Evolution of disease burden over five years in a multicenter inception systemic lupus erythematosus cohort

Arthritis Care Res (Hoboken). 2012 Jan;64(1):132-7. doi: 10.1002/acr.20648.

Abstract

Objective: We describe disease activity, damage, and the accrual of key autoantibodies in an inception systemic lupus erythematosus (SLE) cohort.

Methods: The Systemic Lupus International Collaborating Clinics (SLICC) International Research Network, comprising 27 centers from 11 countries, has followed an inception cohort of SLE patients yearly according to a standardized protocol. Of these patients, 298 were followed for a minimum of 5 years and constitute the study population. Disease activity was assessed using the SLE Disease Activity Index 2000 (SLEDAI-2K) and damage was assessed using the SLICC/American College of Rheumatology Damage Index (SDI). Antinuclear antibody (ANA), anti-DNA, and anticardiolipin antibody (aCL) levels and lupus anticoagulant were assessed yearly. Descriptive statistics were generated and repeated-measures general linear models were used to evaluate SLEDAI-2K and SDI over time between whites and nonwhites.

Results: Of the 298 patients, 87% were women, 55% were white, 12% were African American, 14% were Asian, 16% were Hispanic, and 2% were categorized as "other." At enrollment, the mean age was 35.3 years, the mean SLEDAI-2K score was 5.9, and the mean disease duration was 5.5 months. Mean SLEDAI-2K scores decreased in the first year and then remained low. SLEDAI-2K scores were significantly lower at each year in whites compared to nonwhites. Mean SDI scores increased progressively over 5 years; there was no significant difference between whites and nonwhites. As expected, ANA positivity was high and anti-DNA positivity was relatively low at enrollment, and both increased over 5 years. Although lupus anticoagulant increased slightly over 5 years, aCL positivity did not.

Conclusion: Disease activity in newly diagnosed patients decreases over their first 5 years, while damage increases. Antibody positivity ran variable courses over this period.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • African Americans / statistics & numerical data
  • Antibodies, Anticardiolipin / blood
  • Antibodies, Antinuclear / blood
  • Asian Continental Ancestry Group / statistics & numerical data
  • Biomarkers / blood
  • Cohort Studies
  • Cost of Illness
  • DNA / immunology
  • Disease Progression
  • Europe / epidemiology
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Linear Models
  • Lupus Coagulation Inhibitor / blood
  • Lupus Erythematosus, Systemic / blood
  • Lupus Erythematosus, Systemic / diagnosis*
  • Lupus Erythematosus, Systemic / drug therapy
  • Lupus Erythematosus, Systemic / ethnology
  • Lupus Erythematosus, Systemic / immunology
  • Male
  • Middle Aged
  • North America / epidemiology
  • Registries
  • Severity of Illness Index
  • Time Factors
  • Young Adult

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Anticardiolipin
  • Antibodies, Antinuclear
  • Biomarkers
  • Lupus Coagulation Inhibitor
  • DNA