Session Type: Abstract Submissions (ACR)
Background/Purpose: Clinical experience and some previous research suggest that patients with lupus who live in more socio-economically vulnerable conditions fair worse than other patients. We sought to identify factors associated with damage accrual using the Lupus Clinical Trials Consortium, Inc. (LCTC) Lupus Data Registry, a patient registry of SLE in 16 lupus centers in North America.
Methods: The LCTC Lupus Data Registry began enrollment in 2010. We compared lupus patients who had accumulated ≥2 points in the SLICC Damage Index (SDI) over 2 years to those who had not with respect to demographics, features of disease, and factors that may enhance socio-economic vulnerability. A Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between a ≥2 point change in SDI and factors that were statistically significant in a univariate analysis. A most parsimonious model was created using a backwards-selection process, keeping all variables in the multivariable model that had a p-value <0.10.
Results: 1,478 patients with documented SDI scores at both enrollment and follow-up contributed a total of 2,503 person-years of follow-up (mean 1.77 years). 91.4% were female, 37.4% were non-Hispanic Caucasian, 34.0% were non-Hispanic African-American, and 8.2% reported Hispanic ethnicity.
In univariate analysis, higher baseline damage, higher baseline lupus disease activity (SLEDAI), longer duration of SLE, and more ACR classification criteria were each associated with a ≥2point increase in SDI. Prior treatments with immunosuppressants or with high dose prednisone were also associated with damage accrual while hydroxychloroquine use at enrollment was protective against damage accrual.
Among socioeconomic characteristics, there was no association between rate of damage accrual and educational attainment, marriage status, and insurance status; however, a two-fold increase in the rate of damage accrual was observed for those not working compared to those who either were working or were students (RR 2.06, 95% CI 1.42-3.01). After adjusting for the other socioeconomic characteristics, this association remained (RR 2.34, 95% CI 1.53-3.56).
In the multivariable model, work was no longer significantly associated with the rate of damage accrual. Additional factors losing significance in the multivariable model included duration of SLE, number of ACR criteria, high dose prednisone, and prior immunosuppressant use. Baseline SDI (p<0.0001) and SLEDAI (p=0.0036) remained significantly associated with the rate of damage accrual.
Conclusion: Baseline SDI and SLE activity were associated with damage accrual. Socio-economic factors did not demonstrate independent associations, contrary to our perceived clinical experience. The cross-sectional relationship between work and damage may in fact be a result rather than a cause of severe illness and damage.
The authors would like to thank and acknowledge the Lupus Clinical Trials Consortium, Inc. (“LCTC”) for its financial support and for access to data in the LCTC Lupus Data Registry. The views expressed in this publication are those of the authors and LCTC is not responsible for its specific content.
M. E. B. Clowse,
J. M. Grossman,
J. T. Merrill,
M. D. Lockshin,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-damage-accrual-over-a-2-year-period-in-a-large-multi-racialethnic-lupus-cohort/