Background Systemic lupus erythematosus (SLE) is an idiopathic autoimmune disease associated with significant co-morbidity, affecting both quality of life, but also life expectancy. In most of the cases, disease course and treatment have an important contribution to accumulation of damage. This is way, for patients with SLE it is important to obtain control of disease activity, but also to prevent irreversible organ damage.
Objectives We performed a prospective, observational study aiming to evaluate possible factors related to damage accrual in a roumanian SLE cohort.
Methods This study included 65 patients diagnosed with SLE according to ACR 1997 classifications criteria. They were evaluated according to an established protocol in order to obtain relevant data about disease history, disease activity and damage accumulated from the beginning of SLE. For this purpose, we obtained immunological profile for all patients; we recorded all relevant laboratory data connected to organ involvement in SLE and applied scores like SELENA-SLEDAI – to evaluate activity - and SLICC/ACR damage index (SDI). In order to be able to apply SDI to all patients, one of the inclusion criteria was the disease older then 1 year. All patients had an evaluation of their status for 25(OH) Vitamin D.
Results Study group had a female predominance (93.84%), with a mean age of 42.45 [15.859] and a mean disease duration of 8.0 [7.7] years. The mean SELENA-SLEDAI score was 5.37 [3.385]. Mean prednisone equivalent dose was 7.45 [8.38] daily. More then half of the patients (34 from 65) had a SDI equal or more than 1. When compared between the one that already accumulated damage (SDI≥1) with the others, significant differences (p<0.05) were observed related to more frequent association with renal involvement (p 0.05), presence of antiphospholipidic antibody (p0.001), presence of disease activity (p 0.031) and atherosclerotic vascular disease (p<0.001) in the group with SDI≥1. When compared according to 25(OH) Vitamin D level, more patients from the group with SDI≥1 had levels below 30ng/ml and the difference was significant statistic: p 0.037 for Vitamin D insufficiency (21-30ng/ml) and p 0.016 for vitamin D deficiency (<20ng/ml). Dividing patients according to corthicotherapie duration, SDI≥1 was found more frequent when corticotherapie duration was more than 5 years (p 0.007).
Conclusions It is well known that damage accrual has a continuum evolution in patients with SLE. Identification of factors related to that gives us the opportunity to slow down this evolution. Prompt treatment of disease activity especially renal flares, screening for association with antiphosholipidic syndrome or atherosclerotic vascular disease will improve evolution in this cases. This data shows that corthicotherapie over treating has an important contribution in damage related to SLE.
M. Petri et al. Predictors of organ damage in systemic lupus erythematosus: the Hopkins Lupus Cohort. Arthritis Rheum 2012; 64(12): 4021-8.
Disclosure of Interest None declared