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Rheumatology Advance Access originally published online on August 15, 2003
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Rheumatology 2004; 43: 202-205
© British Society for Rheumatology 2003; all rights reserved

Clinical

Systemic lupus erythematosus in three ethnic groups. XX. Damage as a predictor of further damage

G. S. Alarcón, J. M. Roseman1, G. McGwin, Jr1,2, A. Uribe, H. M. Bastian, B. J. Fessler, B. A. Baethge3, A. W. Friedman4 and J. D. Reveille4 for the LUMINA Study Group

Departments of Medicine (Division of Clinical Immunology and Rheumatology), 1Epidemiology and 2Surgery (Section of Trauma, Burns, and Critical Care), Schools of Medicine and Public Health, University of Alabama at Birmingham, Birmingham, AL, 3Department of Medicine (Division of Rheumatology), University of Texas Medical Branch at Galveston, Galveston, TX and 4Department of Medicine (Division of Rheumatology and Clinical Immunogenetics), University of Texas-Houston Health Science Center, Houston, TX, USA. For a complete list of current LUMINA investigators and staff, see below.

Correspondence to: G. S. Alarcón, 615 MEB, University of Alabama at Birmingham, Birmingham, AL 35294, USA. E-mail: graciela.alarcon{at}ccc.uab.edu

Objective. To examine the predictors of damage in a multiethnic cohort of systemic lupus erythematosus (SLE) patients with a specific focus on damage at baseline.

Patients and methods. SLE patients from a multiethnic US (Hispanic, African-American and Caucasian) cohort (LUMINA: Lupus in Minority populations, Nature versus nurture) were included if they had >=6 months of follow-up in the cohort. Damage was measured with the Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (SDI). The dependent variable was the change in SDI score between study visits. Predictors were from the preceding visit. Variables known to affect damage accrual in SLE were included in the analyses.

Results. Three hundred and fifty-two patients (82 Hispanics, 153 African-Americans and 117 Caucasians) representing 1795 patient visits were included. Previous damage was found to be a significant predictor of subsequent damage accrual (P < 0.0001). Other variables predictive of subsequent damage accrual were disease activity (P < 0.0001), older age (P = 0.041) and use of corticosteroids (P = 0.0048).

Conclusions. Once damage occurs in SLE, further damage is expected to occur. This is more likely to be the case if disease activity persists. These data have clinical implications for the management of SLE patients.

KEY WORDS: Lupus, Damage, Ethnicity, Outcome, Predictors.

Current LUMINA investigators and staff: (University of Alabama at Birmingham) G. S. Alarcón, H. M. Bastian, B. J. Fessler, G. McGwin Jr, J. Roseman, S. Toloza, A. G. Uribe, B. S. Agee, M. L. Sanchez, E. Sowell and B. Johnson; (University of Texas-Houston Health Science Center) J. D. Reveille, A. W. Friedman, K. Ho, C. Ahn, R. Sandoval, J. Charles and L.-L. Wang; (University of Texas Medical Branch at Galveston) B. A. Baethge and S. Hunnicutt; (University of Puerto Rico Medical Sciences Campus) L. M. Vilá, W. Borges and C. Pinilla.


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