Emily J Sutton1, Julie E Davidson, Ian N Bruce. 1. Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK. Electronic address: emily.sutton@manchester.ac.uk.
Abstract
OBJECTIVES: We performed a systematic literature review to determine factors that influence damage and damage progression in SLE patients and how damage relates to mortality in this population. METHODS: A search of Medline, Embase and Web of Science was performed, with papers included if they met the requirements of containing keywords relating to SLE and damage assessment using the SDI, published between 1990 and October 2012. RESULTS: A total of 358 articles were identified, with 50 included in this review. From 17 studies reporting damage at more than 2 time points, damage progressed over time, but the rate of damage accrual reported was variable across studies. Demographic factors that influence the accrual of damage in several reports include male gender, older age, longer disease duration, Afro-Caribbean and Indo-Asian ethnicity. Patients with higher disease activity at a single time point or over time accrue greater damage. Certain organ system involvement also predicts damage accrual, in particular renal and neuropsychiatric involvement. Corticosteroids, cyclophosphamide and azathioprine all show an association with damage accrual, while hydroxychloroquine appears to have a "protective" effect. Four studies, which examined prognosis, all demonstrated that damage is a predictor of future mortality. CONCLUSIONS: Damage in SLE patients increases over time and predicts future mortality. Patients at risk of damage can be identified from demographics factors and the pattern of clinical involvement. Disease activity, corticosteroids and immunosuppressive therapy are also associated with future damage but further studies are needed to separate the mechanisms of these associations from the problem of residual confounding.
OBJECTIVES: We performed a systematic literature review to determine factors that influence damage and damage progression in SLEpatients and how damage relates to mortality in this population. METHODS: A search of Medline, Embase and Web of Science was performed, with papers included if they met the requirements of containing keywords relating to SLE and damage assessment using the SDI, published between 1990 and October 2012. RESULTS: A total of 358 articles were identified, with 50 included in this review. From 17 studies reporting damage at more than 2 time points, damage progressed over time, but the rate of damage accrual reported was variable across studies. Demographic factors that influence the accrual of damage in several reports include male gender, older age, longer disease duration, Afro-Caribbean and Indo-Asian ethnicity. Patients with higher disease activity at a single time point or over time accrue greater damage. Certain organ system involvement also predicts damage accrual, in particular renal and neuropsychiatric involvement. Corticosteroids, cyclophosphamide and azathioprine all show an association with damage accrual, while hydroxychloroquine appears to have a "protective" effect. Four studies, which examined prognosis, all demonstrated that damage is a predictor of future mortality. CONCLUSIONS: Damage in SLEpatients increases over time and predicts future mortality. Patients at risk of damage can be identified from demographics factors and the pattern of clinical involvement. Disease activity, corticosteroids and immunosuppressive therapy are also associated with future damage but further studies are needed to separate the mechanisms of these associations from the problem of residual confounding.
Authors: Alexandra Legge; Susan Kirkland; Kenneth Rockwood; Pantelis Andreou; Sang-Cheol Bae; Caroline Gordon; Juanita Romero-Diaz; Jorge Sanchez-Guerrero; Daniel J Wallace; Sasha Bernatsky; Ann E Clarke; Joan T Merrill; Ellen M Ginzler; Paul Fortin; Dafna D Gladman; Murray B Urowitz; Ian N Bruce; David A Isenberg; Anisur Rahman; Graciela S Alarcón; Michelle Petri; Munther A Khamashta; M A Dooley; Rosalind Ramsey-Goldman; Susan Manzi; Kristjan Steinsson; Asad A Zoma; Cynthia Aranow; Meggan Mackay; Guillermo Ruiz-Irastorza; S Sam Lim; Murat Inanc; Ronald F van Vollenhoven; Andreas Jonsen; Ola Nived; Manuel Ramos-Casals; Diane L Kamen; Kenneth C Kalunian; Soren Jacobsen; Christine A Peschken; Anca Askanase; John G Hanly Journal: Arthritis Rheumatol Date: 2019-05-29 Impact factor: 10.995
Authors: Alexandra Legge; Susan Kirkland; Kenneth Rockwood; Pantelis Andreou; Sang-Cheol Bae; Caroline Gordon; Juanita Romero-Diaz; Jorge Sanchez-Guerrero; Daniel J Wallace; Sasha Bernatsky; Ann E Clarke; Joan T Merrill; Ellen M Ginzler; Paul Fortin; Dafna D Gladman; Murray B Urowitz; Ian N Bruce; David A Isenberg; Anisur Rahman; Graciela S Alarcón; Michelle Petri; Munther A Khamashta; M A Dooley; Rosalind Ramsey-Goldman; Susan Manzi; Asad A Zoma; Cynthia Aranow; Meggan Mackay; Guillermo Ruiz-Irastorza; S Sam Lim; Murat Inanc; Ronald F van Vollenhoven; Andreas Jonsen; Ola Nived; Manuel Ramos-Casals; Diane L Kamen; Kenneth C Kalunian; Soren Jacobsen; Christine A Peschken; Anca Askanase; John G Hanly Journal: J Rheumatol Date: 2019-04-15 Impact factor: 4.666