Effect of treatment on the hemodynamics system in systemic lupus erythematosus patients
Authors: Blachut D , Przywara-Chowaniec B , Morawiec B , Tomasik A , Nowalany-Kozielska E 
Published: October 2021

Abstract

Systemic lupus erythematosus (SLE) is a rare autoimmune disease which is associated with inflammation and accelerated atherogenesis, as it's related to the endothelium activation process. Measurements of arterial stiffness and IMTc are a repeatable and noninvasive methods to estimate a CVD risk. We could assume that the outcome of the correct therapy, if applied in the early stage of the SLE, could prevent the consequences of vessel inflammation and retract endothelium lesions.

Purpose
The main objective of this study was to assess the common carotid artery thickness of the intima-media complex (IMTc), ankle-brachial index (ABI), and pulse wave velocity (PWV) in patients with SLE and compare the studied parameters between individuals treated with corticosteroids with patients with other medications or without treatment.

Methods
Consecutive patients with SLE were included prospectively to the study between X 2016 and XII 20120 in the 2nd Department of Cardiology of our Medical University. Patients with other connective tissue diseases and chronic inflammation were excluded from this study. Activity of SLE was measured by The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K), with cut-off point at 6 points for active disease. Basic clinical data and cardiovascular (CVS) risk factors were gathered, each patient underwent the measurement of IMTc, ABI and cfPWV. All data were compared between groups treated or not treated with glicocorticosteroids (GCS).

Results
The study group consisted of 43 patients with SLE. Mean age was 57.4 years, 39 of the studied subjects were women, and 21 patients (48.84%) were treated with GCS. Mean duration of SLE time was 12.3 years, mean time of treatment with GCS was 5.3 years. On average the mean SLEDAI-2K value was 6.35±5.83 points and 18 patients (41.86%) had above 6 points. New-onset CV disease occurred in 6 patients (33.33%) treated with CGS and in 3 pts (25%) not treated with GCS (p=0.2546) Patients treated with GCS had lower values of ABI when compared to patients not treated with GCS (right ankle: 1.76 vs 1.86, p=0.047, left ankle: 1.63 vs 1.81, p=0.041) although the values were in the scope of standards. Similar situation occurred with the carotid femoral artery (cfPWV) (8.00 vs 8.83 m/s, p=0.032). However, the carotid radial artery PWV values were not significantly altered between groups (8.89 vs 9.61 m/s, p=0.12). The IMTc values were significantly higher in the GCS group (1.51 vs 1.13 mm, p&lt;0.001). Statistically significant correlation with CVS risk factors was found for cfPWV (r=0.812, p=0.021).

Conclusions
Patients treated with GCS had lower cfPWV and ABI when compared to the group not treated with GCS. Further studies to establish the prognostic value of PWV among SLE patients are justified, as it could be superior to the IMTc measures at the early stage of vascular impairment, because PWV explores a greater range of vessels.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Silesia in Katowice, Poland