Kandane-Rathnayake Rangi, Milea Dominique, Louthrenoo Worawit, Hoi Alberta, Golder Vera, Cho Jiacai, Lateef Aisha, Luo Shue-Fen, Wu Yeong-Jian Jan, Hamijoyo Laniyati, Sockalingam Sargunan, Li Zhanguo, Navarra Sandra, Zamora Leonid, Harigai Masayoshi, Katsumata Yasuhiro, Chan Madelynn, Hao Yanjie, Zhang Zhuoli, O'Neill Sean, Goldblatt Fiona, Oon Shereen, Xu Xiaomeng, Navarro Rojas Aldo A, Bae Sang-Cheol, Lau Chak Sing, Nikpour Mandana, Morand Eric
Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
Value, Evidence & Outcomes, GSK, Singapore.
Lupus Sci Med. 2025 Jan 19;12(1):e001363. doi: 10.1136/lupus-2024-001363.
To estimate the prevalence of organ damage (damage) and flare and to examine longitudinal associations between flares and subsequent damage accrual, in patients with systemic lupus erythematosus (SLE).
Patients enrolled in the Asia Pacific Lupus Collaboration cohort with ≥3 years of prospectively captured data were studied. Flares were assessed at routine visits, while damage ((Systemic Lupus International Collaborating Clinics/American College of Rheumatology) Damage Index) was assessed annually. Multivariable, multifailure survival analyses were carried out to quantify the association between flares and damage accrual.
1556 patients with SLE with a median (IQR) of 5.7 (3.9, 7.0) years of follow-up were studied. 39.5% (n=614) of patients had damage at enrolment, and 31.9% (n=496) accrued damage during the study observation period. The incidence of damage accrual during observation was ~58/1000 person-years. Overall, 74.1% (n=1153) of patients experienced a flare of any severity (mild/moderate or severe) at least once; 56.9% (n=885) experienced recurrent (≥2) flares. The risk of subsequent damage accrual in patients who experienced mild-to-moderate flare, after controlling for confounders, was 32% greater than in patients without flares (adjusted HR) (95% CI 1.32 (1.17 to 1.72)). The risk of damage accrual was greater if patients had severe flares (HR (95% CI) 1.58 (1.18 to 2.11)). For each additional flare, the risk of damage accrual increased by 7% (HR (95% CI) 1.07 (1.02 to 1.13)).
Flares independently increased the risk of damage accrual. Prevention of flares should be considered a necessary goal of SLE disease management to minimise permanent damage.
评估系统性红斑狼疮（SLE）患者器官损伤和病情活动的患病率，并研究病情活动与随后损伤累积之间的纵向关联。
对亚太狼疮协作队列中纳入的、有≥3年前瞻性收集数据的患者进行研究。在常规访视时评估病情活动，而每年评估损伤情况（采用系统性红斑狼疮国际协作临床/美国风湿病学会损伤指数）。进行多变量、多失败生存分析以量化病情活动与损伤累积之间的关联。
研究了1556例SLE患者，中位随访时间（四分位间距）为5.7（3.9，7.0）年。39.5%（n = 614）的患者在入组时有损伤，31.9%（n = 496）在研究观察期内出现损伤累积。观察期内损伤累积的发生率约为58/1000人年。总体而言，74.1%（n = 1153）的患者至少经历过一次任何严重程度（轻度/中度或重度）的病情活动；56.9%（n = 885）经历过复发（≥2次）病情活动。在控制混杂因素后，经历轻度至中度病情活动的患者随后发生损伤累积的风险比未经历病情活动的患者高32%（调整后风险比）（95%置信区间1.32（1.17至1.72））。如果患者发生重度病情活动，损伤累积的风险更高（风险比（95%置信区间）1.58（1.18至2.11））。每增加一次病情活动，损伤累积的风险增加7%（风险比（95%置信区间）1.07（1.02至1.13））。
病情活动独立增加损伤累积的风险。应将预防病情活动视为SLE疾病管理的必要目标，以尽量减少永久性损伤。
