AB0560 A 10-YEAR REVIEW OF DAMAGE ACCRUAL AND PROGRESSION IN A MULTI-ETHNIC COHORT OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) IN MALAYSIA
Authors: Syahrul Sazliyana Shaharir, Wong Michelle Heng Ting, Asrul Abdul Wahab, Sakthiswary Rajalingham, Abdul Halim Abdul Gafor, Mohd Shahrir Mohamed Said, Ruslinda Mustafar
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with an unpredictable course of disease. The severity and outcomes of SLE vary across different ethnicities. <h3>Objectives</h3> This study is aimed to determine the pattern of development and progression of organ damage in a cohort of multi-ethnic SLE patients followed for at least 10 years, and to identify the factors associated with the damage accrual. <h3>Methods</h3> We reviewed the medical records of an inception cohort of patients who attended regular monitoring since 2007 at the Rheumatology and Nephrology/SLE Clinic, National University of Malaysia Medical Centre (UKMMC). Their medical records were retrospectively reviewed to obtain information on SLE disease characteristics, frequency of disease flares, cumulative corticosteroid dose and the use of other immunosuppressive treatment from 2007 until their last visit in 2017. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI) was used to determine the organ damage at baseline and after 10 years of being followed up. For patients who have succumbed or lost to follow up during the 10-year observation period, the SDI scores just before death or time of follow up loss were recorded. <h3>Results</h3> A total of 258 patients were included with majority of them were Malays (n=145, 56.2%), followed by Chinese (n=100, 38.8%) and Indians (n=13, 5.0%). The mean SDI score increased from 0.39±0.79 at baseline to 1.13±1.47 after 10 years, p&lt;0.001. At 10 years, Indian patients were found to have a significant increase in their SDI scores from baseline compared to Malay and Chinese (p&lt;0.05). New damage accrual was recorded in 38.8% patients with the most common new organ damage significantly occurred in renal (p&lt;0.001), ocular (p=0.05) and cardiovascular (p=0.07). Higher age at baseline, higher ACR criteria at diagnosis, persistent active disease ≥ 6 months, and prednisolone use of ≥ 1mg/kg were independently associated with higher risk of damage accrual. In contrast, hydroxychloroquine treatment was associated with lower risk of damage accrual. <h3>Conclusion</h3> The SDI scores of our SLE cohort increased significantly over 10 years which predominantly affecting the renal. Indian patients accumulated higher SDI scores while persistent active disease, higher ACR criteria at diagnosis, and the use of high dose steroid were associated with new organ damage. <h3>References</h3> [1] Bruce IN, O'Keeffe AG, Farewell V, et al. (2015) Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. Ann Rheum Dis 74(9):1706-13. [2] Yee CS, Su L, Toescu V, et al. (2015) Birmingham SLE cohort: outcomes of a large inception cohort followed for up to 21 years. Rheumatology (Oxford) 54(5):836-43. <h3>Acknowledgement</h3> This study received funding from the Fundamental Research Grant Scheme (FRGS/1/2015/SKK02/UKM/03/1) from the Ministry of Higher Education, Malaysia. <h3>Disclosure of Interests</h3> Syahrul Sazliyana Shaharir: None declared, Wong Michelle Heng Ting: None declared, Asrul Abdul Wahab: None declared, Sakthiswary Rajalingham Speakers bureau: Pfizer. Less than 1000USD, Abdul Halim Abdul Gafor: None declared, Mohd Shahrir Mohamed Said Speakers bureau: Eli Lilly. Less than 2000USD, Ruslinda Mustafar: None declared