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

Ian N. Bruce*, Aidan G. O'Keeffe, Vern Farewell, John G. Hanly, Susan Manzi, Li Su, Dafna D. Gladman, Sang Cheol Bae, Jorge Sanchez-Guerrero, Juanita Romero-Diaz, Caroline Gordon, Daniel J. Wallace, Ann E. Clarke, Sasha Bernatsky, Ellen M. Ginzler, David A. Isenberg, Anisur Rahman, Joan T. Merrill, Graciela S. Alarcón, Barri J. FesslerPaul R. Fortin, Michelle Petri, Kristjan Steinsson, Mary Anne Dooley, Munther A. Khamashta, Rosalind Ramsey-Goldman, Asad A. Zoma, Gunnar K. Sturfelt, Ola Nived, Cynthia Aranow, Meggan Mackay, Manuel Ramos-Casals, Ronald F. Van Vollenhoven, Kenneth C. Kalunian, Guillermo Ruiz-Irastorza, Sam Lim, Diane L. Kamen, Christine A. Peschken, Murat Inanc, Murray B. Urowitz

*Corresponding author for this work

Research output: Contribution to journalArticle

170 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1706-1713
Number of pages8
JournalAnnals of the Rheumatic Diseases
Volume74
Issue number9
DOIs
StatePublished - Sep 1 2015

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

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    Bruce, I. N., O'Keeffe, A. G., Farewell, V., Hanly, J. G., Manzi, S., Su, L., Gladman, D. D., Bae, S. C., Sanchez-Guerrero, J., Romero-Diaz, J., Gordon, C., Wallace, D. J., Clarke, A. E., Bernatsky, S., Ginzler, E. M., Isenberg, D. A., Rahman, A., Merrill, J. T., Alarcón, G. S., ... Urowitz, M. B. (2015). Factors associated with damage accrual in patients with systemic lupus erythematosus: Results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. Annals of the Rheumatic Diseases, 74(9), 1706-1713. https://doi.org/10.1136/annrheumdis-2013-205171