Irreversible organ damages in a cohort of patients with systemic lupus erythematosus (RENAISSANCE)

Objective: to reveal irreversible organ damages and to establish factors that influence their development in a RENAISSANCE cohort of patients with systemic lupus erythematosus (SLE) admitted to the clinic of the V.A. Nasonova Research Institute of Rheumatology in the period 2012 to 2014.Subjects and methods. The investigation enrolled 231 young (mean age, 34.91±11.10 years) patients (209 women and 22 men) with a mean SLE duration of 107.65±97.36 months. On admission of the patients, the investigators collected history data (disease duration, the number of exacerbations and hospitalizations during the follow-up period), assessed current disease activity by SLEDAI-2K, irreversible organ damages by SLICC damage index (DI), and the therapy performed.Results and discussion. Irreversible organ damages were absent in 95 (41%) patients; one or more damages associated with both disease itself and the therapy were observed in the other (59%) patients. There were low (1), mean (2–4), and high (>4) SLICC DI values in 64 (28%), 62 (27%), and 11 (5%) patients, respectively. Ocular lesions were most common (35%); a significant proportion of patients were found to have damages to the cardiovascular (22%), musculoskeletal (19%), and nervous (10%) systems. Lung disease, diabetes mellitus, and cancer were less prevalent (6.0, 3.4, and 1.3%, respectively). The patients with damages were significantly older (p = 0.02), had a longer disease duration (p = 0.0005) and more frequent SLE exacerbations and hospitalizations (p = 0.0003 and p = 0.001, respectively). The patients with DI ≥1 received glucocorticoids (GCs) longer (p = 0.001). At the onset of SLE they had significantly higher doses of GCs (mean 44.06±18.97 mg) than those without damages (35.91±20.12 mg; р = 0.002). DI correlated with GC doses at the onset of the disease, duration of GC use, number of hospitalizations and exacerbations. There was also a statistically significant correlation of overall SLICC DI with the duration of disease (r = 0.23) and the total dose of cyclophosphamide (CP) (r = 0.19).Conclusion. Irreversible organ damages are present in 59 patients in the RENAISSANCE cohort. Older individuals develop a larger number of damages, with higher frequency of exacerbations and hospitalizations, longer use of GCs, and higher cumulative dose of CP. DI correlates with the dose of GC and does not depend on the activity and clinical manifestations of SLE at its onset.