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

Ann Rheum Dis 2015 Sep 16;74(9):1706-13. Epub 2014 May 16.

Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.

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.

Download full-text PDF

Source
http://ard.bmj.com/content/early/2014/05/16/annrheumdis-2013
Web Search
http://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2013-20517
Publisher Site
http://dx.doi.org/10.1136/annrheumdis-2013-205171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552899PMC
September 2015
95 Reads

Publication Analysis

Top Keywords

systemic lupus
16
international collaborating
8
lupus erythematosus
8
collaborating clinics
8
clinics slicc
8
inception cohort
8
slicc inception
8
lupus international
8
damage accrual
8
damage
5
american college
4
maximum likelihood
4
transition maximum
4
likelihood estimation
4
estimation multistate
4
method estimated
4
estimated probabilities
4
kaplan-meier method
4
model kaplan-meier
4
multistate model
4

References

(Supplied by CrossRef)
Outcome measures to be used in clinical trials in systemic lupus erythematosus
Strand et al.
J Rheumatol 1999
The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index for Systemic Lupus Erythematosus International Comparison
Gladman et al.
J Rheumatol 2000
High predictive value of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for survival in systemic lupus erythematosus
Nived et al.
J Rheumatol 2002
Accrual of organ damage over time in patients with systemic lupus erythematosus
Gladman et al.
J Rheumatol 2003
The rate and pattern of organ damage in late onset systemic lupus erythematosus
Maddison et al.
J Rheumatol 2002

Similar Publications