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2019-EULAR/ACR classification criteria domains at diagnosis: predictive factors of long-term damage in systemic lupus erythematosus

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Abstract

The objective of this study is to assess the role of the 2019-European League Against Rheumatism/American College of Rheumatology (2019-EULAR/ACR) classification criteria at diagnosis and its domains in predicting long-term damage in systemic lupus erythematosus(SLE). We performed a retrospective analysis using an electronic chart database utilized in routine clinical care of SLE patients and established in 2000 in a tertiary hospital. Two hundred and nine consecutive SLE patients with disease onset ≥18 years old and long disease duration were included. Cumulative damage at the last visit was scored using the SLICC/ACR-Damage Index (SDI). The median age at SLE diagnosis was 28 years (18–63), disease duration was 14 years (8–25), and 88% were females. Damage (SDI≥1) was observed in 116/209 (55%). Patients with (SDI≥1, n=116) and without damage (SDI=0, n=93) had similar median disease duration [14 (8–25) vs. 12 (8–25) years, p=0.090] and age at diagnosis [23 (18–55) vs. 23 (18–56) years, p=0.998]. No correlation was observed between total 2019-EULAR/ACR score at diagnosis and SDI at last visit (r=0.007, p=0.913). Presence of renal domain at diagnosis was associated with renal damage at last visit (OR=3.6, 95%CI 1.2–10.4, p=0.017) and antiphospholipid antibodies domain predicted neuropsychiatric damage (OR=3.0, 95%CI 1.2–7.6, p=0.015). A ROC analysis identified that a cut-off >24 in 2019-EULAR/ACR score could predict a trend for renal damage (p=0.077) with a lower renal survival (Kaplan-Meier curve) for patients above this limit (p=0.029). A multivariate logistic regression analysis revealed that 2019-EULAR/ACR score >24 at diagnosis (OR 4.583, 95%CI 1.052–19.962, p=0.043) was independently associated with renal damage. Specific domains in the 2019-EULAR/ACR criteria at diagnosis were associated with long-term organ-specific damage, particularly renal and neuropsychiatric harm. A 2019-EULAR/ACR score >24 predicted worse renal survival.

Key Points

• Presence of renal domain of the 2019-EULAR/ACR classification criteria at diagnosis was associated with long-term renal damage.

• Presence of antiphospholipid antibodies domain at diagnosis was associated with long-term neuropsychiatric damage.

• A 2019-EULAR/ACR overall score >24 at diagnosis was independently associated with renal damage and predicted worse renal long-term survival.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

Our gratitude to Ulysses Doria-Filho for the statistical analysis.

Funding

This work was supported by grants from Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP) (#2015/03756-4 to NEA, SGP, CAS, and EB, and #2018/16162-3 to EFB), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq #304984/2020-5 to CAS, #305242/2019-9 to EB, and #306879/2018-2 to EFB), and by Núcleo de Apoio à Pesquisa “Saúde da Criança e do Adolescente” da USP (NAP-CriAd) to CAS.

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Author notes

  1. Carlos E. Insfrán, Nadia E. Aikawa, Clovis A. Silva and Eloisa Bonfa contributed equally to this work.

Authors and Affiliations

  1. Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil

    Carlos E. Insfrán, Nadia E. Aikawa, Sandra G. Pasoto, Dilson M. N. Filho, Francisco F. C. Formiga, Ana C. Pitta, Eduardo F. Borba, Carolina T. Ribeiro, Clovis A. Silva & Eloisa Bonfa

  2. Pediatric Rheumatology Unit, Children’s Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Nadia E. Aikawa, Ana C. Pitta & Clovis A. Silva

Authors
  1. Carlos E. Insfrán
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  2. Nadia E. Aikawa
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Contributions

• Carlos E. Insfrán: concept and design, data acquisition, data analysis and interpretation, significant manuscript writer, significant manuscript reviewer

• Nadia E. Aikawa: concept and design, data acquisition, data analysis and interpretation, significant manuscript writer, significant manuscript reviewer, statistical expertise, supervision

• Sandra G. Pasoto: significant manuscript writer, significant manuscript reviewer, statistical expertise

• Dilson M. N. Filho: data acquisition, data analysis and interpretation, significant manuscript reviewer

• Francisco F. C. Formiga: data acquisition, significant manuscript reviewer

• Ana C. Pitta: data acquisition, data analysis and interpretation, significant manuscript reviewer

• Eduardo F. Borba: significant manuscript writer, significant manuscript reviewer, statistical expertise

• Carolina T. Ribeiro: data acquisition, significant manuscript reviewer

• Clovis A. Silva: concept and design, data analysis and interpretation, significant manuscript writer, significant manuscript reviewer, statistical expertise, supervision, project administration, funding acquisition

• Eloisa Bonfá: concept and design, data analysis and interpretation, significant manuscript writer, significant manuscript reviewer, statistical expertise, supervision, project administration, funding acquisition

All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published.

Corresponding author

Correspondence to Eloisa Bonfa.

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Ethics approval

Institutional review board approval status: The present study was approved by local ethics committee (Comissão de Ética para Análise de Projetos de Pesquisa – CAPPesq) #39705014.6.0000.0068.

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Insfrán, C.E., Aikawa, N.E., Pasoto, S.G. et al. 2019-EULAR/ACR classification criteria domains at diagnosis: predictive factors of long-term damage in systemic lupus erythematosus. Clin Rheumatol 41, 1079–1085 (2022). https://doi.org/10.1007/s10067-021-05989-w

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  • DOI: https://doi.org/10.1007/s10067-021-05989-w

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