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Epidemiology and outcomes
Original research
High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus
  1. Rachel Koelmeyer1,
  2. Hieu Tri Nim2,
  3. Mandana Nikpour3,4,
  4. Ying B Sun5,
  5. Amy Kao6,
  6. Oliver Guenther5,
  7. Eric Morand1,7 and
  8. Alberta Hoi1,7
  1. 1Monash Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
  2. 2Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
  3. 3Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
  4. 4Rheumatology, St Vincent Hospital Melbourne, Fitzroy, Victoria, Australia
  5. 5Global Evidence & Value Development, Merck Healthcare KGaA, Darmstadt, Germany
  6. 6Global Clinical Development, EMD Serono Research and Development Institute, Darmstadt, Germany
  7. 7Department of Rheumatology, Monash Health, Clayton, Victoria, Australia
  1. Correspondence to Dr Alberta Hoi; alberta.hoi{at}monash.edu

Abstract

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.

  • systemic lupus erythematosus
  • disease activity
  • autoimmune diseases
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/lupus-2019-000372

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    Footnotes

    • Contributors All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication. RK had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study conception and design: RK, HTN, MN, YBS, AK, OG, EM and AH. Acquisition of data: EM and AH. Analysis and interpretation of data: RK, HTN, MN, YBS, AK, OG, EM and AH.

    • Funding This study was funded by Merck Healthcare KGaA (Part sponsorship). Conduct of the Australian Lupus Registry and Biobank at the Monash Lupus Clinic and related analyses have been supported by unrestricted grants from Merck KGaA, GlaxoSmithKline, UCB, and Astra Zeneca. Merck KGaA in particular provided financial support for this study. MN is supported by an NHMRC Career Development Fellowship.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval Monash Health Human Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. Deidentified data have been provided through the Australian Lupus Registry & Biobank. Access is subjected to Data Access Policy.