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

  • Author(s): 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
  • et al.
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.

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