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JOURNAL ARTICLE
MULTICENTER STUDY

Evolution of disease burden over five years in a multicenter inception systemic lupus erythematosus cohort

M B Urowitz, D D Gladman, D Ibañez, P R Fortin, S C Bae, C Gordon, A Clarke, S Bernatsky, J G Hanly, D Isenberg, A Rahman, J Sanchez-Guerrero, D J Wallace, E Ginzler, G S Alarcón, J T Merrill, I N Bruce, G Sturfelt, O Nived, K Steinsson, M Khamashta, M Petri, S Manzi, R Ramsey-Goldman, M A Dooley, R F van Vollenhoven, M Ramos, T Stoll, A Zoma, K Kalunian, C Aranow
Arthritis Care & Research 2012, 64 (1): 132-7
21954226

OBJECTIVE: We describe disease activity, damage, and the accrual of key autoantibodies in an inception systemic lupus erythematosus (SLE) cohort.

METHODS: The Systemic Lupus International Collaborating Clinics (SLICC) International Research Network, comprising 27 centers from 11 countries, has followed an inception cohort of SLE patients yearly according to a standardized protocol. Of these patients, 298 were followed for a minimum of 5 years and constitute the study population. Disease activity was assessed using the SLE Disease Activity Index 2000 (SLEDAI-2K) and damage was assessed using the SLICC/American College of Rheumatology Damage Index (SDI). Antinuclear antibody (ANA), anti-DNA, and anticardiolipin antibody (aCL) levels and lupus anticoagulant were assessed yearly. Descriptive statistics were generated and repeated-measures general linear models were used to evaluate SLEDAI-2K and SDI over time between whites and nonwhites.

RESULTS: Of the 298 patients, 87% were women, 55% were white, 12% were African American, 14% were Asian, 16% were Hispanic, and 2% were categorized as "other." At enrollment, the mean age was 35.3 years, the mean SLEDAI-2K score was 5.9, and the mean disease duration was 5.5 months. Mean SLEDAI-2K scores decreased in the first year and then remained low. SLEDAI-2K scores were significantly lower at each year in whites compared to nonwhites. Mean SDI scores increased progressively over 5 years; there was no significant difference between whites and nonwhites. As expected, ANA positivity was high and anti-DNA positivity was relatively low at enrollment, and both increased over 5 years. Although lupus anticoagulant increased slightly over 5 years, aCL positivity did not.

CONCLUSION: Disease activity in newly diagnosed patients decreases over their first 5 years, while damage increases. Antibody positivity ran variable courses over this period.

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