7)	0.192
Anti-SSB/La	14 (19.7)	8 (22.9)	6 (16.7)	0.512
Lupus anticoagulant	13 (18.3)	9 (25.7)	4 (11.1)	0.112
Anti-cardiolipin	8 (11.3)	3 (8.6)	5 (13.9)	0.710
Anti-beta2-glycoprotein1	8 (11.3)	5 (14.3)	3 (8.3)	0.478
Other clinical features
Diffuse interstitial lung diseases	1 (1.4)	1 (2.9)	0 (0)	0.493
Pulmonary arterial hypertension	0 (0)	0 (0)	0 (0)	1.000

Values are presented as median (interquartile range) or number (%). SLEDAI-2K: systemic lupus erythematosus Disease Activit Index 2000, RNP: ribonucleoprotein, SSA/Ro: Sjögren's syndrome-related antigen A, SSB/La: Sjögren's syndrome-related antige B.

Table 2.

Comparison of variables of the follow-up SLEDAI-2K scores and SLE flare rate during the first follow-up year between SLE patients with and without anti-RNP

Characteristic	Patient with anti-RNP (n=35)	Patient without anti-RNP (n=36)	p-value
Demographic data
Follow-up period (mo)	11.0 (8.0∼11.0)	11.0 (11.0∼12.0)	0.077
SLEDAI-2K at flare
Clinical features
Seizure	0 (0)	0 (0)	NA
Psychosis	0 (0)	1 (2.8)	1.000
Organic brain syndrome	0 (0)	0 (0)	NA
Visual disturbance	0 (0)	0 (0)	NA
Lupus headache	2 (5.7)	0 (0)	0.239
Cerebrovascular accident	0 (0)	0 (0)	NA
Vasculitis	0 (0)	0 (0)	NA
Arthritis	12 (34.3)	3 (8.3)	0.007
Myositis	0 (0)	0 (0)	NA
Pleurisy	4 (11.4)	3 (8.3)	0.710
Pericarditis	1 (2.9)	1 (2.8)	1.000
Rash	14 (40.0)	2 (5.6)	0.001
Alopecia	4 (11.4)	2 (5.6)	0.429
Mucosal ulcers	15 (42.9)	4 (11.1)	0.003
Fever	6 (17.1)	2 (5.6)	0.151
Laboratory results
Urinary casts	5 (14.3)	0 (0)	0.025
Hematuria	4 (11.4)	5 (13.9)	0.036
Proteinuria	10 (28.6)	6 (16.7)	0.230
Pyuria	11 (31.4)	4 (11.1)	0.329
Low complement	13 (37.1)	11 (30.6)	0.557
Increased DNA binding	8 (22.9)	10 (27.8)	0.634
Thrombocytopenia	9 (25.7)	9 (25.0)	0.945
Leukopenia	11 (31.4)	11 (30.6)	0.937
Score	9.0 (7.0∼10.0)	4.0 (2.0∼6.8)	<0.001
Change in score	0.7	−0.9	0.142
Flare of SLE	15 (62.5)	3 (23.1)	0.001
Other clinical features
Diffuse interstitial lung diseases	4 (11.4)	0 (0)	0.054
Pulmonary arterial hypertension	3 (8.6)	1 (2.8)	0.357
Treatment
Hydroxychloroquine	31 (88.6)	30 (83.3)	0.735
Steroid	27 (77.1)	30 (83.3)	0.563
Azathioprine	7 (20.0)	7 (19.4)	1.000
Mycophenolate mofetil	5 (14.3)	3 (8.3)	0.478
Cyclophosphamide	3 (8.6)	1 (2.8)	0.357

Values are presented as median (interquartile range) or number (%). NA: not available, RNP: ribonucleoprotein, SLE: systemic lupus erythematosus, SLEDAI-2K: SLE Disease Activity Index 2000.

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