Ho KT et al. (2005) Systemic lupus erythematosus in a multiethnic cohort (LUMINA): XXVIII. Factors predictive of thrombotic events. Rheumatology 44: 1303–1307

Smoking and disease activity are strongly associated with thrombotic events in patients with systemic lupus erythematosus (SLE), according to a recent report of data from the LUMINA (Lupus in Minorities: Nature versus Nurture) patient cohort.

A number of risk factors and disease-related factors might be linked to thrombotic events in patients with SLE; of these, an association with the presence of antiphospholipid antibodies (aPL) has been demonstrated. A number of trials have recommended the use of hydroxychloroquine, known to have immunosuppressant and antiplatelet activity, as thromboembolic prophylaxis in patients with ANTIPHOSPHOLIPID SYNDROME.

To determine the relationship between the presence of aPL, hydroxychloroquine use and the occurrence of thrombotic events (arterial and/or venous; peripheral and/or central), Ho and colleagues studied 442 patients with SLE by generalized estimating equation (GEE). Although a number of variables were significant in univariate analysis, only smoking and disease activity remained significant by multivariate GEE analysis: aPL were not significant in either analysis, and although hydroxychloroquine use was protective in univariate analysis, this significance was not maintained in multivariate GEE.

Although disease activity is generally efficiently managed, these data emphasize that overall management should also include encouragement of patients with SLE to stop smoking in order to reduce their risk of thrombotic events.