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Ann Rheum Dis. 2015 Sep;74(9):1706-13. doi: 10.1136/annrheumdis-2013-205171. Epub 2014 May 16.

Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort.

Author information

1
Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
2
Department of Statistical Science, University College London, London, UK.
3
MRC Biostatistics Unit, Cambridge, UK.
4
Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
5
Department of Medicine, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA.
6
Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.
7
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
8
Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
9
Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
10
Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
11
Division of Rheumatology, University of Calgary, Alberta, Canada.
12
Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
13
Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA.
14
Centre for Rheumatology Research, University College London, London, UK.
15
Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.
16
Department of Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
17
Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada.
18
Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
19
Center for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland.
20
Division of Rheumatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
21
Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK.
22
Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA.
23
Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK.
24
Department of Rheumatology, University Hospital Lund, Lund, Sweden.
25
Feinstein Institute for Medical Research, Manhasset, New York, USA.
26
Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain.
27
Unit for Clinical Therapy Research Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden.
28
UCSD School of Medicine, La Jolla, California, USA.
29
Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
30
Emory University, Atlanta, Georgia, USA.
31
Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA.
32
University of Manitoba, Winnipeg, Manitoba, Canada.
33
Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

Abstract

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.

KEYWORDS:

Corticosteroids; Inflammation; Outcomes research; Systemic Lupus Erythematosus

PMID:
24834926
PMCID:
PMC4552899
DOI:
10.1136/annrheumdis-2013-205171
[Indexed for MEDLINE]
Free PMC Article
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