TY - JOUR
T1 - Contributors to Organ Damage in Childhood Lupus
T2 - Corticosteroid Use and Disease Activity
AU - Hanif, Maria
AU - Sarker, Chandni
AU - Al-Abadi, Eslam
AU - Armon, Kate
AU - Bohm, Marek
AU - Brennan, Mary
AU - Ciurtin, Coziana
AU - Gardner-Medwin, Janet
AU - Hawley, Daniel P
AU - Kinder, Alison
AU - Leahy, Alice
AU - Malik, Gulshan
AU - McLaren, Zoe
AU - Moraitis, Elena
AU - Mosley, Ellen
AU - Ramanan, Athimalaipet V
AU - Rangaraj, Satyapal
AU - Ratcliffe, Annie
AU - Riley, Philip
AU - Rostron, Heather
AU - Sen, Ethan
AU - Beresford, Michael W
AU - Smith, Eve M D
N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.
PY - 2024/10/22
Y1 - 2024/10/22
N2 - 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.
AB - 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.
U2 - 10.1093/rheumatology/keae592
DO - 10.1093/rheumatology/keae592
M3 - Article (Academic Journal)
C2 - 39460632
SN - 1462-0324
SP - 1
EP - 28
JO - Rheumatology
JF - Rheumatology
ER -