Lupus Disease Activity Decreases, but Damage Accumulates

Disease burden in patients with a new diagnosis of systemic lupus erythematosus (SLE) changes over the first 5 years. Disease activity decreases and remains at a low level, but damage, especially damage related to corticosteroid therapy, accumulates.

Urowitz and colleagues monitored an inception cohort of 298 patients from the Systemic Lupus International Collaborating Clinics (SLICC) International Research Network for a minimum of 5 years. They assessed disease activity with the SLE Disease Activity Index 2000 (SLEDAI-2K) and damage with the SLICC/American College of Rheumatology Damage Index (SDI). Antinuclear antibody (ANA), anti-DNA, and anticardiolipin antibody levels and lupus anticoagulant were assessed.

Mean SLEDAI-2K scores decreased in the first year and remained low; scores were significantly lower in white patients than in nonwhite patients. Mean SDI scores increased progressively over 5 years with no significant difference between white and nonwhite patients. Damage resulting from corticosteroids increased over the 5 years. At enrollment, ANA positivity was high and anti-DNA positivity was somewhat low; both increased over 5 years.

The authors noted that in this study, the damage resulting from corticosteroids did not increase as dramatically as in previous years, possibly reflecting a more judicious use of these agents in the current era.