Milena Mimica, Oslando Padilla, Guillermo Pons-Estel, Rosana Quintana, Oscar Neira, Luis Jose Catoggio, Veronica Saurit, Cristina Drenkard, Guillermo Berbotto, Mercedes A Garcia, Eduardo F Borba, Eloisa Bonfá, Emilia I Sato, Ana Carolina de O E Silva, Lilian Costallat, João Carlos Tavares Brenol, Gloria Vásquez, Oscar Uribe-Uribe, Antonio Iglesias, Marlene Guibert Toledano, Gil Reyes Llerena, Virginia Pascual-Ramos, Mary-Carmen Amigo, Leonor Barile-Fabris, Ignacio García De La Torre, Eduardo M Acevedo-Vazquez, María Inés Segami, Rosa Chacón-Díaz, María H Esteva-Spinetti, Graciela S Alarcon, Bernardo A Pons-Estel, Manuel F Ugarte-Gil, Loreto Massardo
{"title":"与系统性红斑狼疮损伤累积相关的项目特异性因素:来自多种族,多民族拉丁美洲队列的见解。","authors":"Milena Mimica, Oslando Padilla, Guillermo Pons-Estel, Rosana Quintana, Oscar Neira, Luis Jose Catoggio, Veronica Saurit, Cristina Drenkard, Guillermo Berbotto, Mercedes A Garcia, Eduardo F Borba, Eloisa Bonfá, Emilia I Sato, Ana Carolina de O E Silva, Lilian Costallat, João Carlos Tavares Brenol, Gloria Vásquez, Oscar Uribe-Uribe, Antonio Iglesias, Marlene Guibert Toledano, Gil Reyes Llerena, Virginia Pascual-Ramos, Mary-Carmen Amigo, Leonor Barile-Fabris, Ignacio García De La Torre, Eduardo M Acevedo-Vazquez, María Inés Segami, Rosa Chacón-Díaz, María H Esteva-Spinetti, Graciela S Alarcon, Bernardo A Pons-Estel, Manuel F Ugarte-Gil, Loreto Massardo","doi":"10.1136/lupus-2025-001570","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To identify factors associated with individual Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) accrual items in 1385 patients from the Latin American SLE incident cohort (GLADEL (Grupo Latino Americano Del Estudio de Lupus)).</p><p><strong>Methods: </strong>Longitudinal cohort study. SDI assessed yearly, and damage accrual defined as a SDI change in any individual item during follow-up. Sociodemographic and clinical characteristics at entry, along with regular medication use up to the month prior to each damage item accrued, were analysed using multivariate Cox proportional hazard models with time-varying hazard risk effect performed. Models for overall damage and 10 items with at least 28 patients per item are reported.</p><p><strong>Results: </strong>New damage was accrued by 658 patients with SLE (48%) over a median of 54 months (p25-75: 29-71) of follow-up. Mestizo ethnicity, recent SLE Disease Activity Index (SLEDAI) and immunosuppressants were predictors of overall damage accrual, while antimalarials and rural residence were protectors; mixed effects were observed for SDI >0 and glucocorticoids (GCs) use. Protectors for scarring chronic alopecia (23.7% at 7 years follow-up) included older age, longer disease duration, diagnostic delay, SDI >0 and cytotoxic use. Proteinuria >3.5 g/24 hours (11.5% at 7 years follow-up) was associated with protective factors like older age, longer disease duration and higher GCs dose, while risk factors were Mestizo ethnicity, low medical coverage, higher SLEDAI scores and cytotoxic use. In addition, Mestizo ethnicity was a risk factor for estimated glomerular filtration rate <50% and end-stage renal disease (ESRD) whereas antimalarial protected from ESRD. GCs were risk factors for pericarditis, retinal change or optic atrophy but provided protection against proteinuria >3.5 g/24 hours. Recent disease activity and cytotoxic use were significant risk factors for additional items.</p><p><strong>Conclusions: </strong>Factors associated with damage accrual differ substantially by individual SDI items. Mestizo ethnicity and recent disease activity increased renal risks, while antimalarials were protective. GCs showed mixed effects. Item-specific strategies are crucial to mitigate long-term damage.