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Conclusions Add-on treatment with BEL was effective to
achieve low disease activity during PSL tapering which would
lead to reducing GC related organ damages. However, recur-
rence was observed in both groups indicating the need for
GC tapering strategies in an individual setting.
LP-063 CLINICAL CHARACTERISTICS AND OUTCOMES OF
LIBMAN SACKS ENDOCARDITIS IN PATIENTS WITH
SYSTEMIC LUPUS ERYTHEMATOSUS
1
Eunsong Kang*,
2
Joo Hyang Chun,
1
Soo Min Ahn,
1,3
Ji Seon Oh,
1
Yong Gil Kim,
1
Chang
Keun Lee,
1
Bin Yoo,
1
Seokchan Hong.
1
Division of Rheumatology, Department of Internal
Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea;
2
Department of Internal Medicine, Seoul Gorden Hospital at Gangseo, Seoul,
Republic of Korea;
3
Department of Information Medicine, Big Data Research Center, Asan
Medical Center, Republic of Korea
10.1136/lupus-2023-KCR.172
Background Libman-Sacks (LS) endocarditis is one of the
major cardiac involvement of systemic lupus erythematosus
(SLE) and can manifest with neuropsychiatric events including
stroke. However, data on the clinical features of LS endocar-
ditis in comparison with infective endocarditis are limited.
Thus, we compared SLE patients with LS endocarditis and
those with infective endocarditis and analyzed the long-term
clinical outcomes.
Methods We reviewed the medical records of SLE patients
who were diagnosed with LS endocarditis or infective endo-
carditis between 1990 and 2021. Poor outcomes were defined
as the occurrence of stroke, transient ischemic attack, or seiz-
ure during follow-up.
Results A total of 47 patients with LS endocarditis were com-
pared with 5 patients with infective endocarditis. Patients with
LS endocarditis were less likely to have fever, chest pain, and
vegetation (40.4% vs. 100%, p=0.019) and had smaller vege-
tation size (median, 0 mm, vs. 12 mm, p=0.008) compared
with those with infective endocarditis. Of the 37 patients with
LS endocarditis who were followed for more than one year,
11 patients had poor outcomes, who had a significantly higher
rate of vegetation (63.6% vs. 29.2%, p=0.048) and a lower
rate of pericardial effusion (27.3% vs. 66.7%, p=0.039) than
those without poor outcomes. The presence of vegetation and
pericardial effusion were significantly associated with the
development of poor outcomes.
Conclusions Patients with LS endocarditis had different clinical
features compared with those with infective endocarditis. Neu-
ropsychiatric outcomes occurred in approximately 30% of
patients with LS endocarditis during follow-up, and the pres-
ence of vegetation and pericardial effusion were significant
factors for the development of poor outcomes.
LP-064 EFFECT OF OSTEOPOROSIS ON MAJOR ADVERSE
CARDIOVASCULAR EVENTS (MACES) IN SYSTEMIC
LUPUS ERYTHEMATOSUS (SLE): A LONGITUDINAL
STUDY
1
Chi-Chiu Mok*,
1
Kar Li Chan,
1
Ling Yin Ho,
2
Chi Hung To.
1
Medicine, Tuen Mun Hospital,
Hong Kong;
2
Medicine, Pok Oi Hospital, Hong Kong
10.1136/lupus-2023-KCR.173
Background To study the effect of osteoporosis on MACEs in
a longitudinal cohort of patients with SLE.
Methods Patients who fulfilled 4 ACR criteria for SLE and
had a DEXA scan performed were followed longitudinally.
The incidence of MACEs documented by imaging studies was
evaluated. Osteoporosis/fracture at baseline was defined as a T
score of <-2.5 or Z score <-2.0 at the hip/femoral neck/
spine, or old fragility fractures. The effect of osteoporosis on
incident MACEs was studied by Cox regression, adjusted for
confounders.
Results 383 SLE patients were studied (age 40.5±13 years;
94% women). Osteoporosis/fractures was present in 113
patients at baseline. Over 153±41 months, 44 MACEs (acute
coronary syndrome [n=19]; ischemic stroke [n=19]; periph-
eral vascular disease with digital gangrene [n=6]) developed in
42 patients. The incidence of MACEs was significantly higher
in patients with osteoporosis/fracture than those without (1.59
vs 0.63/100 patient-years; p=0.001). The cumulative risk of
MACEs by KM plot was significantly higher in the osteoporo-
sis than non-osteoporosis groups (p=0.002). Cox regression
revealed osteoporosis/fracture was an independent risk factor
for MACEs after adjustment for age, sex, vascular risk factors,
past MACE, aPL antibodies, and the use of immunosuppres-
sive drugs, aspirin/warfarin, statins, vitamin D and bisphospho-
nates (HR 2.41[1.25–4.67];p=0.009). 62(16%) patients
succumbed and osteoporosis/fracture at baseline was associated
with vascular mortality (HR 11.1[1.02–120]; p=0.048) but
not with all-cause mortality after adjustment for the same
confounders.
Conclusions Osteoporosis increases the risk of MACEs and
vascular mortality in patients with SLE, which is not
accounted by traditional vascular risk factors.
LP-065 PREVALENCE AND RISK FACTORS OF FRAGILITY
FRACTURES IN SYSTEMIC LUPUS ERYTHEMATOSUS
(SLE): A LONGITUDINAL STUDY OVER 12 YEARS
1
Chi-Chiu Mok*,
1
Kar Li Chan,
1
Ling Yin Ho,
2
Chi Hung To.
1
Medicine, Tuen Mun Hospital,
Hong Kong;
2
Medicine, Pok Oi Hospital, Hong Kong
10.1136/lupus-2023-KCR.174
Background To study the prevalence and risk factors of fragil-
ity fractures in patients with SLE.
Methods 383 patients who fulfilled 4 ACR criteria for SLE
and had a DEXA scan performed (baseline) were longitudi-
nally followed for new fragility fractures. Osteoporosis/fracture
was defined as a DEXA T score <-2.5 or Z score <-2.0 at
the hip/femoral neck/spine or a history of old fractures. The
cumulative incidence of new fractures was studied by Kaplan-
Meier’s analysis and risk factors by Cox regression, adjusted
for confounders.
Results 383 SLE patients were studied (age 40.5±13 years;
94% women). Patients with osteoporosis/fracture at baseline
(n=113) were more likely to have childhood onset disease
(<18 years), longer SLE duration and higher prevalence of
hematological or neuropsychiatric manifestations than those
without. Use of glucocorticoids (GCs) and MMF/AZA,
BMI£18kg/m2, premature menopause (<45 years) were also
more frequent in the osteoporosis/fracture group. However,
no difference in the SLEDAI scores was observed. Over 153
±41 months, new symptomatic fragility fractures developed in
34(8.9%) patients (vertebral [n=19], hip [n=2], limbs (non-
hip) [n=6], digital/rib [n=7]; incidence 0.69 per 100 patient-
years). The cumulative risk of fragility fractures was
Abstracts
A112 Lupus Science & Medicine 2023;10(Suppl 1):A1–A171
on August 8, 2023 by guest. Protected by copyright.http://lupus.bmj.com/Lupus Sci Med: first published as 10.1136/lupus-2023-KCR.174 on 6 August 2023. Downloaded from