AB0489 ORGANIC DAMAGE MEASURED BY SDI IN A LONG-FOLLOW-UP SLE COHORT

Abstract

BackgroundSLICC Damage Index (SDI) index was designed to reflect accrual damage in patients with systemic lupus erythematosus (SLE). It reflects an irreversible change, unrelated to inflammatory activity, that has occurred since the diagnosis of SLE, verified by clinical assessment, and has been present for at least 6 months.ObjectivesOur objective is to determine the factors associated with higher mean SDI and SDI≥1 in patients with SLE in a long-follow-up cohort.MethodsSingle-centre retrospective observational study of SDI in SLE in a Spanish Lupus Cohort (HAPLES cohort: single-center cohort designed for the prospective evaluation of cardiac involvement in SLE). We included 219 SLE patients but 9 were excluded from the study because they did not fulfill the EULAR/ACR 2019 classification criteria.ResultsTwo hundred and ten patients with a mean age at diagnosis of 35.3 years (89.1% women) were analyzed. The mean follow-up time was 15.4 years. Mean SDI was 2.21 (range 0-26). The majority (70,9%) of patients presented an SDI≥1. However, an SDI≥1 was more frequent with longer follow-up (p=0.034): 23.8% in ≤5 years vs 74% in ≥10 years. The mean SDI increases over time (follow-up) (p<0.001): in patients with <5 years since diagnosis is 1.16, between 5-10 years 2.14 and in >10 years of follow-up 2.47. A positive correlation was also found between mean SDI and age (p<0.001), hypertension (p<0.001), diabetes (p=0.004), dyslipidemia (p<0.001), obesity (p=0.045), thrombosis (p<0.001), serositis (p=0.005), renal involvement (p=0.012), neurolupus (p<0.001), cardiac involvement (p<0.001) and antiphospholipid antibodies (aPLs) (p=0.002). A negative (protective) correlation was only found with antimalarials (p=0.002). Patients with SDI=0 (no damage) vs. SDI≥1 (any damage) were compared (Table 1) to evaluate the risk factors of presenting some irreversible accrual damage in the follow-up.Table 1.Damage accrual measured by SDI (SDI=0 vs SDI≥1)SDI=0SDI≥1p valueOR (IC95%)Female sex (%)88.71 %88.51 %p=0.967Late onset SLE (≥50 years) (%)6.45 %23.65 %p=0.0033.43 (1.41-8.32)Obesity (%)6.45 %16.89 %p=0.0452.83 (1.07-7.48)Hypertension (%)24,19 %53.38 %p<0.0012.21 (1.27-3.86)Diabetes (%)1.61 %7.43 %p=0.097Dyslipidemia (%)22.58 %45.27 %p=0.0021.96 (1.10-3.47)Thrombosis (%)3.23 %18.24 %p=0.0046.00 (1.71-21.01)Serositis (%)12.90 %27.03 %p=0.0262.08 (1.01-4.26)Neurolupus (%)8.06 %25.00 %p=0.0053.12 (1.35-7.26)Glomerulonephritis (%)14.52 %24.32 %p=0.114Cardiac involvement (%)15.52 %54.86 %p<0.0013.67 (1.95-6.92)DNAds+ (%)56.45 %63.51 %p=0.338Anti-Sm (%)12.90 %14.86 %p=0.711Anti-Ro (%)29.03 %25.68 %p=0.616Anti-RNP (%)11.29%8.11%p=0.463Antiphospholipid antibodies (%)25.81 %54.05 %p<0.0012.16 (1.25-3.75)LLDAS (%)56.14 %63.51 %p=0.331DORIS (%)41.38%48.65%p=0.347Prednisone (or equivalent) >7.52.94 %12.93 %p=0.0194.33 (1.20-15.67)Antimalarials90.16 %79.73 %p=0.0220.43 (0.17-1.09)Conventional DMARDs (%)37.70%47.97%p=0.175Belimumab (%)1.64%5.41%p=0.223Death (%)0.00 %2.03 %p=0.259ConclusionSDI in our SLE-cohort was correlated with age, vascular risk factors, severe organ involvement, aPLs and steroid use. Only antimalarials were associated with a lower mean SDI. SDI increases significantly with longer follow-up time, especially after the fifth year of follow-up. Prevention and early treatment of the aforementioned risk factors could avoid irreversible organ accrual damage in lupus.