Changes in Lipid Profile Between Flare and Remission of Patients with Systemic Lupus Erythematosus: A Prospective Study

Objective. To determine the lipid profile of patients with systemic lupus erythematosus (SLE) according to the disease activity, and to calculate the percentage of patients that diverged from optimal values. Methods. Serum was collected from 52 patients with SLE at flare and at remission. SLE disease activity was measured by using the SLE Disease Activity Index (SLEDAI). Clinical and biological measures were evaluated in both situations. Total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), and trilglyceride (TG) levels were analyzed after overnight fasting. We also calculated the atherogenic ratios of TC/HDLC and LDLC/HDLC. Results. SLE patients had significantly higher median TC/HDLC and LDLC/HDLC ratios at flare than during remission: 4.5 +/- 1.5 versus 3.9 +/- 1.0 (p = 0.007) and 2.7 +/- 1.1 versus 2.4 +/- 0.8 (p 0.015), respectively. The differences persisted after adjustments based on kidney disease and treatment but not after adjusting by creatinine clearance <60 ml/min/1.73 m(2) in remission. The variation between flare and remission of the percentage of SLE patients with high-risk levels of lipid profile to desirable values, and vice versa, was statistically significant for the LDLC/HDLC ratio (9 vs I p = 0.021). Conclusion. Our results reflect a higher risk of atherosclerosis phenomena in SLE patients during flare than during clinical remission. This might explain the propensity to develop coronary heart disease in patients with SLE. (First Release June 15 2009; J Rheumatol 2009;36:1639-45; doi: 10.3899/jrheum.091097)