{
  "abstract": "Objectives Long-term follow-up of systemic lupus erythematosus (SLE) provides valuable insight into the natural history of disease activity and the cumulative burden of organ damage. Understanding these dynamics is essential to refine therapeutic strategies and improve long-term outcomes.Objective To characterize patterns of disease activity and organ damage accrual over a 10-year in a tertiary care SLE cohort and to identify clinical predictors of irreversible damage.Methods A retrospective longitudinal cohort study was conducted including adult SLE patients fulfilling the 2019 EULAR/ACR criteria, followed between 2014 and 2024 in our tertiary academic centre. Disease activity was evaluated using the SLE Disease Activity Index (SLEDAI-2K), and cumulative organ damage by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Patients were stratified by disease duration into: early (<2 years), established (2–10 years), and long-standing (>10 years) disease. Temporal trends were analysed using paired statistics, and multivariate regression identified predictors of SDI progression.Results Among 105 patients (90.5% female, mean age = 42.3±12.8 years, median disease duration = 8.6 years), mean SLEDAI-2K declined from 10.2±5.4 at baseline to 4.8 ± 3.1 at last follow-up (p < 0.001), reflecting improved disease control. In contrast, mean SDI increased from 0.4 ± 0.7 to 1.6 ± 1.2 (p<0.001), with cumulative damage observed in 47.6% of patients. The most frequent domains of accrual were musculoskeletal (66.7%), hematologic (47,25), renal (32.4%), neuropsychiatric (6.66%); sustained glucocorticoid use > 7.5 mg/day had a 2.8-fold higher risk of SDI progression (OR 2.82, 95% CI 1.42–5.61, p=0.003), while persistent moderate activity (SLEDAI > 6) was independently associated with organ damage (OR 2.37, 95% CI 1.18–4.76, p=0.016). Patients achieving sustained remission or low disease activity had minimal SDI increase (mean delta SDI 0.2 vs 1.4, p<0.001). Damage-free survival at 10 years was 61.3%, declining to 42.7% among those with chronic steroid use.Conclusions Despite improved disease control over time, irreversible organ damage continues to accrue in SLE, predominantly driven by chronic inflammation and prolonged corticosteroid exposure. These findings reinforce the importance of early, sustained treat-to-target strategies and glucocorticoid-sparing regimens to mitigate cumulative damage and improve long-term outcomes.",
  "authors": [
    {
      "affiliations": [
        "University of Medicine and Medical Sciences, USV, St. John Clinical Emergency Hospital, Suceava, Romania"
      ],
      "name": "Iulia Codruta Bran"
    },
    {
      "affiliations": [
        "Gr. T. Popa University of Medicine, Faculty of Medicine, Iasi, Romania",
        "Clinical Rehabilitation Hospital, Iasi, Romania"
      ],
      "name": "Mara Russu"
    },
    {
      "affiliations": [
        "private practice, Iasi, Romania"
      ],
      "name": "Eugen Gigel Ancuta"
    },
    {
      "affiliations": [
        "Sanocare, Iasi, Romania"
      ],
      "name": "Rodica Chirieac"
    },
    {
      "affiliations": [
        "Gr. T. Popa University of Medicine, Faculty of Medicine, Iasi, Romania",
        "Clinical Rehabilitation Hospital, Iasi, Romania"
      ],
      "name": "Codrina Mihaela Ancuta"
    }
  ],
  "title": "PO:03:095 Patterns of disease activity and organ damage accrual in systemic lupus erythematosus: insights from a 10-year tertiary care cohort",
  "uid": "579f1015-5515-5f32-97fe-8fb82d00ac50"
}