New organ damage more common in lupus’ early stages; musculoskeletal system most impacted
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Key takeaways:
- The first year after systemic lupus erythematosus diagnosis brings the greatest risks for new organ damage.
- Musculoskeletal was among the most impacted systems both early and late in the disease.
Most new organ damage in systemic lupus erythematosus occurs in the first year after diagnosis, with the greatest impacts reported in the cardiovascular and musculoskeletal systems, according to data published in Lupus Science & Medicine.
“Damage is an irreversible clinical feature that occurs after diagnosis in SLE,” Irene Altabás-González, MD, PhD, a rheumatologist at the Vigo University Hospital Group, in Spain, and colleagues wrote.
“Although some reports describe damage occurring during the early stages of the disease, they involved small samples or short follow-up periods,” they added. “In addition, few data are available on the timing of damage manifestations across the different [Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology Damage Index (SDI)] domains during the course of the disease.”
To assess damage to organ systems over time in patients with SLE, Altabás-González and colleagues conducted a national, multicenter, descriptive study using patient data from the lupus registry of the Spanish Rheumatology Society. Their analysis included 4,219 patients with SLE (mean age at diagnosis, 35.9 years).
The researchers assessed organ damage using each domain of the SDI, as well as globally, and assessed the data against the amount of time that had passed since SLE diagnosis. Damage was considered early if it occurred within 5 years from SLE diagnosis and late if it occurred after 5 years. The longitudinal analysis was conducted for 1,274 patients with the dates of their damage events recorded.
According to the results, 20% of the 1,274 patients demonstrated new damage manifestations in the first year after SLE diagnosis. New damage was less common afterward, occurring in 11% of patients at year 2, 9% at year 3, and 5% after year 5.
The musculoskeletal system was the most impacted in the first year after diagnosis, occurring in 21% of patients presenting new damage, followed by neuropsychiatric (17%), renal (15%), cardiovascular (13%) and pulmonary (13%) damage. By years 10 and 15, the musculoskeletal, ocular and cardiovascular systems were among the most frequently affected.
Noting their “cardiovascular origin,” the researchers also tested what would happen when they moved “cerebrovascular accidents” and “claudication for 6 months” from other systems into the cardiovascular domain. With the adjustment, the cardiovascular system became the second-most impacted system during early SLE, presenting damage in 19% of patients 1 year after diagnosis. By year 20, 25% of patients presenting new damage did so in this modified cardiovascular domain.
“It is imperative to better understand damage in patients with SLE, since any intervention aimed at preventing onset and/or progression will likely help reduce mortality, both in the early and in the late stages of the disease,” Altabás-González and colleagues wrote. “Our study of a large cohort of patients with SLE demonstrates that the first year after diagnosis is crucial, with the greatest percentage of patients with damage recorded within that period. The cardiovascular system is one of the most affected during the earliest stages of the disease.
“As more pronounced disease activity and higher glucocorticoid doses are common features during the early stages, minimizing activity via therapeutic strategies that prioritize rapid glucocorticoid dose tapering at the start of treatment should prevent damage,” they added. “These strategies, as well as interventions to reduce the cardiovascular burden, should be implemented immediately after diagnosis of SLE.”
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