Damage in lupus patients--what have we learned so far?

With the improvement of survival of systemic lupus erythematosus (SLE) patients, prevention of organ damage has become a major goal in the management of these patients. The need for a reliable tool for assessment of cumulative damage over time led to the development of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) that allowed a standardized measurement of damage and facilitated research in the field. Damage accumulates over the course of the disease; however, some patients do not accrue any damage even after many years. Damage accrues at a higher rate among patients with more active disease, highlighting the importance of prompt control of disease manifestations. However, medications administered to control disease activity, particularly corticosteroids, can also result in organ damage, emphasizing the need for adjustment of these agents as soon as disease is under control.