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Abstract
Background Preclinical autoimmunity may offer a unique opportunity for preventing the development of SLE. This study was initiated to compare clinical and immunological characteristics in patients with undifferentiated connective tissue disease (UCTD) treated with hydroxychloroquine (HCQ) in a large academic clinical practice.
Materials and methods This cross-sectional study included all patients diagnosed with UCTD according to the preliminary classification criteria (1) seen at the Columbia University Lupus Centre in New York, from January to December 2015. Clinical and immunological variables were ascertained. Chi squared tests were used to compare the following characteristic between treated and untreated patients: demographic characteristics, number of ACR criteria, SLICC criteria, individual symptoms and laboratory values.
Results Eighty-three patients were identified; 93% were female, mean age at diagnosis of 44 years + 14.9; 67% were Caucasian, 20% Hispanic and 11% Black/African American; median disease duration of 3.91 years + 5.35. The most prevalent symptoms that required medical attention are described in Figure 1. 95% of patients had positive antinuclear antibody (ANA) titers and 5% were ANA negative Ro+, 87% had titers between 1:80 and 1:640, with speckled pattern in 69% of patients. Interestingly, 16% of the patients met SLICC SLE criteria. Half of the patients, 42 (51%) were treated with HCQ and 41 (49.3%) were not treated. The patients treated with HCQ were more likely to also meet SLICC criteria (10 vs. 3, respectively; p = 0.03), have a history of arthralgia (38 vs. 29; p = 0.02), arthritis (28 vs. 10; p = 0.0001), and fatigue (25 vs. 14; p = 0.02). A history of low complement was more prevalent in the treated group (12 vs. 3, p = 0.01).
Conclusions Data from this single-centre cohort of patients with UCTD show that patients treated with HCQ by their rheumatologist are more likely to have multiple clinical criteria and low complement compared to those that were not treated. These data suggest that rheumatologist treat pre-clinical autoimmunity in the setting of clinical symptoms. None of patients were treated based on serologies alone. Longitudinal studies are needed to evaluate the long-term impact of HCQ on outcomes in patients with UCTD.
Clinical Manifestations Requiring Medical Attention