Longitudinal associations of flare and damage accrual in patients with systemic lupus erythematosus

Kandane-Rathnayake R 1 , Milea D 2 , Louthrenoo W 3 , Hoi A 4 , Golder V 4 , Cho J 5 Show all authors , Lateef A 6 , Luo SF 7 , Wu YJ 8 , Hamijoyo L 9 , Sockalingam S 10 , Li Z 11 , Navarra S 12 , Zamora L 12 , Harigai M 13 , Katsumata Y 13 , Chan M 14 , Hao Y 15 , Zhang Z 16 , O'Neill S 17 , Goldblatt F 18 , Oon S 15 , Xu X 2 , Navarro Rojas AA 19 , Bae SC 20 , Lau CS 21 , Nikpour M 15 , Morand E 4

Affiliations 

  • 1 Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia rangi.kandane-rathnayake@monash.edu
  • 2 Value, Evidence & Outcomes, GSK, Singapore
  • 3 Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand
  • 4 Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
  • 5 Rheumatology Division, Department of Medicine, National University Hospital, Singapore
  • 6 Department of Medicine, Woodlands Health, Singapore
  • 7 Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
  • 8 Department of Rheumatology, Allergy and Immunology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
  • 9 Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
  • 10 Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
  • 11 Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
  • 12 Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
  • 13 Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
  • 14 Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore
  • 15 Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
  • 16 Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
  • 17 The University of Sydney, Sydney, New South Wales, Australia
  • 18 Department of Rheumatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
  • 19 Medical Affairs, Greater China & Intercontinental, GSK, Singapore
  • 20 Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seongdong-gu, Seoul, Republic of Korea
  • 21 Division of Rheumatology & Clinical Immunology, The University of Hong Kong, Pok Fu Lam, Hong Kong
Lupus Sci Med, 2025 Jan 19;12(1).
PMID: 39832908 DOI: 10.1136/lupus-2024-001363

Abstract

OBJECTIVE: To estimate the prevalence of organ damage (damage) and flare and to examine longitudinal associations between flares and subsequent damage accrual, in patients with systemic lupus erythematosus (SLE).

METHODS: Patients enrolled in the Asia Pacific Lupus Collaboration cohort with ≥3 years of prospectively captured data were studied. Flares were assessed at routine visits, while damage ((Systemic Lupus International Collaborating Clinics/American College of Rheumatology) Damage Index) was assessed annually. Multivariable, multifailure survival analyses were carried out to quantify the association between flares and damage accrual.

RESULTS: 1556 patients with SLE with a median (IQR) of 5.7 (3.9, 7.0) years of follow-up were studied. 39.5% (n=614) of patients had damage at enrolment, and 31.9% (n=496) accrued damage during the study observation period. The incidence of damage accrual during observation was ~58/1000 person-years. Overall, 74.1% (n=1153) of patients experienced a flare of any severity (mild/moderate or severe) at least once; 56.9% (n=885) experienced recurrent (≥2) flares. The risk of subsequent damage accrual in patients who experienced mild-to-moderate flare, after controlling for confounders, was 32% greater than in patients without flares (adjusted HR) (95% CI 1.32 (1.17 to 1.72)). The risk of damage accrual was greater if patients had severe flares (HR (95% CI) 1.58 (1.18 to 2.11)). For each additional flare, the risk of damage accrual increased by 7% (HR (95% CI) 1.07 (1.02 to 1.13)).

CONCLUSIONS: Flares independently increased the risk of damage accrual. Prevention of flares should be considered a necessary goal of SLE disease management to minimise permanent damage.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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