Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. Issue 9 (16th May 2014)

• Record Type: Journal Article
• Authors: Bruce, Ian N; O'Keeffe, Aidan G; Farewell, Vern; Hanly, John G; Manzi, Susan; Su, Li; Gladman, Dafna D; Bae, Sang-Cheol; Sanchez-Guerrero, Jorge; Romero-Diaz, Juanita; Gordon, Caroline; Wallace, Daniel J; Clarke, Ann E; Bernatsky, Sasha; Ginzler, Ellen M; Isenberg, David A; Rahman, Anisur; Merrill, Joan T; Alarcón, Graciela S; Fessler, Barri J; Fortin, Paul R; Petri, Michelle; Steinsson, Kristjan; Dooley, Mary Anne; Khamashta, Munther A; Ramsey-Goldman, Rosalind; Zoma, Asad A; Sturfelt, Gunnar K; Nived, Ola; Aranow, Cynthia; Mackay, Meggan; Ramos-Casals, Manuel; van Vollenhoven, Ronald F; Kalunian, Kenneth C; Ruiz-Irastorza, Guillermo; Lim, Sam; Kamen, Diane L; Peschken, Christine A; Inanc, Murat; Urowitz, Murray B;
• Is Part Of: Annals of the rheumatic diseases. Volume 74:Issue 9(2015)
• Page Start: 1706
• Page End: 1713
• Publication Date: 2014-05-16
• Subjects: Systemic Lupus Erythematosus -- Outcomes research -- Corticosteroids -- Inflammation; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2013-205171
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background and aims: We studied damage accrual and factors determining development and progression of damage in an international cohort of systemic lupus erythematosus (SLE) patients. Methods: The Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort recruited patients within 15 months of developing four or more 1997 American College of Rheumatology (ACR) criteria for SLE; the SLICC/ACR damage index (SDI) was measured annually. We assessed relative rates of transition using maximum likelihood estimation in a multistate model. The Kaplan–Meier method estimated the probabilities for time to first increase in SDI score and Cox regression analysis was used to assess mortality. Results: We recruited 1722 patients; mean (SD) age 35.0 (13.4) years at cohort entry. Patients with damage at enrolment were more likely to have further worsening of SDI (SDI 0 vs ≥1; p<0.001). Age, USA African race/ethnicity, SLEDAI-2K score, steroid use and hypertension were associated with transition from no damage to damage, and increase(s) in pre-existing damage. Male gender (relative transition rates (95% CI) 1.48 (1.06 to 2.08)) and USA Caucasian race/ethnicity (1.63 (1.08 to 2.47)) were associated with SDI 0 to ≥1 transitions; Asian race/ethnicity patients had lower rates of new damage (0.60 (0.39 to 0.93)). Antimalarial use was associated with lower rates of increases in pre-existing damage (0.63 (0.44 to 0.89)). Damage was associated with future mortality (HR (95% CI) 1.46 (1.18 to 1.81) per SDI point). Conclusions: Damage in SLE predicts future damage accrual and mortality. We identified several potentially modifiable risk factors for damage accrual; an integrated strategy to address these may improve long-term outcomes.