Petri Michelle, Purvey Sneha, Fang Hong, Magder Laurence S
Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Arthritis Rheum. 2012 Dec;64(12):4021-8. doi: 10.1002/art.34672.
The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index (SDI) is the accepted measure of permanent organ damage in systemic lupus erythematosus (SLE). We analyzed data from a large SLE cohort to identify variables associated with rates of damage accrual as measured by the SDI.
The study included 2,054 SLE patients (92% female, 56% white, and 37% African American) with a mean age at diagnosis of 33 years. The SDI score was calculated retrospectively at the time of cohort entry and prospectively during followup. The relationships between time-invariant patient characteristics and rates of damage accrual were assessed based on the damage score at the last available followup visit. The relationships between time-varying patient characteristics and damage accrual were assessed based on the timing of damage accrual during cohort participation.
Overall, the SDI score increased at a rate of 0.13 per year. Higher rates of damage were observed for those who were older, male, or African American, had a lower income or education level, were hypertensive, were positive for lupus anticoagulant, or had proteinuria. During followup, the risk of damage was higher for those who were older, had more disease activity, had low complement levels, were positive for anti-double-stranded DNA, satisfied more ACR criteria for SLE, or were receiving corticosteroids. Lower risk was observed among patients receiving hydroxychloroquine. After adjustment for other variables, age, hypertension, and corticosteroid use emerged as the most important predictors of damage accrual.
Our findings indicate that rates of damage vary in demographic subgroups, but much variation appears to be explained by hypertension and corticosteroid use. These data clearly point to the need for tight control of disease activity without reliance on corticosteroids.
系统性红斑狼疮国际协作临床研究组/美国风湿病学会（ACR）损伤指数（SDI）是系统性红斑狼疮（SLE）永久性器官损伤的公认衡量指标。我们分析了一个大型SLE队列的数据，以确定与SDI所衡量的损伤累积率相关的变量。
该研究纳入了2054例SLE患者（92%为女性，56%为白人，37%为非裔美国人），诊断时的平均年龄为33岁。SDI评分在队列入组时进行回顾性计算，并在随访期间进行前瞻性计算。基于最后一次可用随访时的损伤评分，评估时间不变的患者特征与损伤累积率之间的关系。基于队列参与期间损伤累积的时间，评估随时间变化的患者特征与损伤累积之间的关系。
总体而言，SDI评分以每年0.13的速度增加。年龄较大、男性、非裔美国人、收入或教育水平较低、患有高血压、狼疮抗凝物阳性或有蛋白尿的患者，损伤率较高。在随访期间，年龄较大、疾病活动度较高、补体水平较低、抗双链DNA阳性、满足更多SLE的ACR标准或正在接受皮质类固醇治疗的患者，损伤风险较高。接受羟氯喹治疗的患者风险较低。在对其他变量进行调整后，年龄、高血压和皮质类固醇的使用成为损伤累积的最重要预测因素。
我们的研究结果表明，不同人口统计学亚组的损伤率有所不同，但许多差异似乎可以由高血压和皮质类固醇的使用来解释。这些数据明确指出，需要在不依赖皮质类固醇的情况下严格控制疾病活动。
