Background Various factors have been implicated in the disease damage in SLE.
Objectives To investigate disease damage among SLE patients and to determine their association with patient exposure to the various immunosuppressive treatment.
Methods A total of 220 SLE patients from the Universiti Kebangsaan Malaysia Medical Centre and Putrajaya Hospital were recruited. Information on the sociodemographic background, lupus characteristics and treatment were obtained from the medical records. Patients were stratified by the Systemic Lupus International Collaborating Clinics/ American College of Rheumatology cumulative disease damage index (SDI ≥ 1= damage).
Results Overall, 35% (78/220) patients had disease damage. Those who had ever received hydroxychloroquine (HCQ) were less likely to develop disease damage (37.5% vs 89.3%, p<0.001). Early HCQ treatment (≤3 months from the onset of diagnosis) and receipt of a loading dose of HCQ (6.5mg/kg daily) were less likely to be associated with disease damage [23.2% vs 67.1% and 28 % vs 54%, p<0.001 respectively]. In the HCQ treated group of patients, those with disease damage had a significantly lower cumulative HCQ [189.3 ± 192.2 g vs 314.1 ± 339.4 g, p<0.01]. Those who had a longer duration of corticosteroid treatment tended to develop disease damage (5.1 ± 4.8 years vs 3.8 ± 3.1 years, p=0.057) and more patients who received high dose prednisolone (≥ 1mg/kg daily) developed disease damage (52.2% vs 35.3%, p=0.04). Cyclophosphamide and cyclosporin A use were also associated with disease damage, 78.7% vs 31.7% and 85% vs 41%, p<0.001 respectively. After adjustment of age and major organ involvement of SLE (renal and NPSLE), in the regression analysis, presence of treatment with HCQ (OR 0.12, CI 95% 0.02-0.61, p=0.01) and early treatment with HCQ (≤ 3 months before the onset of SLE) protected against disease damage (OR0.32, CI 95% 0.11-0.91, p=0.03). Cyclophosphamide was an independent risk for disease damage (OR 11.5 CI 95% 3.5-35.6, p=<0.01). These data suggest that the use of cytotoxic agents such as cyclophosphamide and cyclosporine A were probably associated with more severe disease manifestations such as severe lupus nephritis.
Conclusions Cyclophosphamide use increased the risk of disease damage whilst early treatment with HCQ protected against disease damage. A larger prospective study is needed to further delineate the contribution of the immunosuppressive treatment towards disease damage among SLE.
References M. Petri et al. Predictors of Organ Damage in SLE: The Hopkins Lupus Cohort Arthritis Rheum. 2012 Dec;64(12):4021-8.
Disclosure of Interest None Declared