Systemic lupus erythematosus in a multiethnic cohort (LUMINA): XXIX. Elevation of erythrocyte sedimentation rate is associated with disease activity and damage accrual.

OBJECTIVE To determine if different categories of erythrocyte sedimentation rate (ESR) elevation are associated with disease activity and/or damage in systemic lupus erythematosus (SLE). METHODS We studied 2317 study visits in 553 SLE patients (> or = 4 American College of Rheumatology criteria, < or = 5 years' disease duration at enrollment) from a multiethnic (Hispanic, African American, and Caucasian) longitudinal study of outcome. A study visit was done every 6 months for the first year and annually thereafter. Erythrocyte sedimentation rate (ESR) was measured using the Westergren method; results were expressed in 4 categories: < 25 (normal), 25-50 (mild elevation), 51-75 (moderate elevation), and > 75 (marked elevation) mm/h. Anti-dsDNA antibodies were measured at enrollment with the Crithidia luciliae assay. Disease activity was assessed with the Systemic Lupus Activity Measure (SLAM) and the Physician's Global Assessment (PGA). Because ESR is one of the measures evaluated in the SLAM, it was excluded from the total SLAM score. Disease damage was assessed with the Systemic Lupus International Collaborating Clinics damage index (SDI). The relationship between the SLAM (total and PGA) and SDI scores (at baseline and for all visits) and anti-dsDNA antibodies (at enrollment) with ESR was examined by univariable and generalized estimating equation (GEE) regression analyses. Ethnicity, age, and sex were entered in all regression models. RESULTS The cohort consisted of 89.7% women with mean age 36.8 (SD 12.6) years and disease duration 4.6 (SD 3.2) years. GEE analyses showed that increasing levels of ESR and anti-dsDNA antibody positivity were independently associated with SLAM and PGA scores, at enrollment and for all visits. Overall, the associations of ESR with SLAM and PGA scores were stronger than for the presence of anti-dsDNA antibodies. At baseline, there was no relationship of ESR elevation or anti-dsDNA positivity with SDI scores. However, when all visits were studied, moderate and marked elevations of ESR were independently associated with SDI scores. CONCLUSION Mild, moderate, and marked ESR elevations are strongly associated with disease activity in SLE. Moderate and marked ESR elevations are also associated with damage accrual. These associations are stronger than those for the presence of anti-dsDNA antibodies. Our data suggest that ESR could be used to assess disease activity and predict organ/system damage in a relatively rapid and inexpensive manner in SLE.

[1]  D A Bloch,et al.  The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. , 2010, Arthritis and rheumatism.

[2]  J. Reveille,et al.  Early clinical manifestations, disease activity and damage of systemic lupus erythematosus among two distinct US Hispanic subpopulations. , 2003, Rheumatology.

[3]  I. Shapira,et al.  Significant dominance of fibrinogen over immunoglobulins, C‐reactive protein, cholesterol and triglycerides in maintaining increased red blood cell adhesiveness/aggregation in the peripheral venous blood: a model in hypercholesterolaemic patients , 2003, European journal of clinical investigation.

[4]  M. Abrahamowicz,et al.  Organ manifestations influence differently the responsiveness of 2 lupus disease activity measures, according to patients' or physicians' evaluations of recent lupus activity. , 2002, The Journal of rheumatology.

[5]  T. Arendt,et al.  Limited value of elevated erythrocyte sedimentation rate as an indicator of malignancy. , 2002, Family practice.

[6]  F. Akçay,et al.  Serum Oxidant/Antioxidant Status in Patients with Systemic Lupus Erythematosus , 2002, Clinical chemistry and laboratory medicine.

[7]  J. Reveille,et al.  Systemic lupus erythematosus in three ethnic groups. IX. Differences in damage accrual. , 2001, Arthritis and rheumatism.

[8]  E. Letsky,et al.  Pregnancy and the erythrocyte sedimentation rate , 2001, BJOG : an international journal of obstetrics and gynaecology.

[9]  T. Witte,et al.  Prognostic parameters for flare in systemic lupus erythematosus. , 2000, Rheumatology.

