title: Systemic lupus erythematosus in a multiethnic US cohort LUMINA LI: anaemia as a predictor of disease activity and damage accrual.
abstract: OBJECTIVE
  To examine if anaemia (and its severity) is associated with disease activity and damage accrual in systemic lupus erythematosus (SLE).
  
  
  METHODS
  Four thousand four-hundred study visits in 613 SLE patients enrolled in LUMINA were studied. Anaemia was expressed in four categories of haematocrit (Hct) as defined by the Systemic Lupus Activity Measure-Revised (SLAM-R): no anaemia (Hct >35%), mild (Hct = 30-35%), moderate (Hct = 25-29%) and severe (Hct <25%). Anti-dsDNA antibodies were measured at baseline. Disease activity was assessed with the SLAM-R and damage with the Systemic Lupus International Collaborating Clinics Damage Index (SDI). The relationship between anaemia and anti-dsDNA antibodies with the SLAM and SDI scores was examined by univariate (one-way ANOVA) and multivariate (generalized linear models and generalized estimating equation regression) analyses.
  
  
  RESULTS
  All categories of anaemia and anti-ds DNA were significantly associated with the SLAM-R at baseline and over time. However, only moderate and severe anaemia were associated with the SDI at baseline and over time, while the presence of anti-ds DNA was only associated with the SDI over time but not at baseline. Several clinical domains of the SLAM-R and SDI were associated with anaemia at baseline and over time.
  
  
  CONCLUSIONS
  Mild, moderate and marked anaemia are strongly associated with disease activity in SLE. Moderate and marked anaemia are associated with damage accrual. These associations are observed both early and during the course of SLE. Different levels of anaemia could be used to monitor disease activity and predict organ/system damage in SLE.
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067. lvila@rcm.upr.edu.
authors.forename: A M
authors.initials: AM
authors.lastname: Bertoli
authors.forename: L M
authors.initials: LM
authors.lastname: Vilá
authors.forename: M
authors.initials: M
authors.lastname: Apte
authors.forename: B J
authors.initials: BJ
authors.lastname: Fessler
authors.forename: H M
authors.initials: HM
authors.lastname: Bastian
authors.forename: J D
authors.initials: JD
authors.lastname: Reveille
authors.forename: G S
authors.initials: GS
authors.lastname: Alarcón
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology*; D000974:Antibodies, Antinuclear / Q000097:blood; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004247:DNA / Q000276:immunology; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
chemical_list: D000974:Antibodies, Antinuclear; D015415:Biomarkers; D004247:DNA