Background/Purpose: The aims of our study were to determine the cumulative prevalence of damage at baseline, 5 years and 10 years of follow-up, to identify factors associated with damage accrual and incident damage in a mexican-mestizo SLE inception cohort.

Methods: Patients fulfilling the ACR classification criteria for SLE were enrolled at inception and followed-up to 10 years at a tertiary care center in Mexico City. SLICC damage index (SDI) was measured annually. Damage was defined as an SDI score ≥1 and progression or incident damage as an increase of ≥1 in SDI score compared to baseline. We assessed disease characteristics, comorbidities, medication, autoantibodies profile, clinical and laboratory variables at baseline and follow up (FU). Univariate and multivariate analysis were performed.

Results: : Two hundred and twenty three patients were included (89.7% females, mean age 27.2±9.2 years), with a mean disease duration of 5.2 months at time of enrolment. At baseline, no damage was present in 200 patients (89.7%). During FU, 34 (15%) died and 48 (21%) were lost before 10 year assessment, so 141 were included for the analysis for incident damage. Eighty four (48.3%) and 88 patients (62.4%) accrued damage at 5 and 10 years, respectively. Among patients without damage at baseline, 75 (58.6%) developed damage and 53 (41.1%) remained damage free at 10 yrs. Patients with damage at enrolment were more likely to accrue damage at 5 and 10 years FU (p< 0.001 and p< 0.003). Lupus nephritis at baseline (p=0.014 and  p=0.01), lower C3 (p=0.004 and p< 0.008), lower serum albumin levels (p< 0.001 both), cyclophosphamide use (p=0.03) and a higher cumulative prednisone dose at 1 year (p=0.002 both) were more frequent in patients with damage at 5 and 10 years compared to patients with no damage. Patients with damage at 10 years showed at baseline higher SLEDAI-2K score (p=0.03), higher systolic blood pressure (p=0.006), lymphopenia (p=0.03) and lower antimalarial length usage (p=0.03), compared to patient with no damage. Patients with incident damage had higher systemic blood pressure (p=0.005), lymphopenia (p=0.03), low C3 levels (p< 0.002), higher baseline SLEDAI-2K score (p=0.03), renal activity (p=0.04) and higher prednisone cumulative dose at 1 year FU (p=0.0003). A higher prevalence of any anti-cardiolipin antibody positivity (< 0.001), low dose aspirin use (p=0.03), photosensitivity (p=0.03) and longer antimalarial use (p=0.03) were observed in patients free of damage at 10 years. In multivariate analysis, only photosenstivity (HR 0.52, 95% CI 0.3-0.90, p=0.02) and a higher GFR at baseline (HR 0.99, 95% CI 0.98-0.99) were inversely associated with incident damage at 10 years. Antimalarial usage was associated with a protective effect for damage accrual at 5 years (HR 0.99, 95% CI 0.98-0.99, p=0.01) but this effect did not persist at 10 years (HR 0.99, 95% CI 0.99-1.00, p=0.081) and for incident damage (HR 1.32, 95% CI 0.70-2.48, p=0.39).

Conclusion: Damage accrual was present in 10% of SLE patients at baseline, at 5 years of FU it progress to 48.3% and 62.4% at 10 years. Incident damage was observed in 58.6%. Photosensitivity and higher GFR at baseline were protective for incident damage in our cohort.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/progression-and-factors-associated-with-damage-accrual-in-a-sle-inception-cohort-of-hispanic-patients/