title: Birmingham SLE cohort: outcomes of a large inception cohort followed for up to 21 years.
abstract: OBJECTIVE
  The aim of this study was to describe the outcomes and predictors for development of damage in a large inception cohort of SLE patients.
  
  
  METHODS
  This was a prospective longitudinal study of a cohort of SLE patients. SLE patients were included if they were recruited within 3 years of achieving the fourth ACR criterion for SLE. Data were collected on disease activity, damage and treatment. Information on death was provided by the Office for National Statistics. The censoring date for analysis was 31 December 2010. A standardized mortality ratio was calculated. Poisson regression was used to determine the incidence rate for damage accrual. Multistate Markov modelling was used to determine predictors for development of damage.
  
  
  RESULTS
  There were 382 patients (92.4% females, 51.6% Caucasian, 22% South Asian, 20.7% Afro-Caribbean) with 12 072 assessments and total follow-up of 2958 patient-years. There were 300 items of damage (in 143 patients) and 37 deaths. The overall standardized mortality ratio was 2.0 (95% CI 1.5, 2.8) and the most common causes of death were infection (37.8%), cardiovascular (27%) and malignancy (13.5%). The predictors for damage accrual were higher prior damage, older age at diagnosis, active disease, systemic corticosteroid exposure and CYC exposure. Patients were more likely to develop new damage earlier in their disease than later. Ethnicity was not predictive of damage accrual or death in this cohort.
  
  
  CONCLUSIONS
  SLE patients have premature mortality. Active disease, corticosteroid exposure and CYC exposure were independently associated with the development of damage. Damage accrual is more likely to occur in early disease.
authors.affiliation: Department of Rheumatology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, MRC Biostatistics Unit, University of Cambridge, Cambridge, UK, Rheumatology Research Group, University of Birmingham, Department of Rheumatology, Sandwell and West Birmingham NHS Trust and Department of Rheumatology, Queen Elizabeth Hospital Birmingham, Birmingham, UK csyee@ymail.com.
authors.forename: Chee-Seng
authors.initials: CS
authors.lastname: Yee
authors.affiliation: Department of Rheumatology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, MRC Biostatistics Unit, University of Cambridge, Cambridge, UK, Rheumatology Research Group, University of Birmingham, Department of Rheumatology, Sandwell and West Birmingham NHS Trust and Department of Rheumatology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Li
authors.initials: L
authors.lastname: Su
authors.affiliation: Department of Rheumatology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, MRC Biostatistics Unit, University of Cambridge, Cambridge, UK, Rheumatology Research Group, University of Birmingham, Department of Rheumatology, Sandwell and West Birmingham NHS Trust and Department of Rheumatology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Veronica
authors.initials: V
authors.lastname: Toescu
authors.affiliation: Department of Rheumatology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, MRC Biostatistics Unit, University of Cambridge, Cambridge, UK, Rheumatology Research Group, University of Birmingham, Department of Rheumatology, Sandwell and West Birmingham NHS Trust and Department of Rheumatology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Hickman
authors.affiliation: Department of Rheumatology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, MRC Biostatistics Unit, University of Cambridge, Cambridge, UK, Rheumatology Research Group, University of Birmingham, Department of Rheumatology, Sandwell and West Birmingham NHS Trust and Department of Rheumatology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Deva
authors.initials: D
authors.lastname: Situnayake
authors.affiliation: Department of Rheumatology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, MRC Biostatistics Unit, University of Cambridge, Cambridge, UK, Rheumatology Research Group, University of Birmingham, Department of Rheumatology, Sandwell and West Birmingham NHS Trust and Department of Rheumatology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Bowman
authors.affiliation: Department of Rheumatology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, MRC Biostatistics Unit, University of Cambridge, Cambridge, UK, Rheumatology Research Group, University of Birmingham, Department of Rheumatology, Sandwell and West Birmingham NHS Trust and Department of Rheumatology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Vernon
authors.initials: V
authors.lastname: Farewell
authors.affiliation: Department of Rheumatology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, MRC Biostatistics Unit, University of Cambridge, Cambridge, UK, Rheumatology Research Group, University of Birmingham, Department of Rheumatology, Sandwell and West Birmingham NHS Trust and Department of Rheumatology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Gordon
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D003520:Cyclophosphamide
keywords: SLE; damage; disease activity; inception cohort; mortality; therapy