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 1st year 7.4% of patients present damage in any system, only 2.9% per year do so since the 1st to the 5th year after diagnosis and, between the 5th and 10th 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 1st 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.
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 October 31, 2020.
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ACR Meeting Abstracts - 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/