Thirty-year trajectory of organ damage accrual and damage-free survival in Colombian patients with systemic lupus erythematosus: A registry-based retrospective follow-up study

Abstract

Objective

To analyze the 30-year trajectory of organ damage accrual and damage-free survival (DFS) in a registry-based cohort of Colombian patients with systemic lupus erythematosus (SLE) enrolled in the ARTMEDICA program for autoimmune diseases.

Method

We conducted a retrospective registry-based follow-up study including patients aged ≥18 years, treated between March 2011 and August 2017, who met the 2012 SLICC classification criteria for SLE. Organ damage was assessed using the SLICC/ACR Damage Index (SDI), and disease activity and relapses were evaluated with the SLEDAI-2K. Mean annual change ratios (MACR) in SDI were estimated using multilevel generalized linear models. Parametric survival models for interval-censored data were used to assess overall and system-specific DFS.

Results

A total of 559 patients were included, with a mean follow-up of 14.7 years; 96.6% were female, and the median age at diagnosis was 30 years (IQR: 20–48). The median number of relapses was 3.5 (IQR: 1–8). Mean SDI increased linearly to 1.24 (95% CI: 1.08–1.40) at 15 years and continued to 1.53 (95% CI: 1.16–1.90) at 30 years. Median organ DFS was 7.2 years (95% CI: 5.8–8.5), with substantial variability across systems. Myelopathy (MACR 2.24; 95%CI 1.26–3.98), cellular casts (MACR 2.15; 95%CI 1.09–4.22), seizures (MACR 1.82; 1.30–2.55) and disease activity (MACR 1.22; 95%CI 1.10–1.35) were associated with faster damage accrual.

Conclusion

The trajectory of organ damage accrual underscores the long-term burden of SLE and the need for comprehensive interventions, particularly in patients with high-risk clinical features.