Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort.
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Author
Bruce, Ian NO'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
Journal title
Annals of the rheumatic diseasesDate Published
2014-05-16Publication Volume
74Publication Issue
9Publication Begin page
1706Publication End page
13
Metadata
Show full item recordAbstract
We studied damage accrual and factors determining development and progression of damage in an international cohort of systemic lupus erythematosus (SLE) patients.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.
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).
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.
Citation
Bruce IN, O'Keeffe AG, Farewell V, Hanly JG, Manzi S, Su L, Gladman DD, Bae SC, Sanchez-Guerrero J, Romero-Diaz J, Gordon C, Wallace DJ, Clarke AE, Bernatsky S, Ginzler EM, Isenberg DA, Rahman A, Merrill JT, Alarcón GS, Fessler BJ, Fortin PR, Petri M, Steinsson K, Dooley MA, Khamashta MA, Ramsey-Goldman R, Zoma AA, Sturfelt GK, Nived O, Aranow C, Mackay M, Ramos-Casals M, van Vollenhoven RF, Kalunian KC, Ruiz-Irastorza G, Lim S, Kamen DL, Peschken CA, Inanc M, Urowitz MB. Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. Ann Rheum Dis. 2015 Sep;74(9):1706-13. doi: 10.1136/annrheumdis-2013-205171. Epub 2014 May 16. PMID: 24834926; PMCID: PMC4552899.DOI
10.1136/annrheumdis-2013-205171ae974a485f413a2113503eed53cd6c53
10.1136/annrheumdis-2013-205171
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