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AB0570 Association between sledai-2k domains and organ damage accrual
  1. K. Zhang1,
  2. S. Boyd2,
  3. F. Petitjean2,
  4. A. Hoi3,
  5. R. Koelmeyer3,
  6. E. Morand3,
  7. H. Nim2
  1. 1Monash University, Melbourne, Australia
  2. 2Information Technology
  3. 3Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia


Background Prevention of permanent organ damage is a key goal of SLE management1. Overall disease activity measured by SLE Disease Activity Index (SLEDAI-2k) is a risk factor for damage2, but the contribution of organ-specific activity to damage risk has not been enumerated.

Objectives We sought to determine the degree to which organ domains of SLEDAI-2k are associated with damage accrual.

Methods A dataset of SLE patients (2007 – 2017) at the Australian Lupus Registry was studied. Variables collected at each visit included all domains of SLEDAI-2k, Physician Global Assessment, and medications. Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) was recorded annually and each visit was labelled “damage transition” or “non-damage transition” based on whether SDI increased at the subsequent annual measure. The association of risk of SDI increase with SLEDAI-2k domains was assessed using multivariable logistic regression analysis adjusted for confounding by medication use.

Results 5538 visits from 266 patients (86.5% female, 47.4% Caucasian, 66% dsDNA positive) were analysed; at enrolment median (range) SLEDAI-2k was 4 (0–26) and SDI was 0 (0–4 ). Upon multivariable regression analysis, domains found to be significant were: low complement, proteinuria, haematuria, leukopenia, pyuria, pericarditis, alopecia, rash and arthritis. Upon further adjustment for prednisolone exposure, the effects of some domains were attenuated, but pericarditis (odd ratio (OR)=4.06, 95%CI=1.68–9.83), pyuria (OR=1.94, 1.47–2.56), arthritis (OR=1.71, 1.35–2.16), and rash (OR=1.43, 1.20–1.70), alopecia (OR=1.43, 1.10–1.86) and leukopenia (OR=1.36, 1.03–1.78) remained significant. No other SLEDAI-2k domains showed a significant association, in part due to infrequent occurrence. SLEDAI-2k domains weightings were not congruent with the respective risk of damage accrual.

Conclusions In study, only some SLEDAI-2k domains were significantly associated with organ damage accrual. Re-appraisal of weightings in SLE disease activity scores based on their association with outcome is potentially warranted.

References [1] Van Vollenhoven RF, Mosca M, Bertsias G, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Annals of the rheumatic diseases2014:annrheumdis-2013.

[2] Bruce IN, O’Keeffe AG, Farewell V, et al. Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. Annals of the rheumatic diseases2015;74(9):1706–13.

Disclosure of Interest None declared

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