The Hopkins Lupus Cohort is a longitudinal study in which all SLE patients are seen quarterly, by protocol, by one rheumatologist. The specific aims include prevention of organ damage. In this abstract, two projects - noncalcified plaque (NCP) and treatment of antiphospholipid antibodies - will be reviewed.
For the study on NCP, 64-slice (n = 106) or 320-slice (n = 121) coronary multidetector computed tomography (MDCT) was performed in 227 patients with SLE. The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software. The NCP score was a sum of plaque severity multiplied by the plaque composition divided by the number of vessels examined.
For the study on treatment of antiphospholipid antibodies, we studied 1,795 SLE patients (56% Caucasian, 37% African American, 93.3% female, mean age 37.0 ± 12.5) with no previous thrombosis prior to entry in the cohort. The primary outcome was first thrombotic event (arterial or venous). Univariate analysis and multivariable modeling were used to examine associations between prednisone, hydroxycholoquine, and NSAID use with the risk of thrombosis.
For NCP, methotrexate increased NCP, possibly via homocysteine. For thrombosis, hydroxychloroquine significantly reduced thrombosis, but prednisone increased it. SLE longitudinal cohorts can address many clinical questions that are not suitable for clinical trials.