Chronological Analysis of Damage Accrual in Patientes with Systemic Lupus Erythematosus: Results from the Spanish Registry of Patients with SLE of the Spanish Society of Rheumatology (RELESSER)

JM Pego-Reigosa^1,2, Ana Lois-Iglesias³, Coral Mouriño-Rodriguez⁴, Francisco Javier López Longo⁵, Maria Galindo Izquierdo⁶, Jaime Calvo-Alen⁷, Jacobo de Uña⁸, Vanessa Balboa⁹, Alejandro Olivé¹⁰, Maria Teresa Oton Sanchez¹¹, Jesus Ibañez¹², Maria Loreto Horcada¹³, Ana Sánchez Atrio¹⁴, Carlos Alberto Montilla Morales¹⁵, Rafael-Benito Melero González⁴, Víctor Martínez Taboada¹⁶, Elvira DIez¹⁷, Mónica Fernández de Castro¹⁸, Esther Ruiz Lucea¹⁹, José Hernández Beiraín²⁰, Marian Gantes²¹, Blanca Hernández-Cruz²², Angela Pecondon-Español²³, Nuria Lozano-Rivas²⁴, Gema Bonilla²⁵, Vicente Torrente-Segarra²⁶, Iñigo Rúa-Figueroa²⁷ and RELESSER-EASSER, ¹Rheumatology Section, Hospital de Meixoeiro, Pontevedra, Spain, Vigo, Spain, ²Rheumatology, Instituto de Investigación Biomédica de Vigo(IBIV), Vigo, Spain, ³Rheumatology, University Hospital A Coruña, A Coruña, Spain, ⁴Rheumatology, EOXI Vigo, Vigo, Spain, ⁵Rheumatology, Hospital Gregorio Marañón, Madrid, Spain, ⁶Sociedad Española de Reumatología, Grupo EAS-SER, Spain, Spain, ⁷Rheumatology, Txagorritxu Hospital, Araba, Vitoria, Vitoria, Spain, ⁸Statistics and OR, Vigo University, Vigo, Spain, ⁹Statistics and OR, Viho University, Vigo, Spain, ¹⁰Rheumatology, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain, ¹¹Rheumatology Department. Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain, ¹²Rheumatology, Hospital Povisa, Vigo, Spain, ¹³Rheumatology, Complejo Hospitalario de Navarra, Pamplona, Spain, ¹⁴University Hospital Príncipe de Asturias, Immune System Diseases, Rheumatology department, Alcalá de Henares, Madrid, Spain, ¹⁵Rheumatology, HOSPITAL CLÍNICO UNIVERSITARIO DE SALAMANCA, Salamanca, Spain, ¹⁶Rheumatology, Hospital Marqués de Valdecilla, Santander, Spain, ¹⁷Hospital de León, León, Spain, ¹⁸Hospital Puerta de Hierro, Madrid, Spain, ¹⁹Hospital de Basurto, Bilbao, Spain, ²⁰Rheumatology, Hospital Insular de Gran Canaria, Las palmas Gran Canarias, Spain, ²¹Rheumatology, Hospital Universitario de Canarias, La Laguna; Tenerife, Spain, ²²Rheumatology, Hospital Universitario Virgen Macarena, Sevilla, Spain, ²³Rheumatology, Hospital Miguel Servet, Zaragoza, Spain, ²⁴Rheumatology, Hospital Virgen de la Arrixaca, Murcia, Spain, ²⁵Rheumatology, Hospital La Paz - IdiPaz, Madrid, Spain, ²⁶Hospital de L'Hospitalet, L'Hospitalet de Llobregat, Spain, ²⁷Rheumatology Division, Hospital Doctor Negrin, Las Palmas GC, Spain

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: registry and systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 14, 2016

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster II: Damage Accrual and Quality of Life

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Mortality in systemic lupus erythematosus (SLE) has improved over the last decades. Outcome measures as damage became more important. Objectives: To study the manifestations of damage from the point of view of the timing of its appearance.

