title: Characterization of damage in Portuguese lupus patients: analysis of a national lupus registry.
abstract: BACKGROUND
  Although the survival rate has considerably improved, many patients with systemic lupus erythematosus (SLE) develop irreversible organ damage.
  
  
  OBJECTIVE
  The objectives of this paper are to characterize cumulative damage in SLE patients and identify variables associated with its presence and severity.
  
  
  METHODS
  A cross-sectional analysis of SLE patients from the Portuguese Lupus register Reuma.pt/SLE in whom damage assessment using the SLICC/ACR-Disability Index (SDI) was available was performed. Predictor factors for damage, defined as SDI ≥ 1, were determined by logistic regression analyses. A sub-analysis of patients with severe damage (SDI ≥ 3) was also performed.
  
  
  RESULTS
  In total, 976 patients were included. SDI was ≥1 in 365 patients, of whom 89 had severe damage. Musculoskeletal (24.4%), neuropsychiatric (24.1%) and ocular (17.2%) domains were the most commonly affected. Older age, longer disease duration, renal involvement, presence of antiphospholipid antibodies and current therapy with steroids were independently associated with SDI ≥ 1. The subpopulation with severe damage had, in addition, a greater interval between the first manifestation attributable to SLE and the clinical diagnosis as well as and more frequently early retirement due to SLE.
  
  
  CONCLUSIONS
  This large lupus cohort confirmed that demographic and clinical characteristics as well as medication are independently associated with damage. Additionally, premature retirement occurs more often in patients with SDI ≥ 3. Diagnosis delay might contribute to damage accrual.
authors.affiliation: Hospital de Santa Maria, Lisboa, Portugal Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal.
authors.forename: M J
authors.initials: MJ
authors.lastname: Gonçalves
authors.affiliation: Hospital Garcia de Orta, Almada, Portugal sandrainsousa@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Sousa
authors.affiliation: Hospitais da Universidade de Coimbra, Coimbra, Portugal.
authors.forename: L S
authors.initials: LS
authors.lastname: Inês
authors.affiliation: Hospitais da Universidade de Coimbra, Coimbra, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Duarte
authors.affiliation: Instituto Português de Reumatologia, Lisboa, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Borges
authors.affiliation: Instituto Português de Reumatologia, Lisboa, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Silva
authors.affiliation: Hospital de Santa Maria, Lisboa, Portugal Hospital Garcia de Orta, Almada, Portugal.
authors.forename: V C
authors.initials: VC
authors.lastname: Romão
authors.affiliation: Hospital de São João, Porto, Portugal.
authors.forename: G
authors.initials: G
authors.lastname: Terroso
authors.affiliation: Hospital de São João, Porto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Bernardes
authors.affiliation: Hospital Conde de Bertiandos, Ponte de Lima, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Cerqueira
authors.affiliation: Hospital Conde de Bertiandos, Ponte de Lima, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Raposo
authors.affiliation: Hospital de Faro, Faro, Portugal.
authors.forename: G
authors.initials: G
authors.lastname: Sequeira
authors.affiliation: Hospital de Aveiro, Aveiro, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Barcelos
authors.affiliation: Hospital de Santa Maria, Lisboa, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Macieira
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Canas da Silva
authors.affiliation: Hospital de São João, Porto, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Costa
authors.affiliation: Hospital de Santa Maria, Lisboa, Portugal.
authors.forename: J A
authors.initials: JA
authors.lastname: Pereira da Silva
authors.affiliation: Instituto Português de Reumatologia, Lisboa, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Cunha-Miranda
authors.affiliation: Hospitais da Universidade de Coimbra, Coimbra, Portugal.
authors.forename: J A P
authors.initials: JA
authors.lastname: Da Silva
authors.affiliation: Hospital de Santa Maria, Lisboa, Portugal Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal.
authors.forename: H
authors.initials: H
authors.lastname: Canhão
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal Hospital Garcia de Orta, Almada, Portugal.
authors.forename: M J
authors.initials: MJ
authors.lastname: Santos
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D012042:Registries; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000962:Antimalarials
keywords: Portugal; Reuma.pt; Systemic lupus erythematosus