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.
Highlights
Systemic Lupus Erythematosus (SLE) is an autoimmune disease which is characterized by multi-system organ inflammation
Disease damage measured with SLICC/ACR damage index is well correlated with mortality [4] and quality of life in patients with SLE [5]
Our cohort consisted of a multi-ethnic populations with predominant Malays (n = 265, 62.5%), followed by Chinese (n = 137, 32.3%), Indians (n = 18, 4.2%), and others (n = 4, 0.9%)
Summary
Systemic Lupus Erythematosus (SLE) is an autoimmune disease which is characterized by multi-system organ inflammation. Apart from disease activity and quality of life, measurement of disease damage is very important as part of a standard assessment in the management of SLE patients. The Systemic Lupus Erythematosus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index for SLE is a well validated tool to assess accumulated damage index (DI) since the onset of the disease [2]. The SLICC/ACR damage index is highly reproducible and has been shown to have a good agreement with prospective and retrospective measurement of DI [3]. Disease damage measured with SLICC/ACR damage index is well correlated with mortality [4] and quality of life in patients with SLE [5]. A different pattern of organ damage such as renal, neuropsychiatry, cardiovascular and pulmonary damage predicts poorer prognosis and mortality [2, 6]
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