THU0355 Damage accrual and mortality rates among different age groups in a cohort of patients with lupus
Authors: G.A. Ramirez, B. Tejera-Segura, R. Lopez, A. Rahman, D.A. Isenberg
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Systemic lupus erythematosus (SLE) is a chronic, multi-system autoimmune disease, characterised by relapses and remissions, which eventually can lead to progressive, irreversible organ damage accrual. SLE-related damage implies increased morbidity and impaired quality of life. In addition, it constitutes itself a risk factor for the development of further damage and associates with early mortality. Age at disease onset has been postulated to affect the presenting clinical phenotype, the rate and likelihood of accruing damage and eventually mortality risk. Early-onset SLE patients have been reported to present with a more aggressive disease, especially in the first years after diagnosis. However, long-term data from large cohorts are scanty. <h3>Objectives</h3> To assess retrospectively the mortality and damage accrual rates in a large cohort of patients with SLE. <h3>Methods</h3> Demographic, clinical and laboratory data from 692 consecutive patients with SLE (631 females, 61 males), diagnosed according to the revised American College of Rheumatology (ACR) criteria in a single tertiary referral centre, were retrospectively analysed focusing on age of diagnosis. Damage accrual was assessed according to the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC)/ACR damage index (SDI). Cox's regression analysis, chi-square test, Kruskal-Wallis test and ANOVA were employed as appropriate. <h3>Results</h3> Thirty-three out of 692 patients were diagnosed with SLE before the age of 12, 172 between 12 and 20, 443 between 21 and 50 and 44 after 50 years of age. As previously reported, a female preponderance was more evident in the central part of the age spectrum (p=0.015). Nephritis and decreased complement were more frequent in patients with early-onset SLE (p=0.001 and p=0.033 respectively), serositis in the central age groups (p=0.025), and arthritis in late-onset patients (p=0.002). Neuropsychiatric manifestations were less frequent in patients aged &gt;50 years (p=0.013; table 1). The global incidence rate for any damage was 48.36 per 1000 persons-years, whereas the death incidence rate was 8.54 per 1000 persons-years. Late-onset SLE associated with a higher risk of damage accrual (HR=1.63, p=0.024) and of death (HR=6.22, p&lt;0.001). However, there were no significant differences in the time to first damage, to death after diagnosis and to death after the development of the first damage item, according to the age of diagnosis. <h3>Conclusions</h3> Younger patients with SLE show a distinct clinical phenotype, but share an accelerated accrual of morbidity and a higher risk of early mortality with patients of older age. Identifying age-specific predictors of disease severity will be of outstanding importance to improve long-term survival rates and patients' quality of life. <h3>References</h3> [1] Lopez R, et al. Rheumatology2012. [2] Ambrose N, et al. Lupus2016. [3] Lim LSH, et al. Arthritis Care Res, 2017. <h3>Disclosure of Interest</h3> None declared