title: Damage in the Multiethnic Malaysian Systemic Lupus Erythematosus (SLE) Cohort: Comparison with Other Cohorts Worldwide.
abstract: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease and despite the improvement in the survival in the past few decades, the morbidity due to disease damage remains significant. The objectives of this study were to investigate the disease damagepattern and determine the associated factors of damage in the multi-ethnic Malaysian SLE patients. We consecutively 424SLE patients who attended a consistent follow-up at the National University of Malaysia Medical Centre and Putrajaya Hospital were recruited. Disease damage was assessed using the SLICC/ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) Damage Index (SDI) scores. Information on their demographics and disease characteristics were obtained from the clinical record. Univariate analysis was performed and the best model of independent predictors of disease damage was determined by multivariate logistic regression analysis. A total of 182 patients (42.9%) had disease damage (SDI ≥1). A significantly higher number of Indian patients had disease/organ damage and they predominantly developed steroid-induced diabetes mellitus (SDM). Patients with corticosteroid-induced osteoporosis (CIOP) were more likely to be Malayswhile majority of patients who developed malignancy were Chinese (p<0.05). In the univariate and multivariate analyses, disease damage was significantly associated with age, Indian ethnicity, lower mean cumulative C3 level, neuropsychiatry lupus (NPSLE), and antiphospholipid syndrome (APLS). Patients who had ever and early treatment with hydroxychloroquine(HCQ)were less likely to develop disease damage while more patients who had received oral prednisolone ≥1mg/kg daily over 2 weeks had disease damage (p<0.05). In conclusion, there were inter-ethnic differences in the damage pattern and risks among SLE patients.
authors.affiliation: Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia.
authors.forename: Syahrul Sazliyana
authors.initials: SS
authors.lastname: Shaharir
authors.affiliation: Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia.|Department of Medicine, Putrajaya Hospital, Jalan P9, Presint 7, 62250 Putrajaya, Malaysia.
authors.forename: Heselynn
authors.initials: H
authors.lastname: Hussein
authors.affiliation: Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia.
authors.forename: Sakthiswary
authors.initials: S
authors.lastname: Rajalingham
authors.affiliation: Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia.
authors.forename: Mohd Shahrir
authors.initials: MS
authors.lastname: Mohamed Said
authors.affiliation: Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia.
authors.forename: Abdul Halim
authors.initials: AH
authors.lastname: Abdul Gafor
authors.affiliation: Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia.
authors.forename: Rozita
authors.initials: R
authors.lastname: Mohd
authors.affiliation: Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC), Jalan Yaacob Latiff, 56000 Kuala Lumpur, Malaysia.
authors.forename: Ruslinda
authors.initials: R
authors.lastname: Mustafar
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D044466:Asian People; D002681:China; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000453:epidemiology / Q000503:physiopathology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007194:India; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000453:epidemiology / Q000503:physiopathology*; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones