{
  "abstract": "Objective To identify factors associated with individual Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) accrual items in 1385 patients from the Latin American SLE incident cohort (GLADEL (Grupo Latino Americano Del Estudio de Lupus)).Methods Longitudinal cohort study. SDI assessed yearly, and damage accrual defined as a SDI change in any individual item during follow-up. Sociodemographic and clinical characteristics at entry, along with regular medication use up to the month prior to each damage item accrued, were analysed using multivariate Cox proportional hazard models with time-varying hazard risk effect performed. Models for overall damage and 10 items with at least 28 patients per item are reported.Results New damage was accrued by 658 patients with SLE (48%) over a median of 54 months (p25–75: 29–71) of follow-up. Mestizo ethnicity, recent SLE Disease Activity Index (SLEDAI) and immunosuppressants were predictors of overall damage accrual, while antimalarials and rural residence were protectors; mixed effects were observed for SDI >0 and glucocorticoids (GCs) use. Protectors for scarring chronic alopecia (23.7% at 7 years follow-up) included older age, longer disease duration, diagnostic delay, SDI >0 and cytotoxic use. Proteinuria >3.5 g/24 hours (11.5% at 7 years follow-up) was associated with protective factors like older age, longer disease duration and higher GCs dose, while risk factors were Mestizo ethnicity, low medical coverage, higher SLEDAI scores and cytotoxic use. In addition, Mestizo ethnicity was a risk factor for estimated glomerular filtration rate <50% and end-stage renal disease (ESRD) whereas antimalarial protected from ESRD. GCs were risk factors for pericarditis, retinal change or optic atrophy but provided protection against proteinuria >3.5 g/24 hours. Recent disease activity and cytotoxic use were significant risk factors for additional items.Conclusions Factors associated with damage accrual differ substantially by individual SDI items. Mestizo ethnicity and recent disease activity increased renal risks, while antimalarials were protective. GCs showed mixed effects. Item-specific strategies are crucial to mitigate long-term damage.",
  "authors": [
    {
      "affiliations": [
        "Facultad de Medicina, Universidad San Sebastián, Santiago, Chile"
      ],
      "name": "Milena Mimica"
    },
    {
      "affiliations": [
        "Escuela de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile"
      ],
      "name": "Oslando Padilla"
    },
    {
      "affiliations": [
        "Grupo Oroño—Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina"
      ],
      "name": "Guillermo Pons-Estel"
    },
    {
      "affiliations": [
        "Grupo Oroño—Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina"
      ],
      "name": "Rosana Quintana"
    },
    {
      "affiliations": [
        "Universidad de Chile Facultad de Medicina, Santiago, Chile",
        "Sección de Reumatología, Hospital Del Salvador, Santiago, Chile"
      ],
      "name": "Oscar Neira"
    },
    {
      "affiliations": [
        "Sección de Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina"
      ],
      "name": "Luis Jose Catoggio"
    },
    {
      "affiliations": [
        "Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina"
      ],
      "name": "Veronica Saurit"
    },
    {
      "affiliations": [
        "Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Cristina Drenkard"
    },
    {
      "affiliations": [
        "Servicio de Reumatología, Hospital Escuela Eva Peron, Granadero Baigorria, Santa Fe, Argentina"
      ],
      "name": "Guillermo Berbotto"
    },
    {
      "affiliations": [
        "Servicio de Reumatología, Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina"
      ],
      "name": "Mercedes A Garcia"
    },
    {
      "affiliations": [
        "Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil",
        "Divisao de Reumatologia, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil"
      ],
      "name": "Eduardo F Borba"
    },
    {
      "affiliations": [
        "Rheumatology, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil"
      ],
      "name": "Eloisa Bonfá"
    },
    {
      "affiliations": [
        "Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil"
      ],
      "name": "Emilia I Sato"
    },
    {
      "affiliations": [
        "Faculdade de Medicina, Universidade Federal de Goias, Goiânia, Brazil"
      ],
      "name": "Ana Carolina de O e Silva"
    },
    {
      "affiliations": [
        "Divisao de Reumatologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Brazil"
      ],
      "name": "Lilian Costallat"
    },
    {
      "affiliations": [
        "Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil"
      ],
      "name": "João Carlos Tavares Brenol"
    },
    {
      "affiliations": [
        "División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia"
      ],
      "name": "Gloria Vásquez"
    },
    {
      "affiliations": [
        "División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia",
        "Seccion de Reumatología, Hospital Universitario San Vicente de Paul, Medellín, Colombia"
      ],
      "name": "Oscar Uribe-Uribe"
    },
    {
      "affiliations": [
        "Unidad de Reumatología, Departamento de Medicina Interna, Universidad Nacional de Colombia, Bogotá, Colombia"
      ],
      "name": "Antonio Iglesias"
    },
    {
      "affiliations": [
        "Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba"
      ],
      "name": "Marlene Guibert Toledano"
    },
    {
      "affiliations": [
        "Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba"
      ],
      "name": "Gil Reyes Llerena"
    },
    {
      "affiliations": [
        "Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, Ciudad de México, Mexico"
      ],
      "name": "Virginia Pascual-Ramos"
    },
    {
      "affiliations": [
        "Reumatología, Centro Médico ABC, Ciudad de México, Mexico"
      ],
      "name": "Mary-Carmen Amigo"
    },
    {
      "affiliations": [
        "Reumatología, Hospital Ángeles del Pedregal, Ciudad de México, Mexico"
      ],
      "name": "Leonor Barile-Fabris"
    },
    {
      "affiliations": [
        "Departamento de Inmunología y Reumatología, Hospital General de Occidente, Guadalajara, Mexico",
        "Universidad de Guadalajara, Guadalajara, Mexico"
      ],
      "name": "Ignacio García De La Torre"
    },
    {
      "affiliations": [
        "Departamento de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru"
      ],
      "name": "Eduardo M Acevedo-Vazquez"
    },
    {
      "affiliations": [
        "Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru"
      ],
      "name": "María Inés Segami"
    },
    {
      "affiliations": [
        "Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela, Bolivarian Republic of"
      ],
      "name": "Rosa Chacón-Díaz"
    },
    {
      "affiliations": [
        "Hospital Central de San Cristóbal Dr José María Vargas, San Cristobal, Táchira, Venezuela, Bolivarian Republic of"
      ],
      "name": "María H Esteva-Spinetti"
    },
    {
      "affiliations": [
        "Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA",
        "Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru"
      ],
      "name": "Graciela S Alarcon"
    },
    {
      "affiliations": [
        "Grupo Oroño—Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina"
      ],
      "name": "Bernardo A Pons-Estel"
    },
    {
      "affiliations": [
        "Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Científica del Sur, Lima, Peru"
      ],
      "name": "Manuel F Ugarte-Gil"
    },
    {
      "affiliations": [
        "Facultad de Medicina, Universidad San Sebastián, Santiago, Chile"
      ],
      "name": "Loreto Massardo"
    }
  ],
  "title": "Item-specific factors associated with damage accrual in systemic lupus erythematosus: insights from a multiethnic, multinational Latin American cohort",
  "uid": "a2e80d82-3ac6-56d5-8ce9-9fd84a542a97"
}