A recent longitudinal study conducted by the Spanish Society of Rheumatology Lupus Registry provided insights into the patterns of organ damage in patients with systemic lupus erythematosus, with a particular focus on cardiovascular complications.
In the multicenter, descriptive study, published in Lupus Science & Medicine, investigators involved a cohort of 4,219 patients with lupus and highlighted early cardiovascular damage as a key factor in the overall disease progression.
The investigators examined the patients over time, analyzing data retrospectively from Spanish Society of Rheumatology Lupus Registry (RELESSER)-TRANS. The cohort had a female predominance (89.6%) and a mean age at diagnosis of 35.9 years. Approximately 50.1% of the patients experienced some type of organ damage, as defined by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). The cohort was predominantly Caucasian (92%), with smaller representations of Latin American (5.3%), Afro-Caribbean (0.3%), Asian (0.7%), and other ethnicities (1.7%).
The investigators revealed that organ damage occurred most frequently within the first year after lupus diagnosis, with 20% of patients developing new damage within this period. Cardiovascular damage was particularly significant, ranking as the second most affected system early in the disease course when modifications to the SDI considered cerebrovascular accidents and claudication as cardiovascular events. The musculoskeletal system was the most commonly affected, with damage observed in 19.3% of the cohort.
Longitudinal analysis of 1,274 patients with recorded dates of damage events demonstrated a clear trend: the annual percentage of patients experiencing new damage decreased from 20% in the first year to 5% after 5 years. Early-stage damage primarily affected the musculoskeletal (21%), neuropsychiatric (17%), renal (15%), and cardiovascular (13%) systems. In contrast, later-stage damage was more prevalent in the musculoskeletal (31%), ocular (20%), and cardiovascular (18%) systems.
Among the patients who accrued damage, the mean SDI score was 2.3, affecting an average of 1.8 SDI domains. These patients were more likely to be male (12.4% vs 8.3% without damage) and Caucasian, and they also had a higher mortality rate (9.6% vs 1.2% without damage).
The overall mortality rate in the cohort was 5.4%. The study linked early damage to increased mortality, reinforcing the importance of aggressive early intervention. The mean disease duration in the cohort was 133.2 months (approximately 11 years), and during this time, the patients with damage had a mean SDI score progression from 0.30 at year 1 to 1.89 by year 20.
The study's findings indicated that early intervention could be crucial in preventing cardiovascular damage in patients with lupus. Given that the cardiovascular system was significantly impacted early in the disease, therapeutic strategies aimed at reducing cardiovascular risk factors should be implemented promptly after diagnosis. Additionally, the data suggested that controlling lupus activity and minimizing glucocorticoid exposure might help reduce long-term damage.
Conflict of interest disclosures can be found in the study.
