TY - JOUR 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 SP - 1706 LP - 1713 DO - 10.1136/annrheumdis-2013-205171 VL - 74 IS - 9 AU - Ian N Bruce AU - Aidan G O'Keeffe AU - Vern Farewell AU - John G Hanly AU - Susan Manzi AU - Li Su AU - Dafna D Gladman AU - Sang-Cheol Bae AU - Jorge Sanchez-Guerrero AU - Juanita Romero-Diaz AU - Caroline Gordon AU - Daniel J Wallace AU - Ann E Clarke AU - Sasha Bernatsky AU - Ellen M Ginzler AU - David A Isenberg AU - Anisur Rahman AU - Joan T Merrill AU - Graciela S Alarcón AU - Barri J Fessler AU - Paul R Fortin AU - Michelle Petri AU - Kristjan Steinsson AU - Mary Anne Dooley AU - Munther A Khamashta AU - Rosalind Ramsey-Goldman AU - Asad A Zoma AU - Gunnar K Sturfelt AU - Ola Nived AU - Cynthia Aranow AU - Meggan Mackay AU - Manuel Ramos-Casals AU - Ronald F van Vollenhoven AU - Kenneth C Kalunian AU - Guillermo Ruiz-Irastorza AU - Sam Lim AU - Diane L Kamen AU - Christine A Peschken AU - Murat Inanc AU - Murray B Urowitz Y1 - 2015/09/01 UR - http://ard.bmj.com/content/74/9/1706.abstract N2 - 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. ER -