According to research presented this week at the American College of Rheumatology Annual Meeting in San Diego, researchers have identified three potentially modifiable risk factors and one protective medication that may improve the health of people living with lupus.
Systemic lupus erythematosus, also called SLE or lupus, is a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system, and/or other organs of the body. The most common symptoms include skin rashes and arthritis, often accompanied by fatigue and fever. Lupus occurs mostly in women, typically developing in individuals in their twenties and thirties -- prime child- bearing age.
"Early tissue and organ damage in people with lupus can predict the likelihood of future damage and death due to the disease," says Ian N Bruce, MD, FRCP; professor of rheumatology at the University of Manchester, UK; current chair of the SLICC Inception Cohort; and lead investigator in the study. Dr. Bruce's team recently studied factors that might contribute to the development and progression of tissue and organ damage as well as the relationship between that damage and long-term survival rates. They found that increased disease activity, high blood pressure, and steroid use were associated with worsening damage, and the use of antimalarials protected against worsening damage from SLE.
Using the SLICC Inception Cohort Study -- which includes patients from 31 centers in 11 countries in North America, Europe, and Asia -- The SLICC group recruited 1,722 patients between 2000 and 2011 and enrolled them in the study within 15 months of meeting their fourth 1997 ACR criteria for having lupus. The average age of participants in the study was 35 years old and they averaged 4.25 follow-up visits throughout the duration of the study. All patients had a careful annual follow-up that included details of their lupus and its treatment as well as details other conditions they may have and other treatments they were taking.
1,502 patients -- including 1,337 females -- were analyzed for changes in the amount of irreversible damage they experienced over the study period. Damage was measured using the ACR/SLICC Damage Index (called SDI), which is an accepted standard measure of damage in SLE patients. Over the duration of the study, damage rates steadily increased so that by six years of follow-up, 51.1 percent had at least one item of damage recorded.
The researchers found that patients with initial damage were more likely to increase their SDI at each follow-up visit. They also found several factors that were associated with an increased risk of developing or increasing damage. These included older age, being of African ancestry within the USA, higher levels of inflammation (measured by the SLEDAI score), steroid use and high blood pressure.
They also found that men and Caucasians living in the United States were most likely to experience new damage and those who were from an Asian background had lower rates of new damage. In addition, taking antimalarial drugs reduced the rate of damage developing in patients with pre-existing damage. Finally, they found that each point increase in SDI score was associated with a moderate increased risk of death.
"This study shows that irreversible damage develops steadily over time in lupus patients and starts early in the course of the disease," says Dr. Bruce. "Many of the risk factors we have identified, such as high blood pressure, use of steroids and ongoing disease activity could potentially be modified. Clinical trials should test whether we can improve the long-term health of SLE patients by specifically targeting these risk factors in our patients."
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