Characterization of damage in Portuguese lupus patients: analysis of a national lupus registry

Lupus. 2015 Mar;24(3):256-62. doi: 10.1177/0961203314555172. Epub 2014 Oct 15.


Background: Although the survival rate has considerably improved, many patients with systemic lupus erythematosus (SLE) develop irreversible organ damage.

Objectives: The objectives of this paper are to characterize cumulative damage in SLE patients and identify variables associated with its presence and severity.

Methods: A cross-sectional analysis of SLE patients from the Portuguese Lupus register in whom damage assessment using the SLICC/ACR-Disability Index (SDI) was available was performed. Predictor factors for damage, defined as SDI ≥ 1, were determined by logistic regression analyses. A sub-analysis of patients with severe damage (SDI ≥ 3) was also performed.

Results: In total, 976 patients were included. SDI was ≥1 in 365 patients, of whom 89 had severe damage. Musculoskeletal (24.4%), neuropsychiatric (24.1%) and ocular (17.2%) domains were the most commonly affected. Older age, longer disease duration, renal involvement, presence of antiphospholipid antibodies and current therapy with steroids were independently associated with SDI ≥ 1. The subpopulation with severe damage had, in addition, a greater interval between the first manifestation attributable to SLE and the clinical diagnosis as well as and more frequently early retirement due to SLE.

Conclusions: This large lupus cohort confirmed that demographic and clinical characteristics as well as medication are independently associated with damage. Additionally, premature retirement occurs more often in patients with SDI ≥ 3. Diagnosis delay might contribute to damage accrual.

Keywords: Portugal;; Systemic lupus erythematosus.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Antimalarials / therapeutic use
  • Comorbidity
  • Female
  • Humans
  • Lupus Erythematosus, Systemic / drug therapy
  • Lupus Erythematosus, Systemic / epidemiology*
  • Male
  • Middle Aged
  • Portugal / epidemiology
  • Registries*
  • Severity of Illness Index
  • Young Adult


  • Adrenal Cortex Hormones
  • Antimalarials