[10]  I. Olivieri,et al.  Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: a prospective follow-up study. , 2000, Seminars in arthritis and rheumatism.

[11]  G. Hughes,et al.  Fibrinogen in systemic lupus erythematosus: more than an acute phase reactant? , 2000, The Journal of rheumatology.

[12]  W. Scherbaum,et al.  Serum thrombomodulin—a reliable marker of disease activity in systemic lupus erythematosus (SLE): advantage over established serological parameters to indicate disease activity , 2000, Clinical and experimental immunology.

[13]  H. Paulus,et al.  Equivalence of the acute phase reactants C-reactive protein, plasma viscosity, and Westergren erythrocyte sedimentation rate when used to calculate American College of Rheumatology 20% improvement criteria or the Disease Activity Score in patients with early rheumatoid arthritis. Western Consortium , 1999, The Journal of rheumatology.

[14]  M. Zhao,et al.  The significance of anti-endothelial cell antibodies in patients with lupus nephritis and immunoblotting analysis of the target components. , 1999, Chinese medical journal.

[15]  J. Reveille,et al.  Systemic lupus erythematosus in three ethnic groups: I. The effects of HLA class II, C4, and CR1 alleles, socioeconomic factors, and ethnicity at disease onset , 1998 .

[16]  I. D. de Messias-Reason,et al.  SC5b-9 is the most sensitive marker in assessing disease activity in Brazilian SLE patients. , 1998, Journal of investigational allergology & clinical immunology.

[17]  N. Goel,et al.  Systemic lupus erythematosus in three ethnic groups: II. Features predictive of disease activity early in its course , 1998 .

[18]  M. M. Ward,et al.  Evaluative laboratory testing practices of United States rheumatologists. , 1998, Arthritis and rheumatism.

[19]  D. Isenberg,et al.  Association of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index with measures of disease activity and health status in patients with systemic lupus erythematosus. , 1997, The Journal of rheumatology.

[20]  D. Fuchs,et al.  Serum soluble markers of immune activation and disease activity in systemic lupus erythematosus , 1995, Lupus.

[21]  M Zlonis,et al.  The mystique of the erythrocyte sedimentation rate. A reappraisal of one of the oldest laboratory tests still in use. , 1993, Clinics in laboratory medicine.

[22]  D. Wallace,et al.  Lupus erythematosus in the 1980s: a survey of 570 patients. , 1991, Seminars in arthritis and rheumatism.

[23]  M. Liang,et al.  Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. , 1989, Arthritis and rheumatism.

[24]  J. Graves,et al.  The erythrocyte sedimentation rate in end-stage renal failure. , 1987, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[25]  R. Fincher,et al.  Clinical significance of extreme elevation of the erythrocyte sedimentation rate. , 1986, Archives of internal medicine.

[26]  J F Fries,et al.  The 1982 revised criteria for the classification of systemic lupus erythematosus. , 1982, Arthritis and rheumatism.

[27]  D. Estes,et al.  THE NATURAL HISTORY OF SYSTEMIC LUPUS ERYTHEMATOSUS BY PROSPECTIVE ANALYSIS , 1971, Medicine.

[28]  D. Isenberg,et al.  Quantitative clinical assessment of disease activity in systemic lupus erythematosus: progress report and research agenda , 2004, Rheumatology International.

[29]  A. Gibofsky.  American College of Rheumatology. , 2002, Journal of the Medical Association of Georgia.

[30]  I. Cicha,et al.  Aggregation and sedimentation of mixtures of erythrocytes with different properties. , 2001, Clinical hemorheology and microcirculation.

[31]  H. Peter,et al.  Rheumatoid factors in systemic lupus erythematosus: association with clinical and laboratory parameters , 2000, Rheumatology International.

[32]  H. Peter,et al.  Association of IgA anti-dsDNA antibodies with vasculitis and disease activity in systemic lupus erythematosus , 1998, Rheumatology International.

[33]  R. Oglesby,et al.  Increased levels of intercellular adhesion molecule-1 in the serum of patients with systemic lupus erythematosus. , 1994, Clinical and experimental rheumatology.