Slicc damage index score in systemic lupus erythematosus patients and its associated factors

The aims of this study were to determine damage index in systemic lupus erythematosus (SLE) patients based on Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) and to determine the laboratory and clinico-demographic factors affecting SDI. This is a retrospective cohort study of 94 SLE patients attending rheumatology clinics in 2 local hospitals in Kelantan, Malaysia. The patients were divided into 2 groups based on SDI score assigned by the attending physician, 0 (without damage) or ≥1 (with damage). Newly diagnosed SLE patients with disease duration less than 6 months were excluded. A total of 45 (47.9%) SLE patients showed damage by SDI score. Majority of the subjects had neuropsychiatric damages (21/94; 22.3%) followed by skin (12/94; 12.8%) and musculoskeletal (6/94; 6.4%) damage. SDI score was significantly associated with higher disease duration (6.2 ± 6.57 years vs 4.5 ± 3.7 years; P = .018), lower prednisolone dose (8.74 ± 10.89 mg vs 4.89 ± 3.81 mg; P < .001), hypertension (P = .007), and exposure to cyclophosphamide (P = .004). Hypertension (P = .020), exposure to cyclophosohamide (P = 0.013), and lower prednisolone dose (P = .023) were significantly associated with damage by multivariable analysis. Higher SDI score was significantly associated with exposure to cyclophosphamide, suggesting that lower cyclophosphamide doses or alternative therapeutic agents are recommended.