title: Predictors of damage progression in Portuguese patients with systemic lupus erythematosus.
abstract: Patients with systemic lupus erythematosus (SLE) have a longer life expectancy. The occurrence of irreversible damage has become a major concern. The present study assessed damage progression in patients with SLE over a 2-year period and identified baseline features associated with damage accrual. Two hundred and twenty-one patients that fulfilled criteria for SLE and had a follow-up longer than 6 months were enrolled. Demographic, clinical, and immunological data were collected at baseline. Accumulated organ damage was scored using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI). Patients were prospectively followed and SDI assessment repeated at 2 years. At baseline 72 patients (33%) presented some irreversible damage, and after 2 years 53 had accrued new damage. The mean SDI for the whole cohort increased from 0.582 to 0.980. Damage progression was higher in ocular, cardiovascular, and musculoskeletal systems. Older age [OR = 1.045; 95% confidence interval (CI) 1.021-1.069; P = 0.03], presence of antiphospholipid antibodies (OR = 3.047; 95% CI 1.169-7.941; P = 0.02), steroid use (OR = 6.401; 95% CI 1.601-25.210; P = 0.008), azathioprine use (OR = 3.501; CI 1.224-10.012; P = 0.01), and hypertension (OR = 3.825; 95% CI 1.490-9.820; P = 0.005) were predictors of damage progression in multivariate analysis. Overall SDI increased over time, with some systems being affected more frequently. Demographic and clinical characteristics, co-morbidity, and treatment options may contribute to irreversible damage. It is necessary to determine whether the control of modifiable factors (e.g., hypertension and judicious use of medications) might prevent damage progression in SLE patients.
authors.affiliation: Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal. mjps@netvisao.pt
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Santos
authors.forename: Filipe
authors.initials: F
authors.lastname: Vinagre
authors.forename: Patrícia
authors.initials: P
authors.lastname: Nero
authors.forename: Filipe
authors.initials: F
authors.lastname: Barcelos
authors.forename: Anabela
authors.initials: A
authors.lastname: Barcelos
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Rodrigues
authors.forename: António Alves
authors.initials: AA
authors.lastname: de Matos
authors.forename: Cândida
authors.initials: C
authors.lastname: Silva
authors.forename: Luis
authors.initials: L
authors.lastname: Miranda
authors.forename: Susana
authors.initials: S
authors.lastname: Capela
authors.forename: Aurora
authors.initials: A
authors.lastname: Marques
authors.forename: Jaime
authors.initials: J
authors.lastname: Branco
authors.forename: José Canas
authors.initials: JC
authors.lastname: da Silva
mesh_terms: D000328:Adult; D000368:Aged; D017152:Antibodies, Antiphospholipid / Q000276:immunology; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000453:epidemiology* / Q000473:pathology; D011174:Portugal / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D017152:Antibodies, Antiphospholipid