Methods: In the first transverse phase of RELESSER, accumulated information on 400 variables per patient at the time of the last evaluation was collected. Among these SLICC/ACR Damage Index (SDI) items were included. We evaluated damage manifestations in each system and the temporal relationship of their appearance with the time of diagnosis of SLE. Cumulative incidence function for damage by the Aalen-Johansen method was estimated. Bootstrap technique was used to calculate the p-values to compare rates os accumulation of damage over time.The impact on mortality was studied controlling for sex, race, age at diagnosis and delay of diagnosis of SLE, with a model of multivariate Cox regression. The rate of increase or accumulation of damage is significantly higher (p<0.001) higher short time after SLE diagnosis. The proportion of patients with damage in at least 1 system at 5 and 10 years was 18.9% (17.3-20.4) and 29.2% (27.3-31.1). That is while in the 1^st year 7.4% of patients present damage in any system, only 2.9% per year do so since the 1^st to the 5^th year after diagnosis and, between the 5^th and 10^th year there was only an annual increase of damage of 2.1%. The risk of death is multiplied by 2.04 (1.7-2.3) at the time that a new system is damaged. When entering into a multivariate model the damage in each systems a statistically significant impact on neuropsychiatric, renal, pulmonary, CV systems and malignancy was found, with multiplicative risk factors of 2.0, 1.8, 2.8, 1.7 and 2.7, respectively.

Results: 2,662 SLE patients had the dates of presentation of each event of damage: 2,417 (91.0%) women, 2,402 (92.8%) Caucasian, mean age (±SD) 34.0 (±13.6) years at the time of diagnosis. The mean follow-up duration was 115.6 (±50.8) months and 112 (4.2%) patients died. At the time of the study 917 (34.4%) patients had at least 1 manifestation of damage, the average number systems per patient with at least 1 manifestation of damage was 0.54 (±0.92) and the average score was 0.65 SDI (±1.2). The systems more frequently damaged were musculoskeletal (MS) (11.9%), ophtalmic (7.8%) and cardiovascular (CV) (5.9%). In the 1^st year after SLE diagnosis, the cumulative incidence (CI 95%) of damage in at least 1 system was estimated in 7.4% (6.4-8.4), at 5 years 18.9% (17.3-20.4) and after more than 10 years 29.2% (27.3-31.1).The systems damaged at earlier stages, 1 year after SLE diagnosis, were: MS 1.7% (1.2-2.2), neuropsychiatric 1.3% (0.8-1.7) and renal 1.2% (0.8-1.6). The CV and cutaneous systems also had relatively early damage, 0.9% (0.6-1.3) and 0.8% (0.5-1.2) respectively.

Conclusion:

Damage occurs already in early stages of the disease. It appears early in MS, neuropsychiatric and kidneys. The increase or accumulation of damage is greater in the 1st year after the diagnosis of SLE. The accumulation of visceral damage increases the mortality rate.

Disclosure: J. Pego-Reigosa, None; A. Lois-Iglesias, None; C. Mouriño-Rodriguez, None; F. J. López Longo, None; M. Galindo Izquierdo, None; J. Calvo-Alen, None; J. de Uña, None; V. Balboa, None; A. Olivé, None; M. T. Oton Sanchez, None; J. Ibañez, None; M. L. Horcada, None; A. Sánchez Atrio, None; C. A. Montilla Morales, None; R. B. Melero González, None; V. Martínez Taboada, None; E. DIez, None; M. Fernández de Castro, None; E. Ruiz Lucea, None; J. Hernández Beiraín, None; M. Gantes, None; B. Hernández-Cruz, None; A. Pecondon-Español, None; N. Lozano-Rivas, None; G. Bonilla, None; V. Torrente-Segarra, None; I. Rúa-Figueroa, None.

To cite this abstract in AMA style:

Pego-Reigosa J, Lois-Iglesias A, Mouriño-Rodriguez C, López Longo FJ, Galindo Izquierdo M, Calvo-Alen J, de Uña J, Balboa V, Olivé A, Oton Sanchez MT, Ibañez J, Horcada ML, Sánchez Atrio A, Montilla Morales CA, Melero González RB, Martínez Taboada V, DIez E, Fernández de Castro M, Ruiz Lucea E, Hernández Beiraín J, Gantes M, Hernández-Cruz B, Pecondon-Español A, Lozano-Rivas N, Bonilla G, Torrente-Segarra V, Rúa-Figueroa I. Chronological Analysis of Damage Accrual in Patientes with Systemic Lupus Erythematosus: Results from the Spanish Registry of Patients with SLE of the Spanish Society of Rheumatology (RELESSER) [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/chronological-analysis-of-damage-accrual-in-patientes-with-systemic-lupus-erythematosus-results-from-the-spanish-registry-of-patients-with-sle-of-the-spanish-society-of-rheumatology-relesser/. Accessed .

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