Background/Purpose: The annual accrual of comorbidities in patients with SLE is not well described.  We report the annual occurrence of these features in an inception cohort of patients with SLE.

Methods: An international research network comprised of 33 centres from 11 countries has followed an inception cohort of SLE patients yearly according to a standardized protocol between 2000 and 2016. Of these, 717 patients followed for a minimum of 8 years constitute the study population.  Comorbidities including atherosclerotic vascular events (AVEs), osteoporosis, osteonecrosis and diabetes are assessed using the SLICC/ACR Damage Index (SLICC/DI). AVEs are described and attributed on a specialized form. Diagnosis of an event is confirmed using standard clinical criteria, relevant laboratory data and imaging where appropriate. Attribution to atherosclerosis is made on the basis of lupus disease being inactive at the time of the event, and/or the presence of typical atherosclerosis (AS) changes on imaging or pathology and/or evidence of AS elsewhere. Diagnosis of osteoporosis is based on abnormal bone mineral density and osteonecrosis was based on joint symptoms associated with abnormal imaging consistent with osteonecrosis. Diabetes diagnosis is based on therapy, regardless of treatment type. Descriptive statistics were used.

Results: Of the 717 patients followed for at least 8 years, 90.2% were female, 47.3% were Caucasian, 13.8% were Black, 19.4% were Asian, 16.3% Hispanic and 3.2% other.  Their mean age at enrolment was 34.2±13.1 years and SLEDAI-2K at enrolment was 4.17±4.49. The duration from diagnosis to enrolment was 5.9±4.4 months. Table 1.  Cumulative SDI, AVEs, Osteoporosis, Osteonecrosis and Diabetes in the first 8 Years of Follow-up (n=717)

    Table 2. Cumulative Comorbidities by Year in Caucasians Compared to All Other Ethnicities

  Mean SDI gradually increases over 8 years. The accumulation of AVEs, osteoporosis, osteonecrosis and diabetes all increase progressively over an 8-year period.  Caucasians accumulate AVEs and osteoporosis more frequently than all “other” ethnicities. In contrast, all “other” ethnicities accumulate osteonecrosis more frequently than Caucasians. All ethnicities accumulate diabetes at the same frequency.

Conclusion: As expected disease damage and comorbidities in newly diagnosed patients increase over their first 8 years. Different ethnicities accumulate comorbidities at different rates