Work

Progression of atherosclerotic plaques over 3 years in patients with systemic lupus erythematosus is inversely associated with continuous hydroxychloroquine treatment

Year: 2025

Type: article

Abstract: OBJECTIVE: Cardiovascular disease (CVD) is a major contributor to organ damage and premature death in patients with systemic lupus erythematosus (SLE). Traditional risk factors do not fully explain the accelerated atherosclerosis or increased CVD risk. Impaired microcirculation and increased intima-media thickness (IMT) may represent early signs of vascular disease. We performed a 3 year follow-up of well-characterized patients with SLE to identify predictors of atherosclerotic plaque progression and accrued organ damage. METHOD: Fifty-seven patients (50 females) were assessed twice (3 years apart) using an extended ultrasound protocol with high-frequency ultrasound (HFUS) to assess IMT and occurrence of atherosclerotic plaques. Microcirculation was assessed via forearm microcirculatory peak oxygen saturation after induced ischaemia (OxyP). RESULTS: At the 3 year follow-up, atherosclerotic plaques were observed in 29/57 patients (50.9%), and progression of plaques was seen in 27 (47.4%). Patients prescribed hydroxychloroquine at follow-up showed significantly less plaque progression (p = 0.045). In multivariable logistic regression analysis, only hydroxychloroquine use remained a statistically significant predictor of less atherosclerotic plaque progression (B = -2.5, p = 0.047). The IMT of common carotid arteries increased significantly in patients who showed progression of atherosclerotic plaques (p = 0.04). OxyP was not significantly associated with either plaque progression or damage accrual. CONCLUSION: Despite quiescent disease state, atherosclerosis progresses over time in patients with SLE. Our data support the use of surveillance with HFUS for assessing CVD risk. Continuous use of hydroxychloroquine protected against atherosclerotic plaque progression and should be offered to all patients with SLE, unless contraindicated.

Source: Scandinavian Journal of Rheumatology

DOI: 10.1080/03009742.2025.2570588