AB0613 Clinical and serological characteristics of lupus enteritis and its prognostic factors in patients with systemic lupus erythematosus
Authors: N. Kajio, Y. Kaneko, R. Anan, J. Kikuchi, T. Takeuchi
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Lupus enteritis, known as mesenteric vasculitis including multiple ulcers or ischaemic colitis, and protein-losing enteropathy, is a potentially life-threatening complication of systemic lupus erythematosus (SLE). Although glucocorticoid therapy is usually effective, some patients experience recurrences or severe complications in that surgical treatment or intensive immunosuppressive therapy is required. Little evidence, however, is available with characteristics and prognostic factors of lupus enteritis. <h3>Objectives</h3> The aim of this study is to clarify clinical characteristics and associated factors for the prognosis with lupus enteritis. <h3>Methods</h3> Consecutive SLE patients in our hospital between 2009 and 2017 were retrospectively reviewed. Patients who developed lupus enteritis which were associated with mesenteric vasculitis or protein losing enteropathy were enrolled. The diagnosis was made by physical examination, contrast enhanced computed tomography and <sup>99m</sup>Tc Albumin scintigraphy. Poor prognosis was defined as any surgical treatment or recurrence. <h3>Results</h3> Among 591 SLE patients who fulfilled the 1997 American College of Rheumatology classification criteria, 23 (3.9%) were identified as developing lupus enteritis, and enrolled. Eighteen (78%) were mesenteric vasculitis and 5 (22%) were protein-losing enteropathy. Eighteen (78%) were female, the mean age at SLE onset was 31.5 years, and the mean duration between the onset of SLE and lupus enteritis was 10.6 years. The mean SLE disease activity index at the onset of lupus enteritis was 9.6. All patients were treated with glucocorticoid (mean initial predonisolon dose was 40.4 mg/day), and 4 patients (17%) were in combination with cyclophosphamide. Among the mesenteric vasculitis patients, 4 patients required surgical treatment and 4 patients experienced recurrence. Comparison between patients with poor prognosis and those without revealed that patients in the poor prognosis group had a higher ratio of multiple ulcer type than ischaemic colitis type (43% vs. 0%, p=0.043), colon lesions (71% vs. 9.1%, p=0.012), higher serum IgA (391 mg/dl vs. 247 mg/dl, p=0.008), and lower serum total cholesterol (152 mg/dl vs. 191 mg/dl, p=0.012). No difference was found in abdominal symptoms, SLE disease activity index score at lupus enteritis onset, anti-dsDNA antibodies and complement levels, initial predonisolone dose, and the concomitant cyclophosphamide use between the two groups. No recurrence was seen in patients with protein-losing enteropathy. <h3>Conclusions</h3> The higher level of serum IgA and lower level of serum total cholesterol are associated with surgical treatment or recurrence and are potential predictive biomarkers for poor prognosis. <h3>Reference</h3> [1] Koo BS, et al. Lupus enteritis: clinical characteristics and predictive factors for recurrence. Lupus. 2015; 24: 628–31. <h3>Disclosure of Interest</h3> None declared