Gastrointestinal manifestations in systemic lupus erythematosus: data from an Indian multi-institutional inception (INSPIRE) cohort

Objectives To study the prevalence, correlates, and outcomes of GI manifestations in a prospectively enrolled nationwide cohort of SLE in India (INSPIRE).Methods It is an observational cohort study with analysis of the baseline database of the INSPIRE cohort with early outcomes assessed till 10 April 2023. Cases with GI manifestations as per the BILAG index were selected, pertinent clinical and laboratory data were retrieved for analysis. Patients with GI manifestations were compared with the rest of the cohort and factors associated with death were determined.Results Of the 2503 patients with SLE enrolled in the INSPIRE cohort, 243 (9.7%) had GI manifestations observed early in the disease course (1, 0-3 months). Ascites (162, 6.5%), followed by enteritis (41,1.6%), pancreatitis (35, 1.4%) and hepatitis (24, 0.9%) were the most prevalent manifestations. All patients received immunosuppressive therapy, and four patients required surgery. Twenty-nine patients died (11.9%), with uncontrolled disease activity (17, 58.6%) and infection (6, 20.7%) accounting for the majority of deaths. Low socioeconomic class [lower Hazard Ratio (95% confidence intervals, CI) 2.8 (1.1-7.9); upper lower 7.5 (2-27.7); reference as upper class] and SLEDAI 2K [1.06 (1.02-1.11)] were associated with death in the GI group. GI manifestations were significantly associated with age [odds ratio and 95% CI 0.97 (0.96-0.99)], pleural effusion [4.9 (3.6-6.7)], thrombocytopenia [1.7 (1.2-2.4)], myositis [1.7 (1.1-2.7)], albumin [0.7 (0.5-0.8)], alkaline phosphatase (ALP) [1.01 (1.0-1.002)], low C3 [1.9 (1.3-2.5)], total bilirubin [1.2 (1.03-1.3)], alopecia [0.62 (0.5-0.96], elevated anti-dsDNA [0.5 (0.4-0.8)], and anti-U1RNP antibody [0.8 (0.5-0.7)] in model one; and age [0.97 (0.96-0.99)], creatinine [1.2 (1.03-1.4)], total bilirubin [1.2 (1.03-1.3)], ALP [1.01 (1.0-1.002)], albumin [0.6 (0.5-0.7)], andanti-U1RNP antibody [0.6 (0.5-0.8)] in model two in multivariate analysis compared with patients without GI features. The mortality was higher in the GI group (11.9% and 6.6%, P = 0.01) as compared with controls.Conclusion GI manifestations were observed in 9.7% of the cohort and were always associated with systemic disease activity and had higher mortality.