Background Organ damage in patients with systemic lupus erythematosus (SLE) occurs as the consequence of the disease itself, administered therapy, primarily corticosteroid and cytostatic, as well as the accompanying diseases and complications.
Objectives Our aim in this paper was to examine the degree of irreversible organ changes in SLE patients using the SLICC/ACR Damage Index (SDI) and to establish the correlation of organ damage with disease activity, quality of life, and severity of fatigue, as well as with the immunological parameters – anti-dsDNA antibodies, anti-nucleosome, anti-C1q antibodies, and MCP1 in the serum and urine.
Methods The study involved 83 SLE patients (77 women and 6 men), aged 45.8±9.2 years on the average, with average disease duration of 10.6±7.9 years, hospitalized at the Clinic of Rheumatology of the “Niška Banja” Institute, in whom the diagnosis was made based on the revised 1997 ACR criteria. The disease activity was evaluated using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and a physician's global assessment. The degree of organ damage was evaluated using the SDI. The quality of life was assessed based on The Medical Outcome Survey Short Form 36 (SF-36), and the severity of fatigue was measured using the Fatigue Severity Scale (FSS). The level of antibodies was determined using the ELISA test, and serum and urine MCP1 with the sandwich enzyme immunosorbent assay method according to the manufacturer's instructions (R&D Systems, Inc. Minneapolis, USA).
Results The mean value of organ damage index in all SLE patients was 1.8±2.0 (median 1, min 0, max 9). Twenty-five (30.1%) patients did not have any organ damage (SDI=0); 21 (25.3%) had SDI=1; SDI=2 or 3 was found in 20 patients (24.1%), and 17 patients (20.5%) had SDI≥4. Neuropsychic and musculoskeletal changes were the most common organ damage manifestations, present in 23 (27.7%) of patients. In 21 patients (25.3%), cardiovascular changes were seen, and ocular lesions in 14 patients (16.9%). Renal and pulmonary changes were found in 13 patients (15.7%), cutaneous changes in 3 patients (3.6%), and gastrointestinal changes in 2 patients (2.4%). In 5 cases (6.0%) malignancies were detected, and diabetes mellitus in 2 patients (2.4%). A statistically significant positive correlation of SDI was established with age (r=0,348, p=0,001), disease duration (r=0,412, p<0,001), SLEDAI (r=0,359, p=0,001), global physician's assessment (r=0,357, p=0,001) and fatigue (r=0,296, p=0,007), and a negative correlation with quality of life (r=-0,386, p<0,001). There were no correlations of SDI with the level of anti-dsDNA, anti-nucleosome, anti-C1q antibodies, nor with serum and urine MCP1 levels.
Conclusions Musculoskeletal, neuropsychic, and cardiovascular changes were the ones most commonly seen. Organ damage positively correlated with age and disease duration, a higher disease activity, poorer quality of life, and more severe fatigue.
Roberts AL, Rizzolo D. Systemic lupus erythematosus: an update on treat-to-target. JAAPA. 2015;28(9):22–8.
Yee CS, Su L, Toescu V, et al. Birmingham SLE cohort: outcomes of a large inception cohort followed for up to 21 years. Rheumatology (Oxford).2015;54(5):836–43.
Cervera R, Doria A, Amoura Z et al. Patterns of systemic lupus erythematosus expression in Europe. Autoimmun Rev. 2014;13(6):621–9.
Disclosure of Interest None declared