Session Information
Date: Tuesday, November 10, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Preventing organ damage is a major challenge in management of Systemic Lupus Erythematosus (SLE). Few data are available on factors related to development of damage in early stages of the disease. This study aim to evaluate the early damage accrual and factors associated with development of damage in the Early Lupus Project, a prospectively followed-up inception cohort of SLE patients diagnosed within 12 months since fulfillment of four or more 1997 ACR classification criteria
Methods:
The development and progression of damage assessed by the SLICC/ACR Damage Index (SDI) were prospectively recorded during the first year of the disease. SDI represent irreversible damage occurred after onset of SLE and being present for at least 6 months; by definition, it scores 0 at disease onset.
Using univariate analysis, we assessed the contribution of covariates collected at baseline (demographic, serological, clinical by BILAG2004 domains, disease activity by ECLAM index) in the development of damage (SDI from 0 to ≥1) within 12 months since disease onset. Stepwise regression models were fitted with covariates with p<0.1 to identify factors independently associated with development of damage.
Results:
A total of 119 patients (93.3% Caucasians, 18 males) were eligible for this study having available data at 12 months of disease. Mean age and mean disease duration since recognition of 4 ACR criteria were 36.7±14.1 years and 2.5±3.9 months (median = 1 month; IR 0-3.1), respectively. Twenty-eight (23.5%) and 31 (26.0%) patients, had an SDI score ≥1 after 6 and 12 months since disease onset (Table 1), respectively.
Univariate analysis revealed that dyslipidemia (p=0.01), anti-Beta2glicoproteinI antibodies positivity (p=0.01), active cardiorespiratory involvement (p=0.02) and high disease activity calculated by ECLAM (p=0.05) registered at baseline were associated with development of damage. However, older age at diagnosis (p<0.01; OR 1.1 95% CI 1.0-1.3), higher number of active BILAG2004 clinical domain (p<0.01; OR 1.7 95% CI 1.2 – 2.4) and neuropsychiatric involvement at baseline (p<0.01; OR 6.7 95% CI 1.4-32.2) were the only independent risk factors for early development of damage in this cohort.
No influence of active renal involvement and medications prescribed at baseline was detected in our cohort, likely because they most contribute to development of late-onset damage.
Table 1. Distribution at 6 and 12 months and prevalence of organ damage stratified according to the SDI domains at 12 months of disease.
|
|
Prevalence (patients) |
|
SLICC 6 Months (median; IR range) SLICC = 0 SLICC = 1 SLICC > 1 |
0 (0-0) 76.5% (91) 16.8% (20) 6.7% (8) |
|
SLICC 12 Months (median; IR range) SLICC = 0 SLICC = 1 SLICC > 1 |
0 (0-1) 73.9% (88) 18.5% (22) 7.6% (9) |
|
SDI domains Neuropsychiatric Cerebrovascular accident Cognitive impairment Peripheral neuropathy Psychosis |
10.1% (12) 5.9% (7) 3.4% (4) 1.7% (2) 0.8% (1) |
|
Ocular Cataract Retinal change |
5.9% (7) 3.4% (4) 2.5% (3) |
|
Miscellanea Malignancy Diabetes |
5.0% (6) 4.2% (5) 0.8% (1) |
|
Cardiac Pericarditis or pericardiectomy Myocardial infarction Valvular disease |
3.4% (4) 1.7% (2) 0.8% (1) 0.8% (1) |
|
Peripheral Vascular Venous thrombosis with swelling, ulceration |
3.4% (4) 3.4% (4) |
|
Pulmonary Pleural fibrosis Pulmonary fibrosis |
2.5% (3) 2.5% (3) 0.8% (1) |
|
Musculoskeletal Deforming or erosive arthritis Muscle atrophy or weakness |
2.5% (3) 1.7% (2) 0.8% (1) |
|
Renal Proteinuria ≥3.5 gm/24hours Estimated or measured glomerular filtration rate<50% |
2.5% (3) 1.7% (2) 0.8% (1) |
|
Mucocutaneous Scarring chronic alopecia |
1.7% (2) 1.7% (2) |
|
Gastrointestinal |
0 |
Conclusion:
Development of organ damage begins early in patients with SLE. In order to prevent damage accrual in the early stage of SLE it is necessary to identify which clinical manifestations and risk factors are associated with it.
To cite this abstract in AMA style:
Piga M, Figus F, Bellisai F, Bettio S, Bortoluzzi A, Coladonato L, Conti F, Doria A, Galeazzi M, Govoni M, Iannone F, Iuliano A, Mosca M, Prevete I, Sebastiani GD, Spinelli FR, Tani C, Mathieu A. Factors Associated with Early Damage Accrual in Patients with Systemic Lupus Erythematosus: 12-Month Preliminary Results from the Inception Cohort of the Multicenter Early Lupus Project [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/factors-associated-with-early-damage-accrual-in-patients-with-systemic-lupus-erythematosus-12-month-preliminary-results-from-the-inception-cohort-of-the-multicenter-early-lupus-project/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-early-damage-accrual-in-patients-with-systemic-lupus-erythematosus-12-month-preliminary-results-from-the-inception-cohort-of-the-multicenter-early-lupus-project/