Disease damage in systemic lupus erythematosus patients: Disease activity, male gender and hypertension as potential predictors

Abstract

Aim of the work: To identify factors associated with damage in systemic lupus erythematosus (SLE) patients. Patients and methods: Based on Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI) patients were divided into 2 groups; patients with damage (SDI ≥ 1) and without (SDI = 0). Groups were compared regarding demographic features, co-morbidities, cumulative clinical features, treatment and assessment of the modified SLE disease activity index (M−SLEDAI) at baseline and every 6 months till the end of follow up.Results: The study included172 patients; 152 (88.4%) females and 20 (11.6%) males with a mean age of 35.5 ± 8.6 years and disease duration of9.8 ± 1.2 years.Eighty-five (49.4%) patients had damage with a mean SDI of 1.04 ± 1.36. The musculoskeletal, renal and neuropsychiatric systems were damaged in 17.4%, 12.8% and 10.4% of patients, respectively. A comparison between patients with and without damage identified male gender (p = 0.001); older age (p = 0.002), age at onset (p < 0.001); hypertension (p = 0.001); renal (p = 0.007) and neuropsychiatric involvement (p = 0.019); vasculitis (p = 0.044); M−SLEDAI last-visit (p = 0.004), average M−SLEDAI (p = 0.007), number and frequency of visits with active disease (p < 0.001 for both); number of flares (p = 0.001); use and cumulative dose of pulse steroids (p < 0.001 and p = 0.042, respectively), overall cumulative steroid dose (p = 0.007), cyclophosphamide use (p < 0.001), hydroxychloroquine dose (p = 0.029) and less use of leflunomide(p = 0.01) as factors associated with damage. On multivariate regression, the association between damage and male gender (p = 0.02), hypertension (p = 0.016) and number of visits with active disease (p = 0.002) was retained. Conclusion: Male gender, hypertension and prolonged disease activity in SLE contribute to damage occurrence.