RT Journal Article
SR Electronic
T1 Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 1706
OP 1713
DO 10.1136/annrheumdis-2013-205171
VO 74
IS 9
A1 Bruce, Ian N
A1 O'Keeffe, Aidan G
A1 Farewell, Vern
A1 Hanly, John G
A1 Manzi, Susan
A1 Su, Li
A1 Gladman, Dafna D
A1 Bae, Sang-Cheol
A1 Sanchez-Guerrero, Jorge
A1 Romero-Diaz, Juanita
A1 Gordon, Caroline
A1 Wallace, Daniel J
A1 Clarke, Ann E
A1 Bernatsky, Sasha
A1 Ginzler, Ellen M
A1 Isenberg, David A
A1 Rahman, Anisur
A1 Merrill, Joan T
A1 Alarcón, Graciela S
A1 Fessler, Barri J
A1 Fortin, Paul R
A1 Petri, Michelle
A1 Steinsson, Kristjan
A1 Dooley, Mary Anne
A1 Khamashta, Munther A
A1 Ramsey-Goldman, Rosalind
A1 Zoma, Asad A
A1 Sturfelt, Gunnar K
A1 Nived, Ola
A1 Aranow, Cynthia
A1 Mackay, Meggan
A1 Ramos-Casals, Manuel
A1 van Vollenhoven, Ronald F
A1 Kalunian, Kenneth C
A1 Ruiz-Irastorza, Guillermo
A1 Lim, Sam
A1 Kamen, Diane L
A1 Peschken, Christine A
A1 Inanc, Murat
A1 Urowitz, Murray B
YR 2015
UL http://ard.bmj.com/content/74/9/1706.abstract
AB 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.