AB0945 CO-MORBID AFFECTIONS FORMATION IN CHILDREN WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Ljudmila Bohmat, Natalia Shevchenko, Irina Bessonova
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> In children with systemic lupus erythematosus (SLE) due to the cascade of immune-inflammatory reactions there is a development of systemic vascular endothelium lesion, which causes not only clinical manifestations of the main process, but also leads to the damage of vital organs and systems, the development of metabolic disorders. Extensive damage aggravates more the course of the disease, worsens its prognosis, complicates the response to therapy and reduces the quality of life of patients. <h3>Objectives</h3> The aim of study was to determine the frequency and variants of comorbid conditions in children depending on the duration and activity of the disease and feathers of the therapeutic complex. <h3>Methods</h3> A survey was conducted on 41 patients with SLE: 37 girls (90.2%), 4 boys (9.8%); the duration of the disease is up to 3 years in 20 patients (48.8%)and more than 3 years in 21 (51,2%). Presence of comorbid conditions determinates as the cardiovascular system, kidney, liver and lungs functions changes. General clinical trials included autoantibodies, disease activity and drugs assessment. Total cholesterol, triglycerides, high density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, ApoA-I and lipoprotein-α were evaluated. The state of the blood coagulation system was also studied: fibrinogen of the blood, prothrombin index, thrombin time, active partial thrombin time, D-dimer, international normalized ratio. Bone mineral density was determined. <h3>Results</h3> In 74.3% of children with SLE, the presence of comorbid conditions characterized by pathology of the cardiovascular system, kidneys, liver, the organ of vision, pulmonary system is established. Besides, atherogenic dislipoproteinemia has been detected in 60,0%, disorders in the hemostasis system were in 25,0% of patients and 43,0% persons have osteopenia. Children with SLE and the presence of comorbid conditions, especially with the involvement of the liver and kidneys and the long-term preservation of the disease activity (SRP, ANA, anti-DNA), are more likely to develop atherogenic dislipoproteinemia and hypercoagulation (increase in the prothrombin index, fibrinogen and D- dimer). The values of the comorbidity index in patients with SLE increased while maintaining the activity of the process and using high doses of glucocorticosteroids (GCS) including pulse therapy. Comorbidity index was 2.9 ± 0.5 points in the patients who received the GCS pulse therapy; 2.5 ± 0.3 in the cases of treatment by combination GCS + azathioprine; 2,0 ± 0,6 in the children without GCS; p&lt;0,05). ANA-positivity was also accompanied by higher values of the comorbidity index (2.8 ± 0.3 vs. 1.4±0.5, p&lt;0.05). <h3>Conclusion</h3> Children with SLE in the long-term course of the disease and while maintaining the activity of the pathologic process (ANA, DNA antibodies high level) have a formation of lesions of systems and organs, the lipids metabolism disorders, prolonged hypercoagulation and the development of osteopenia. Aggressive therapy for reducing the activity of the autoimmune process helps to prevent the formation of comorbid states and persistent metabolic disorders. <h3>Disclosure of Interests</h3> None declared