Contributors to Organ Damage in Childhood Lupus: Corticosteroid Use and Disease Activity

Maria Hanif, Chandni Sarker, Eslam Al-Abadi, Kate Armon, Marek Bohm, Mary Brennan, Coziana Ciurtin, Janet Gardner-Medwin, Daniel P Hawley, Alison Kinder, Alice Leahy, Gulshan Malik, Zoe McLaren, Elena Moraitis, Ellen Mosley, Athimalaipet V Ramanan, Satyapal Rangaraj, Annie Ratcliffe, Philip Riley, Heather RostronEthan Sen, Michael W Beresford, Eve M D Smith*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

BACKGROUND: Awareness of paediatric-specific predictors of damage in Childhood-lupus is needed to inform mitigation measures.

OBJECTIVES: To ascertain how clinical and demographic variables correlate with damage accrual and identify predictors of damage.

METHODS: Analysis included UK JSLE Cohort Study participants. Univariable and multivariable Prentice-Williams-Peterson models investigated how demographic and clinical factors influenced hazards of new damage. Analyses were performed across the entire cohort, in patients with minimal disease activity marked by a time-adjusted average SLEDAI-2K score (AMS)≤2, low activity (AMS ≤ 4), moderate-high activity (AMS > 4) and those with no corticosteroids.

RESULTS: Within the entire cohort (n = 430), factors associated with damage included: any methylprednisolone (Hazard Ratio, HR 2.20, [CI 1.33-3.62]), time-adjusted mean Physicians Global Assessment (PGA) (HR 2.87, [CI 1.48-5.56]) and AMS score (HR 1.13, [CI 1.03-1.24], all p< 0.05). Within the low activity subgroup, any methylprednisolone (HR 2.61, [CI 1.04-6.53]) and time-adjusted mean PGA (HR 3.41, [CI 1.52-7.76]) were associated with damage (both p< 0.05). Within the moderate-high activity subgroup, any methylprednisolone (HR 2.29, [CI 1.31-4.00]), time-adjusted mean PGA (HR 2.66, [CI 1.20-5.87]) and AMS score (HR 1.15, [CI 1.03-1.29]), were predictive of damage (all p< 0.05). Baseline organ damage was predictive of subsequent damage accrual in the minimal activity (HR 1.33, CI [1.78-8.08]) and no corticosteroids subgroups (HR 3.64, CI [1.83-7.24], both p< 0.005).

CONCLUSION: Disease activity levels (AMS/PGA) and proxy indicators (methylprednisolone exposure, baseline damage) were found to be key predictors of damage accrual. This highlights the importance of practical strategies, to reduce disease activity and long-term treatment toxicity, such as treat-to-target.

Original languageEnglish
Pages (from-to)1-28
Number of pages28
JournalRheumatology
Early online date22 Oct 2024
DOIs
Publication statusE-pub ahead of print - 22 Oct 2024

Bibliographical note

© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.

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