DISEASE ACTIVITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A STUDY OF THE GUATEMALAN ISLA COHORT

PV225 / #406 Poster Topic: AS23 - SLE-Diagnosis, Manifestations, & Outcomes Background/Purpose Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by periods of exacerbation and remission. Despite significant advancements in treatment strategies in recent years, patients may experience variable episodes of disease activity throughout their lives. Comorbidities and the accessibility of therapeutic interventions can influence the progression of SLE. Consequently, this study aims to elucidate the current disease activity among patients with SLE in a Guatemalan cohort. Methods This study employs a cross-sectional design and involves reviewing 268 patient records diagnosed with SLE from a single rheumatology center in Guatemala, specifically the Lupus cohort of the Guatemalan Social Security Institute in the Autonomous Unit (ISLA). The analysis focused on disease activity data from the most recent clinical follow-up evaluation conducted in 2024. The Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) was employed to assess disease activity. The study systematically described activity domains, categorized by current disease status; the activity was defined as SLEDAI-2K > 4 points and included an overview of treatment regimens and comorbidities. Results The study identified that 48.88% of patients were active cases, predominantly women at 92.4%. The mean SLEDAI-2K score was 6.51, indicating significant disease activity, especially in renal aspects, with proteinuria in 28.2% and pyuria in 31.3%, with a mean proteinuria value over 24 hours amounting to 560.83 mg. Hypocomplementemia was found in 49.6% of cases, and 55.7% had anti-DNA levels elevated. Among inactive patients, 11.7% had low C3-C4 levels, and 26.3% had anti-DNA elevated. (Table 1) Corticosteroids were the most common treatment used by 79.6% of inactive and 82.4% of active patients, with average dosages of 5.63 mg and 9.96 mg, respectively. Hydroxychloroquine (HCQ) and azathioprine (AZA) were also used, with cyclophosphamide (CYC) as the primary rescue therapy during follow-up. Kidney transplantation occurred in 2.92% of inactive and 2.29% of active patients. (Table 2) Concerning comorbidities, the cardiovascular system was identified as the most affected, with arterial hypertension being the most prevalent condition, affecting 33.58% of the total patient sample. Moreover, 17 cases overlapped with other autoimmune diseases, the most common being systemic sclerosis (Table 2). Table 1. Table 2. Conclusions This study describes the current activity characteristics of the patient cohort observed. It is essential to emphasize our population’s high percentage of activity, particularly regarding significant renal involvement associated with immunological phenomena. Furthermore, the study underscores the presence of the serologically active clinically quiescent phenomenon, which is pertinent as it may predict future clinical activity. In light of the crucial role that access to medications and related comorbidities play in the manifestation of disease activity, this observation prompts a critical inquiry into whether we possess the necessary tools to address the challenges posed by lupus adequately.

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