RECURRENT MAJOR INFECTIONS IN JUVENILE-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS: A CLOSE LINK WITH LONG-TERM DISEASE DAMAGE

Abstract

INTRODUCTION: Infection is a significant cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). We postulated that patients with recurrent infections are more likely to have poorer disease outcome. OBJECTIVE: The objectives of this study were to describe the pattern of infections and disease damage that occurred in a cohort of patients with juvenile-onset SLE and to determine whether cumulative disease damage was associated with recurrent infections in these patients. METHODS: We retrospectively reviewed (1988–2004) the clinical characteristics, infective complications, and disease damage as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index Score (SDI) in 47 patients with juvenile-onset SLE. Potential risk factors for disease damage were evaluated by univariate analysis and logistic regression. The correlation between number of major infections and disease damage was determined. RESULTS: Thirty-two (68.1%) patients had lupus nephropathy, and 16 (34.0%) patients had neuropsychiatric lupus. Sixty-one episodes of major infections, defined as infections that required more than 1 week of antimicrobial agents, occurred in 27 (57.4%) patients, and 18 (31.4%) patients had recurrent major infections (≥2 episodes). Organ damage (SDI ≥ 1) was documented in 21 (44.7%) patients. By logistic regression, occurrence of major infections was the only significant risk factor for disease damage. There was a positive correlation between SDI score and the number of recurrent major infections. CONCLUSIONS: Infections and disease damage are common comorbidities in juvenile-onset SLE. Recurrent infections could predict poorer disease outcome and associated organ damage in SLE.