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Arthritis Rheumatol. 2019 Oct 21. doi: 10.1002/art.41144. [Epub ahead of print]

Prediction of damage accrual in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI).

Author information

1
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
2
Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
3
Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
4
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
5
Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
6
Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
7
Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
8
Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
9
Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
10
Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
11
Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
12
Division of Rheumatology, CHU de Québec - Université Laval, Quebec City, Canada.
13
Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, Canada.
14
Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center Manchester, UK.
15
Center for Rheumatology, Department of Medicine, University College London, UK.
16
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
17
Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
18
Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, UK, London.
19
Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.
20
Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
21
Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA.
22
Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK.
23
Feinstein Institute for Medical Research, Manhasset, NY, USA.
24
Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
25
Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA.
26
Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
27
Unit for clinical therapy research (ClinTRID), Karolinska Institute, Stockholm, Sweden.
28
Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.
29
Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain.
30
Medical University of South Carolina, Charleston, South Carolina, USA.
31
UCSD School of Medicine, La Jolla, CA, USA.
32
Copenhagen Lupus and Vasculitis Clinic, 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
33
University of Manitoba, Winnipeg, Manitoba, Canada.
34
Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics, New York, NY.
35
Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada.

Abstract

OBJECTIVE:

The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) has been shown to predict mortality, but its association with other important outcomes is unknown. We examined the association of baseline SLICC-FI values with damage accrual in the SLICC inception cohort.

METHODS:

The baseline visit was defined as the first at which both organ damage (SLICC/ACR Damage Index [SDI]) and health-related quality of life (Short-Form 36 [SF-36]) were assessed. Baseline SLICC-FI scores were calculated. Damage accrual was measured by the increase in SDI between the baseline assessment and the last study visit. Multivariable negative binomial regression estimated the association between baseline SLICC-FI values and the rate of increase in the SDI during follow-up, adjusting for relevant demographic and clinical characteristics.

RESULTS:

The 1549 SLE patients eligible for this analysis were mostly female (88.7%) with mean (standard deviation, SD) age 35.7 (13.3) years and median (interquartile range) disease duration 1.2 (0.9-1.5) years at baseline. Mean (SD) baseline SLICC-FI was 0.17 (0.08) with a range of 0-0.51. Over a mean (SD) follow-up of 7.2 (3.7) years, 653 patients (42.2%) had an increase in SDI. Higher baseline SLICC-FI values (per 0.05 increment) were associated with higher rates of increase in the SDI during follow-up (Incidence Rate Ratio [IRR] 1.19; 95% CI 1.13-1.25), after adjusting for age, sex, ethnicity/region, education, baseline SLEDAI-2K, baseline SDI, and baseline use of corticosteroids, antimalarials, and immunosuppressives.

CONCLUSION:

The SLICC-FI predicts damage accrual in incident SLE, which further supports the SLICC-FI as a valid health measure in SLE.

KEYWORDS:

Frailty; Organ damage; Systemic lupus erythematosus

PMID:
31631584
DOI:
10.1002/art.41144

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