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Predictors of Lipid Abnormalities in Children with New-Onset Systemic Lupus Erythematosus

PASCAL N. TYRRELL, JOSEPH BEYENE, SUSANNE M. BENSELER, TALIN SARKISSIAN, and EARL D. SILVERMAN

ABSTRACT.

Objective. Lipid abnormalities in patients with systemic lupus erythematosus (SLE) are common and likely are one of the causes of premature atherosclerosis in these patients. Our aims were to determine the frequency and pattern of dyslipoproteinemia at presentation of pediatric SLE; and to determine the association between dyslipoproteinemia and markers of disease activity and inflammatory markers at presentation of pediatric SLE.

Methods. Serum lipid measurements were obtained at diagnosis before corticosteroid treatment for an inception cohort of 54 patients. Total cholesterol, triglyceride, LDL-C, and HDL-C levels were regressed on measures of inflammation, disease activity, and disease symptoms.

Results. At least one lipid abnormality was present in the majority of patients (63%), an elevated triglyceride level being the most common lipid abnormality (62%). Triglycerides were best predicted by fibrinogen, nephritis, and pleuritis (model R² = 0.6). Albumin, C4, and white blood cell count were found to predict HDL-C (model R² = 0.6). Erythrocyte sedimentation rate, central nervous system involvement, nasal ulcers, and nephritis were found as predictors for LDL-C:HDL-C (model R² = 0.5). No significant predictors were found for total cholesterol or LDL-C. The European Consensus Lupus Activity Measure disease activity score best predicted abnormal triglyceride and HDL-C levels (OR 1.7, 95% CI 1.2–2.3).

Conclusion. Children with newly diagnosed SLE exhibited the distinct pattern of dyslipoprotein of increased triglycerides and depressed HDL-C that was twice as common in the presence of kidney disease. This lipid profile puts them at risk for premature atherosclerosis. Good disease control and individualized use of lipid-lowering agents based on the observed pattern of lipid abnormalities may lower the risk of premature atherosclerosis in these patients. (First Release Sept 1 2007; J Rheumatol 2007;34:2112-8)

Key Indexing Terms:

LUPUS
PEDIATRICS
AUTOIMMUNE DISEASE
LIPIDS
ATHEROSCLEROSIS

From the Division of Rheumatology and Division of Child Health Evaluative Sciences, The Hospital for Sick Children, and Department of Pediatrics, Department of Immunology, Department of Health Policy, Management and Evaluation, and Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.

Supported by a grant from The Heart and Stroke Foundation to Drs. Silverman and Beyene. P.N. Tyrrell and T. Sarkissian were supported by Graduate Student Scholarships from The Hospital for Sick Children Research Institute (Restracomp) and the Ontario Ministry of Education.

P.N. Tyrrell, MSc, Doctoral Candidate, University of Toronto; J. Beyene, PhD, Scientist, The Hospital for Sick Children Research Institute, Assistant Professor, Department of Health Policy, Management and Evaluation, and Department of Public Health Sciences, University of Toronto; S.M. Benseler, MD, Division of Rheumatology, The Hospital for Sick Children, Assistant Professor, Department of Pediatrics, University of Toronto; T. Sarkissian, MSc, Division of Rheumatology, The Hospital for Sick Children; E.D. Silverman, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, Scientist, The Hospital for Sick Children Research Institute, Professor, Department of Pediatrics and Immunology, University of Toronto.

Address reprint requests to Dr. E. Silverman, Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada. E-mail: earl.silverman@sickkids.ca

Accepted for publication June 12, 2007.