title: Assessment of premature atherosclerosis in systemic lupus erythematosus patients with and without nephritis.
abstract: BACKGROUND
  Risk of subclinical atherosclerosis is increased in patients with systemic lupus erythematosus (SLE). We correlated carotid intima media thickness (CIMT) and endothelial dysfunction through flow-mediated dilation (FMD) in SLE patients with the SLE Disease Activity Index (SLEDAI).
  
  
  METHODS
  This single-centre cross-sectional study recruited 100 consenting SLE outpatients (ACR 1997 criteria) out of which 50 had nephritis, with disease duration of ≥2 years for SLE and ≥6 months for lupus nephritis. We measured baseline laboratory levels, CIMT and FMD (after brachial BP cuff inflation up to 200 mmHg for five minutes), and calculated SLEDAI.
  
  
  RESULTS
  Mean age was 29.88 ± 6.53 years; 95/100 were female. CIMT showed positive correlation (p = 0.037; rho = 0.209), and FMD showed inverse correlation with patient's age (p = 0.011; rho = -0.252). CIMT and FMD were more deranged in patients aged ≥25 years (p < 0.05). CIMT was not significantly different between SLE patients with and without nephritis (p > 0.05), whereas SLEDAI and FMD were more deranged in nephritis patients (p < 0.05). In patients without nephritis, FMD showed significant inverse correlation with disease duration (p = 0.043; rho = -0.288) and urine albumin (p = 0.045; rho = -0.285). In nephritis patients, the correlation between age of the patient was significantly positive with CIMT (p = 0.001; rho = 0.441) and significantly inverse with FMD (p = 0.028; rho = -0.312).
  
  
  CONCLUSIONS
  SLE patients with nephritis are at a higher risk to develop arterial stiffening, leading to early end-organ damage. Early aggressive treatment may prevent endothelial dysfunction. FMD using vascular ultrasonography on the brachial artery represents a non-invasive, repeatable and useful method for the assessment of endothelial dysfunction.
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India sharmashefali@hotmail.com.
authors.forename: S K
authors.initials: SK
authors.lastname: Sharma
authors.affiliation: Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: M
authors.initials: M
authors.lastname: Rathi
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: S
authors.initials: S
authors.lastname: Sahoo
authors.affiliation: Department of Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: M
authors.initials: M
authors.lastname: Prakash
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: V
authors.initials: V
authors.lastname: Dhir
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: S
authors.initials: S
authors.lastname: Singh
mesh_terms: D000328:Adult; D017668:Age of Onset; D000419:Albuminuria / Q000209:etiology; D058070:Asymptomatic Diseases; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001916:Brachial Artery / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006801:Humans; D007194:India; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis; D008181:Lupus Nephritis / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D059289:Vascular Stiffness; D055815:Young Adult
keywords: Systemic lupus erythematosus; carotid intima-media thickness; flow-mediated dilation; lupus nephritis; premature atherosclerosis