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Journal article
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, v 74(9), pp 1706-1713
01 Sep 2015
PMID: 24834926
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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.
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Details
- Title
- Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort
- Creators
- Ian N. Bruce - University of ManchesterAidan G. O'KeeffeVern Farewell - Biostat (United States)John G. Hanly - College Station Medical CenterSusan Manzi - College Station Medical CenterLi Su - Biostat (United States)Dafna D. Gladman - Toronto Western Hosp, Ctr Prognosis Studies Rheumat Dis, Toronto, ON M5T 2S8, CanadaSang-Cheol Bae - Hanyang UniversityJorge Sanchez-Guerrero - Toronto Western Hosp, Ctr Prognosis Studies Rheumat Dis, Toronto, ON M5T 2S8, CanadaJuanita Romero-Diaz - College Station Medical CenterCaroline Gordon - University of BirminghamDaniel J. Wallace - College Station Medical CenterAnn E. Clarke - University of CalgarySasha Bernatsky - McGill UniversityEllen M. Ginzler - College Station Medical CenterDavid A. Isenberg - UCL, Ctr Rheumatol Res, London, EnglandAnisur Rahman - UCL, Ctr Rheumatol Res, London, EnglandJoan T. Merrill - College Station Medical CenterGraciela S. Alarcon - University of AlabamaBarri J. Fessler - University of AlabamaPaul R. Fortin - Ctr Hosp Univ Quebec, Div Rheumatol, Quebec City, PQ, CanadaMichelle Petri - Johns Hopkins UniversityKristjan Steinsson - Landspitali Univ Hosp, Ctr Rheumatol Res, Reykjavik, IcelandMary Anne Dooley - College Station Medical CenterMunther A. Khamashta - College Station Medical CenterRosalind Ramsey-Goldman - Northwestern UniversityAsad A. Zoma - Hairmyres Hosp, Lanarkshire Ctr Rheumatol, E Kilbride, Lanark, ScotlandGunnar K. Sturfelt - Univ Lund Hosp, Dept Rheumatol, S-22185 Lund, SwedenOla Nived - Univ Lund Hosp, Dept Rheumatol, S-22185 Lund, SwedenCynthia Aranow - College Station Medical CenterMeggan Mackay - College Station Medical CenterManuel Ramos-Casals - Hosp Clin Barcelona, Dept Autoimmune Dis, IDIBAPS, Josep Font Autoimmune Dis Lab, Barcelona, SpainRonald F. van Vollenhoven - Karolinska InstitutetKenneth C. Kalunian - College Station Medical CenterGuillermo Ruiz-Irastorza - University of the Basque CountrySam Lim - Emory UniversityDiane L. Kamen - College Station Medical CenterChristine A. Peschken - University of ManitobaMurat Inanc - Istanbul UniversityMurray B. Urowitz - Toronto Western Hosp, Ctr Prognosis Studies Rheumat Dis, Toronto, ON M5T 2S8, Canada
- Publication Details
- Annals of the rheumatic diseases, v 74(9), pp 1706-1713
- Publisher
- Bmj Publishing Group
- Number of pages
- 8
- Grant note
- MC_U105261167 / MRC; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) manmkbru-2012-1 / National Institutes of Health Research (NIHR)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000359378100019
- Scopus ID
- 2-s2.0-84924190291
- Other Identifier
- 991021933903804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology