High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus
Objective Disease severity in SLE is an important concept related to disease activity, treatment burden and prognosis. We set out to evaluate if high disease activity status (HDAS), based on ever attainment of a Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) disease activity score of ≥...
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doaj-d30cbae09c534874963f2ba4686315632021-01-22T17:00:11ZengBMJ Publishing GroupLupus Science and Medicine2053-87902020-12-017110.1136/lupus-2019-000372High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosusAmy KaoEric Morand0Rachel Koelmeyer1Hieu Tri NimYing B SunOliver GuentherAlberta Hoi2Department of Rheumatology, Monash Health, Melbourne, Victoria, AustraliaCentre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, AustraliaDepartment of Rheumatology, Monash Health, Melbourne, Victoria, AustraliaObjective Disease severity in SLE is an important concept related to disease activity, treatment burden and prognosis. We set out to evaluate if high disease activity status (HDAS), based on ever attainment of a Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) disease activity score of ≥10, is an indicator for disease severity in SLE.Methods Using prospectively collected data, we assessed the association of HDAS with sociodemographic and disease characteristics and adverse clinical outcomes using logistic regression or generalised estimating equations.Results Of 286 patients with SLE, who were observed for a median (range) of 5.1 years (1–10.8 years), 43.7% experienced HDAS at least once during the observational period. Autoantibody positivity, particularly anti-dsDNA and anti-Sm positivity, were associated with increased likelihood of HDAS. Age ≥45 years at diagnosis was associated with reduced likelihood of HDAS (p=0.002). Patients with HDAS had higher Physician Global Assessment score (>1: OR 8.1, p<0.001) and were more likely to meet criteria for flare (mild/moderate flare: OR 4.4, p<0.001; severe flare: OR 17.2, p<0.001) at the time of experiencing HDAS. They were also more likely to have overall higher disease activity, as defined by time-adjusted mean SLEDAI-2K score in the highest quartile (OR 11.7, 95% CI 5.1 to 26.6; p>0.001), higher corticosteroid exposure (corticosteroid dose in highest quartile: OR 7.7, 95% CI 3.9 to 15.3; p<0.001) and damage accrual (OR 2.3, 95% CI 1.3 to 3.9; p=0.003) when compared with non-HDAS patients.Conclusions HDAS is associated with more severe disease, as measured by higher disease activity across time, corticosteroid exposure and damage accrual. The occurrence of HDAS may be a useful prognostic marker in the management of SLE.https://lupus.bmj.com/content/7/1/e000372.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Amy Kao Eric Morand Rachel Koelmeyer Hieu Tri Nim Ying B Sun Oliver Guenther Alberta Hoi |
spellingShingle |
Amy Kao Eric Morand Rachel Koelmeyer Hieu Tri Nim Ying B Sun Oliver Guenther Alberta Hoi High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus Lupus Science and Medicine |
author_facet |
Amy Kao Eric Morand Rachel Koelmeyer Hieu Tri Nim Ying B Sun Oliver Guenther Alberta Hoi |
author_sort |
Amy Kao |
title |
High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus |
title_short |
High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus |
title_full |
High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus |
title_fullStr |
High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus |
title_full_unstemmed |
High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus |
title_sort |
high disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus |
publisher |
BMJ Publishing Group |
series |
Lupus Science and Medicine |
issn |
2053-8790 |
publishDate |
2020-12-01 |
description |
Objective Disease severity in SLE is an important concept related to disease activity, treatment burden and prognosis. We set out to evaluate if high disease activity status (HDAS), based on ever attainment of a Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) disease activity score of ≥10, is an indicator for disease severity in SLE.Methods Using prospectively collected data, we assessed the association of HDAS with sociodemographic and disease characteristics and adverse clinical outcomes using logistic regression or generalised estimating equations.Results Of 286 patients with SLE, who were observed for a median (range) of 5.1 years (1–10.8 years), 43.7% experienced HDAS at least once during the observational period. Autoantibody positivity, particularly anti-dsDNA and anti-Sm positivity, were associated with increased likelihood of HDAS. Age ≥45 years at diagnosis was associated with reduced likelihood of HDAS (p=0.002). Patients with HDAS had higher Physician Global Assessment score (>1: OR 8.1, p<0.001) and were more likely to meet criteria for flare (mild/moderate flare: OR 4.4, p<0.001; severe flare: OR 17.2, p<0.001) at the time of experiencing HDAS. They were also more likely to have overall higher disease activity, as defined by time-adjusted mean SLEDAI-2K score in the highest quartile (OR 11.7, 95% CI 5.1 to 26.6; p>0.001), higher corticosteroid exposure (corticosteroid dose in highest quartile: OR 7.7, 95% CI 3.9 to 15.3; p<0.001) and damage accrual (OR 2.3, 95% CI 1.3 to 3.9; p=0.003) when compared with non-HDAS patients.Conclusions HDAS is associated with more severe disease, as measured by higher disease activity across time, corticosteroid exposure and damage accrual. The occurrence of HDAS may be a useful prognostic marker in the management of SLE. |
url |
https://lupus.bmj.com/content/7/1/e000372.full |
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