LONDON, UK—Systemic lupus erythematosus (SLE) patients who accrue neuropsychiatric, musculoskeletal, and/or renal damage are at greater risk of death and should be followed aggressively, according to a new study in Rheumatology.¹

“Patients with damage are at risk of further damage and should be monitored closely for adverse effects of medication and the development of co-morbidities and complications of SLE,” conclude the researchers who were led by Sharon A. Chambers, MRCP, a rheumatologist at the University College London Hospital.

The researchers report that 90% of 232 lupus patients had no damage one year after their diagnosis, but after 10 years 50% had accrued some damage, primarily neuropsychiatric, renal, and/or musculoskeletal damage. Patients with the highest damage scores on the SLICC/ACR Damage Index were most likely to die, the study showed. Specifically, a patient was 1.32 times more likely to die for every one-point increase in their damage score.

Overall, 44 patients died during follow-up. The top causes of death in this cohort were sepsis, cancer and organ failure. The mean disease duration among patients who died was 16.7 years, the study showed.

Discrepancy in lupus damage rates

Other studies have shown higher rates of damage accrual within 10 years of lupus diagnosis, the study authors point out.

“This may be due to the department’s more aggressive approach in identifying and treating active disease and modifying risk factors for damage wherever possible,” they conclude. Changes in lupus treatment strategies such as the use of lower doses of cyclophosphamide and the greater use of steroid-sparing and osteoporosis drugs may result in slower damage accrual, they suggest.

References

1. Chambers SA, Allen E, Rahman A, Isenberg D. Damage and mortality in a group of British patients with systemic lupus erythematosus followed up for over 10 years. Rheumatology. 2009; [epub ahead of print April 9, 2009].