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The majority of Swedish systemic lupus erythematosus patients are still affected by irreversible organ impairment: factors related to damage accrual in two regional cohorts
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
Uppsala Univ, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0002-6916-5490
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
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2019 (English)In: Lupus, ISSN 0961-2033, E-ISSN 1477-0962, article id UNSP 0961203319860198Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background Although the survival of patients with systemic lupus erythematosus (SLE) has improved, irreversible organ damage remains a critical concern. We aimed to characterize damage accrual and its clinical associations and causes of death in Swedish patients. Methods Accumulation of damage was evaluated in 543 consecutively recruited and well-characterized cases during 1998-2017. The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology damage index (SDI) was used to estimate damage. Results Organ damage (SDI amp;gt;= 1) was observed in 59%, and extensive damage (SDI amp;gt;= 3) in 25% of cases. SDI amp;gt;= 1 was significantly associated with higher age at onset, SLE duration, the number of fulfilled SLICC criteria, neurologic disorder, antiphospholipid antibody syndrome (APS), hypertension, hyperlipidemia, depression and secondary Sjogrens syndrome (SS). In addition, SDI amp;gt;= 3 was associated with serositis, renal and haematological disorders and interstitial lung disease. A multiple regression model identified not only well-known risk factors like APS, antihypertensives and corticosteroids, but pericarditis, haemolytic anaemia, lymphopenia and myositis as being linked to SDI. Malignancy, infection and cardiovascular disease were the leading causes of death. Conclusions After a mean SLE duration of 17 years, the majority of todays Swedish SLE patients have accrued damage. We confirm previous observations and report some novel findings regarding disease phenotypes and damage accrual.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD , 2019. article id UNSP 0961203319860198
Keywords [en]
Damage accrual; immunosuppressants; mortality; SLE phenotypes; Sweden; systemic lupus erythematosus
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:liu:diva-159259DOI: 10.1177/0961203319860198ISI: 000477186800001PubMedID: 31296137OAI: oai:DiVA.org:liu-159259DiVA, id: diva2:1340855
Note

Funding Agencies|Swedish Rheumatism Association; County Council of Ostergotland; Swedish Society of Medicine; King Gustaf Vs 80-year Anniversary foundation; King Gustaf V and Queen Victorias Freemasons foundation; Ingegerd Johansson donation; Selander foundation; County Council of Uppsala

Available from: 2019-08-06 Created: 2019-08-06 Last updated: 2019-08-06

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Frodlund, MartinaWetterö, JonasDahlström, ÖrjanSjöwall, Christopher
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Division of Neuro and Inflammation ScienceFaculty of Medicine and Health SciencesDepartment of RheumatologyPsychologyFaculty of Arts and SciencesThe Swedish Institute for Disability Research
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Lupus
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