From Childhood to Adulthood, Lupus Damage Accrues

A longitudinal study of adults with childhood-onset systemic lupus erythematosus shows that disease damage accrues over the entire disease course for these patients without plateauing, researchers recently reported in Arthritis Care and Research.

The study, conducted by Earl Silverman, M.D., and colleagues of Toronto SickKids Hospital, included 473 patients with an average age of 22.2 years. The patients were followed for an average of 5.63 years (or, a maximum of 26.3 years).

Prior to this study, only four other studies had been conducted examining the outcomes of childhood-onset systemic lupus erythematosus patients. This study is important because it identifies prognostic factors that physicians should consider in managing care in a way that modifies the trajectory of damage over a patient’s life.

Here is a summary of the most poignant points from the study:

• Increased doses of prednisone and the use of cyclophosphamide predicted a subsequent increase in the damage trajectory.
• Over the course of disease, each 10 mg increment of prednisone exposure from 6 to 24 months before each visit predicted an increase in damage.
• Increasing prednisone dose from 12 and 24 months before increases the damage trajectory.
• Anti-malarials protected against an increase in the damage trajectory despite high dose prednisone and cyclophosphamide.
• Afro-Caribbean patients have been known to have more damage, but this study shows that this group, as compared to Caucasian and Asians, also persistently had a greater damage trajectory that started early.
• Potentially life-threatening major organ manifestations at baseline were associated with more rapid early damage accrual.
• Throughout the disease course, acute confusion state, lupus headache or fever predicted a subsequent increase in the damage trajectory.
• Active SLE independent of steroid was identified as a risk factor for avascular necrosis.
• Cataracts have been seen in individuals on low-dose steroids or who were steroid naïve.
• Hydroxychloroquine exposure from six months before protected patients against an increase in damage trajectory.

References:

Lily SH Lim, Eleanor Pullenayegum, Lillian Lim, Dafna Gladman, Brian Feldman, Earl Silverman. "From Childhood to Adulthood: The Trajectory of Damage in Patients with Childhood-Onset Systemic Lupus Erythematosus," Jan. 24, 2017. Arthritis Care and Research. DOI: 10.1002/acr.23199