Contributors to organ damage in childhood lupus: corticosteroid use and disease activity.
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Authors
Hanif, Maria
Sarker, Chandni
Al-Abadi, Eslam
Armon, Kate
Bailey, Kathryn
Bohm, Marek
Brennan, Mary
Ciurtin, Coziana
Gardner-Medwin, Janet
Hawley, Daniel P
Issue Date
2025-05-01
Type
Journal Article
Language
en
Keywords
Childhood SLE , corticosteroids , damage , low disease activity , treat-to-target
Alternative Title
Abstract
Objectives: Awareness of paediatric-specific predictors of damage in childhood lupus is needed to inform mitigation measures. The objective of this study was to ascertain how clinical and demographic variables correlate with damage accrual and identify predictors of damage.
Methods: This analysis included UK JSLE Cohort Study participants. Univariable and multivariable Prentice-Williams-Peterson models investigated how demographic and clinical factors influenced the hazards of new damage. Analyses were performed across the entire cohort, in patients with minimal disease activity marked by a time-adjusted average SLEDAI-2K score (AMS) of ≤2, in patients with low activity (AMS of ≤4), patients with moderate-to-high activity (AMS of >4) and patients with no CS use.
Results: Within the entire cohort (n = 430), factors associated with damage included: any methylprednisolone [hazard ratio, HR 2.20 (CI 1.33-3.62)], time-adjusted mean Physician's Global Assessment (PGA) [HR 2.87 (CI 1.48-5.56)] and AMS score [HR 1.13 (CI 1.03-1.24), all P < 0.05]. Within the low activity subgroup, any methylprednisolone [HR 2.61 (CI 1.04-6.53)] and time-adjusted mean PGA [HR 3.41 (CI 1.52-7.76)] were associated with damage (both P < 0.05). Within the moderate-to-high activity subgroup, any methylprednisolone [HR 2.29 (CI 1.31-4.00)], time-adjusted mean PGA [HR 2.66, (CI 1.20-5.87)] and AMS score [HR 1.15 (CI 1.03-1.29)] were predictive of damage (all P < 0.05). Baseline organ damage was predictive of subsequent damage accrual in the minimal disease activity subgroup [HR 1.33 (CI 1.78-8.08)] and the no CSs subgroup [HR 3.64 (CI 1.83-7.24), both P < 0.005].
Conclusion: Disease activity levels (AMS/PGA) and proxy indicators (methylprednisolone exposure, baseline damage) were found to be key predictors of damage accrual. This highlights the importance of practical strategies, such as treat-to-target, for reducing disease activity and long-term treatment toxicity.
Description
© The Author(s) 2024 Published by Oxford University Press on behalf of the British Society for Rheumatology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which
permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Citation
Hanif, M. et al. (2025)' Contributors to organ damage in childhood lupus: corticosteroid use and disease activity', Rheumatology. 64(5) pp. 3028-3038. Available at: https://doi.org/10.1093/rheumatology/keae592
Publisher
Oxford Academic
License
© The Author(s) 2024 Published by Oxford University Press on behalf of the British Society for Rheumatology.
Journal
Rheumatology (Oxford, England)
Volume
64
Issue
5
PubMed ID
ISSN
1462-0332