[2008] [THU0227] RAYNAUD'S PHENOMENON IS NOT AN INDEPENDENT RISK FACTOR FOR ARTERIAL THROMBOTIC EVENTS IN SYSTEMIC LUPUS ERYTHEMATOSUS

S. Appenzeller¹, C.B. Zeller², L.T.L. Costallat^{1 1}Internal Medicine; ²Statistics, UNICAMP, Campinas, Brazil

Background: Raynaud's phenomenon is frequently observed in patients with SLE and in 5% of general population surveys. Suggested pathogenic mechanism are vascular reactions and vascular endothelial cell dysfunction.
Objectives: To determine if the presence and the duration of Raynaud's phenomenon is associated with arterial vascular events in SLE patients.
Methods: We included 748 SLE patients [(690 women; median age: 25 years (SD=10.2 range 5-62 years); median follow-up time 7 years; (SD=3.5; range 0.1-25 years)] that were followed in the State University of Campinas and had their demographic and clinical, laboratory and treatment informations prospectively entered in a database and updated quarterly at each visit. The diagnosis of Raynaud's phenomenon was based on at least two-phase colour reactions of bilateral distribution described by the patient or observed by a physician. The date of first colour changes was inquired and considered the date of Raynaud's onset. All arterial thrombovascular events were confirmed by physician review of medical records. Confirmation included information obtained from clinical notes, discharge diagnoses, and positive diagnostic imaging procedures. We performed a multivariate model considering the presence or absence of Raynaud's phenomenon and arterial vascular events, adjusted for other risk factors associated with arterial thrombotic events such as the presence of hypertension, diabetes, antiphospholipid antibodies, lupus anticoagulant, family history of cardiovascular events, aspirin use and oral anticoagulation. Survival curves and Cox proportional methods were determined to analyze the importance of the duration of Raynaud's phenomenon in the occurrence of arterial vascular events.
Results: Over the follow-up period we identified 48 (6.42%) patients with arterial vascular thrombotic events at disease onset and 119 (15.9%) patients with arterial vascular thrombotic events during the follow-up period. Raynaud's phenomenon was identified in 250 (33.42%) of our cohort. The presence of antiphospholipid syndrome was associated with the occurrence of arterial thrombotic events at both disease onset (p<0.001; Odds ratio (OD)=9.8; confidence interval (CI)= 3.4-14.2) and follow-up (p=0.0002; OR=5.7; CI=1.3-7.6) period. The presence of Raynaud's phenomenon was not an independent risk factor for arterial thrombotic events (p=0.32; OR=1.12; CI=0.52-2.3). On survival curves the duration of Raynaud's phenomenon was not an independent risk factor for occurrence of arterial thrombotic events (p=0.09).
Conclusion: The presence and duration of Raynaud's phenomenon did not increase the risk of arterial thrombotic events in our cohort of SLE patients after adjusting for common thrombotic risk factors.

Ann Rheum Dis 2008;67(Suppl II):209

SLE, Sjögren's and APS Clinical aspects and treatment