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Early damage in SLE patients predicted future damage

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SAN DIEGO — Early damage in patients with systemic lupus erythematosus was predictive of future damage and mortality, with many of the risk factors being potentially modifiable, according to research presented at the American College of Rheumatology annual meeting.

“Early tissue and organ damage … can predict the likelihood of future damage and death due to the disease,” researcher Ian N. Bruce, MD, FRCP, rheumatology professor at the University of Manchester, UK, said in a press release.

Bruce and colleagues recruited 1,722 patients with systemic lupus erythematosus (SLE; mean age, 35 years) between 2000 and 2011 from 11 countries in North America, Europe and Asia. Systemic Lupus International Collaborating Clinics (SLICC)/ACR damage index (SDI) was used to measure damage.

Maximum likelihood estimation was used to measure relative rates of transmission. Probabilities relating to time until the first worsening of SDI score were estimated using Kaplan-Meir method.

Six hundred patients (34.8%) had at least one item of damage at baseline; at 6 years of follow-up 51.1% of patients had damage. Researchers analyzed 1,502 patients (89% female) for SDI change during the study period. Patients with at least one item of damage were more likely to increase SDI at each follow-up visit (P<.01).

Age, African-American race/ethnicity, SLE Disease Activity Index score, steroid use and hypertension were associated with increasing damage. Male sex and US Caucasian race/ethnicity were associated with new damage for transition from SDI 0 to >1 (relative transition rate [RTR]=1.48; 95% CI, 1.06-2.07; RTR=1.63; 95% CI, 1.08-2.46, respectively), while Asian race/ethnicity was associated with lower rates of new damage (RTR=0.6; 95% CI, 0.39-0.93).

Patients treated with antimalarials reduced the increase of pre-existing damage (RTR=0.63; 95% CI, 0.44-0.89). Increased death risk had an association with each 1-point increase in SDI (HR=1.46; 95% CI, 1.18-1.81).

“This study shows that irreversible damage develops steadily over time in lupus patients and starts early in the course of the disease,” Bruce said “Many of the risk factors we have identified, such as high blood pressure, use of steroids and ongoing disease activity could potentially be modified. Clinical trials should test whether we can improve the long-term health of SLE patients by specifically targeting these risk factors in our patients.”

Disclosure: See the abstract for a full list of relevant disclosures.

For more information:

Bruce IN. #2896: Damage in Systemic Lupus Erythematosus Is a Potentially Modifiable Outcome: Results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. Presented at: the 2013 American College of Rheumatology Annual Meeting; Oct. 26-30, San Diego.