SLICC/ACR Damage Index in Afro-Caribbean patients with systemic lupus erythematosus: changes in and relationship to disease activity, corticosteroid therapy, and prognosis.

OBJECTIVE

To apply the recently described Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) in a well defined cohort of patients with systemic lupus erythematosus (SLE) and to study its association with disease activity, corticosteroid therapy, and prognosis.

METHODS

We conducted a record review of 90 patients with SLE followed at a single center for a mean period of 6 years with periodic evaluations of SLE Disease Activity Index (SLEDAI), cumulative damage according to SLICC/ACR-DI, and therapy. Overall disease activity during the disease course was calculated as weighted averages of SLEDAI (WAS).

RESULTS

Mean SLICC/ACR-DI was 0.6 six months after diagnosis and increased to 2.4 at last assessment. Thirteen patients (14%) remained free of accumulated damage at last visit. Index scores showed significant correlations with WAS scores and the number of disease exacerbations (SLEDAI > 10), but not with age, mean daily, or cumulative corticosteroid dosage. High WAS scores were independently associated with poorer survival, but SLICC/ACR-DI scores were not.

CONCLUSION

SLICC/ACR-DI scores correlate with overall disease activity, but not with length or intensity of corticosteroid therapy. While easily applicable, its prognostic value is subordinate to that of persistent disease activity.