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314996/pdf/","citationCount":"0","resultStr":"{\"title\":\"Item-specific factors associated with damage accrual in systemic lupus erythematosus: insights from a multiethnic, multinational Latin American cohort.\",\"authors\":\"Milena Mimica, Oslando Padilla, Guillermo Pons-Estel, Rosana Quintana, Oscar Neira, Luis Jose Catoggio, Veronica Saurit, Cristina Drenkard, Guillermo Berbotto, Mercedes A Garcia, Eduardo F Borba, Eloisa Bonfá, Emilia I Sato, Ana Carolina de O E Silva, Lilian Costallat, João Carlos Tavares Brenol, Gloria Vásquez, Oscar Uribe-Uribe, Antonio Iglesias, Marlene Guibert Toledano, Gil Reyes Llerena, Virginia Pascual-Ramos, Mary-Carmen Amigo, Leonor Barile-Fabris, Ignacio García De La Torre, Eduardo M Acevedo-Vazquez, María Inés Segami, Rosa Chacón-Díaz, María H Esteva-Spinetti, Graciela S Alarcon, Bernardo A Pons-Estel, Manuel F Ugarte-Gil, Loreto Massardo\",\"doi\":\"10.1136/lupus-2025-001570\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To identify factors associated with individual Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) accrual items in 1385 patients from the Latin American SLE incident cohort (GLADEL (Grupo Latino Americano Del Estudio de Lupus)).</p><p><strong>Methods: </strong>Longitudinal cohort study. SDI assessed yearly, and damage accrual defined as a SDI change in any individual item during follow-up. Sociodemographic and clinical characteristics at entry, along with regular medication use up to the month prior to each damage item accrued, were analysed using multivariate Cox proportional hazard models with time-varying hazard risk effect performed. Models for overall damage and 10 items with at least 28 patients per item are reported.</p><p><strong>Results: </strong>New damage was accrued by 658 patients with SLE (48%) over a median of 54 months (p25-75: 29-71) of follow-up. Mestizo ethnicity, recent SLE Disease Activity Index (SLEDAI) and immunosuppressants were predictors of overall damage accrual, while antimalarials and rural residence were protectors; mixed effects were observed for SDI >0 and glucocorticoids (GCs) use. Protectors for scarring chronic alopecia (23.7% at 7 years follow-up) included older age, longer disease duration, diagnostic delay, SDI >0 and cytotoxic use. Proteinuria >3.5 g/24 hours (11.5% at 7 years follow-up) was associated with protective factors like older age, longer disease duration and higher GCs dose, while risk factors were Mestizo ethnicity, low medical coverage, higher SLEDAI scores and cytotoxic use. In addition, Mestizo ethnicity was a risk factor for estimated glomerular filtration rate <50% and end-stage renal disease (ESRD) whereas antimalarial protected from ESRD. GCs were risk factors for pericarditis, retinal change or optic atrophy but provided protection against proteinuria >3.5 g/24 hours. Recent disease activity and cytotoxic use were significant risk factors for additional items.</p><p><strong>Conclusions: </strong>Factors associated with damage accrual differ substantially by individual SDI items. Mestizo ethnicity and recent disease activity increased renal risks, while antimalarials were protective. GCs showed mixed effects. 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引用次数: 0
摘要
目的:在拉丁美洲SLE事件队列(GLADEL (Grupo Latino Americano Del Estudio de Lupus))的1385例患者中,确定与个体系统性狼疮国际合作诊所/美国风湿病学会损伤指数(SDI)应计项目相关的因素。方法:纵向队列研究。SDI每年评估一次,损害累积定义为随访期间任何单个项目的SDI变化。使用具有时变危险风险效应的多变量Cox比例风险模型分析患者入组时的社会人口学和临床特征,以及每次损害项目累积前一个月的常规药物使用情况。报告了总体损伤模型和10个项目,每个项目至少有28例患者。结果:在中位54个月(p25-75: 29-71)的随访期间,658例SLE患者(48%)出现了新的损害。混血儿种族、最近的SLE疾病活动指数(SLEDAI)和免疫抑制剂是总体损害累积的预测因子,而抗疟药和农村居住是保护因子;使用SDI >和糖皮质激素(GCs)观察到混合效应。疤痕性慢性脱发的保护因素(7年随访时为23.7%)包括年龄较大、病程较长、诊断延迟、SDI bb0 0和使用细胞毒。蛋白尿bb0 3.5 g/24小时(随访7年11.5%)与年龄较大、病程较长和GCs剂量较高等保护因素相关,而危险因素为Mestizo种族、低医疗覆盖率、较高SLEDAI评分和细胞毒性使用。此外,Mestizo种族是估计肾小球滤过率3.5 g/24小时的危险因素。最近的疾病活动和细胞毒性使用是附加项目的重要风险因素。结论:与损伤累积相关的因素因个体SDI项目而有很大差异。混血儿种族和最近的疾病活动增加了肾脏风险,而抗疟药具有保护作用。GCs的效果好坏参半。具体项目的战略对于减轻长期损害至关重要。
Item-specific factors associated with damage accrual in systemic lupus erythematosus: insights from a multiethnic, multinational Latin American cohort.
Objective: To identify factors associated with individual Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) accrual items in 1385 patients from the Latin American SLE incident cohort (GLADEL (Grupo Latino Americano Del Estudio de Lupus)).
Methods: Longitudinal cohort study. SDI assessed yearly, and damage accrual defined as a SDI change in any individual item during follow-up. Sociodemographic and clinical characteristics at entry, along with regular medication use up to the month prior to each damage item accrued, were analysed using multivariate Cox proportional hazard models with time-varying hazard risk effect performed. Models for overall damage and 10 items with at least 28 patients per item are reported.
Results: New damage was accrued by 658 patients with SLE (48%) over a median of 54 months (p25-75: 29-71) of follow-up. Mestizo ethnicity, recent SLE Disease Activity Index (SLEDAI) and immunosuppressants were predictors of overall damage accrual, while antimalarials and rural residence were protectors; mixed effects were observed for SDI >0 and glucocorticoids (GCs) use. Protectors for scarring chronic alopecia (23.7% at 7 years follow-up) included older age, longer disease duration, diagnostic delay, SDI >0 and cytotoxic use. Proteinuria >3.5 g/24 hours (11.5% at 7 years follow-up) was associated with protective factors like older age, longer disease duration and higher GCs dose, while risk factors were Mestizo ethnicity, low medical coverage, higher SLEDAI scores and cytotoxic use. In addition, Mestizo ethnicity was a risk factor for estimated glomerular filtration rate <50% and end-stage renal disease (ESRD) whereas antimalarial protected from ESRD. GCs were risk factors for pericarditis, retinal change or optic atrophy but provided protection against proteinuria >3.5 g/24 hours. Recent disease activity and cytotoxic use were significant risk factors for additional items.
Conclusions: Factors associated with damage accrual differ substantially by individual SDI items. Mestizo ethnicity and recent disease activity increased renal risks, while antimalarials were protective. GCs showed mixed effects. Item-specific strategies are crucial to mitigate long-term damage.
期刊介绍:
Lupus Science & Medicine is a global, peer reviewed, open access online journal that provides a central point for publication of basic, clinical, translational, and epidemiological studies of all aspects of lupus and related diseases. It is the first lupus-specific open access journal in the world and was developed in response to the need for a barrier-free forum for publication of groundbreaking studies in lupus. The journal publishes research on lupus from fields including, but not limited to: rheumatology, dermatology, nephrology, immunology, pediatrics, cardiology, hepatology, pulmonology, obstetrics and gynecology, and psychiatry.