The new 2019-EULAR/ACR classification criteria specific domains at diagnosis can predict damage accrual in 670 childhood-onset systemic lupus erythematosus patients

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Pitta, Ana C. ^{[1, 2]} ; Silva, Clovis A. ^{[1, 2]} ; Insfran, Carlos E. ^[2] ; Pasoto, Sandra G. ^[2] ; Trindade, Vitor C. ^[1] ; Novak, V, Glaucia ; Sakamoto, Ana P. ^[3] ; Terreri, Maria T. ^[3] ; Pereira, Rosa M. R. ^[2] ; Magalhaes, Claudia S. ^[4] ; Fonseca, Adriana R. ^[5] ; Islabao, Aline G. ^{[6, 7, 8]} ; Assad, Ana P. L. ^[2] ; Buscatti, Izabel M. ^[9] ; Elias, Adriana M. ^[9] ; Piotto, Daniela P. ^[3] ; Ferriani, Virginia P. ^[10] ; Carvalho, Luciana M. ^[10] ; Rabelo Junior, Carlos N. ^[11] ; Marini, Roberto ^[12] ; Sztajnbok, Flavio R. ^[13] ; Sacchetti, Silvana B. ^[14] ; Bica, Blanca E. ^[15] ; Moraes, Ana J. ^[16] ; Robazzi, Teresa C. ^[17] ; Lotufo, Simone ^[18] ; Cavalcanti, Andre S. ^[19] ; Naka, Erica N. ^[20] ; Carneiro-Sampaio, Magda ^[9] ; Bonfa, Eloisa ^[2] ; Aikawa, Nadia E. ^{[2, 9]} ; Lup, Brazilian Childhood-onset Syst

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^[1] Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med, Pediat Rheumatol Unit, Childrens Inst, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med, Div Rheumatol, Av Dr Arnaldo, 455, 3rd Floor, Room 3190, BR-01246903 Sao Paulo, SP - Brazil

^[3] Univ Fed Sao Paulo, Pediat Rheumatol Unit, Sao Paulo - Brazil

^[4] Sao Paulo State Univ, Pediat Rheumatol Div, UNESP, Botucatu, SP - Brazil

^[5] Rio de Janeiro Fed Univ IPPMG UFRJ, Pediat Rheumatol Unit, Rio De Janeiro - Brazil

^[6] Hosp Crianca Brasilia Jose Alencar, Pediat Rheumatol Unit, Brasilia, DF - Brazil

^[7] Univ Brasilia, Postgrad Program Med Sci, Brasilia, DF - Brazil

^[8] Univ Brasilia, Rheumatol Unit, Brasilia, DF - Brazil

^[9] Novak, Glaucia, V, Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med, Pediat Rheumatol Unit, Childrens Inst, Sao Paulo - Brazil

^[10] Univ Sao Paulo, Pediat Rheumatol Unit, Ribeirao Preto Med Sch, Ribeirao Preto - Brazil

^[11] Hosp Geral Fortaleza, Pediat Rheumatol Unit, Fortaleza, Ceara - Brazil

^[12] Univ Estadual Campinas, Pediat Rheumatol Unit, UNICAMP, Campinas, SP - Brazil

^[13] Pedro Ernesto Univ Hosp, Pediat Rheumatol Unit, Rio De Janeiro - Brazil

^[14] Pediat Rheumatol Unit, Irmandade Santa Casa Misericordia Sao Paulo, Sao Paulo, SP - Brazil

^[15] Univ Fed Rio de Janeiro, Rheumatol Div, Hosp Univ Clementino Fraga Filho, Rio De Janeiro - Brazil

^[16] Fed Univ Para, Pediat Rheumatol Unit, Belem, Para - Brazil

^[17] Univ Fed Bahia, Pediat Rheumatol Unit, Salvador, BA - Brazil

^[18] Hosp Menino Jesus, Pediat Rheumatol Unit, Sao Paulo - Brazil

^[19] Univ Fed Pernambuco, Pediat Rheumatol Unit, Recife, PE - Brazil

^[20] Univ Fed Mato Grosso do Sul, Pediat Rheumatol Unit, Campo Grande, MS - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Lupus; v. 30, n. 14 OCT 2021.
• Citações Web of Science: 1

Resumo

Objective To evaluate if the 2019-European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) criteria at diagnosis of childhood-onset systemic lupus erythematosus (cSLE) are associated with higher rates of early damage scored by Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI). Methods This retrospective multicenter study included 670 cSLE patients with <= 5 years of disease duration. All patients fulfilled both 2019-EULAR/ACR and 1997-ACR classification criteria. Total score of 2019-EULAR/ACR criteria and each of its specific domains were assessed at diagnosis as predictors of damage accrual at the last visit, according to the presence of any organ damage (defined by SDI >= 1). Results Median disease duration was 2.8 (IQR 1.8-3.8) years and 200 (29.9%) patients had at least one organ damage (SDI >= 1). The most frequent domains were neuropsychiatric (12%), renal (7%), and musculoskeletal (6%). There was a higher frequency of renal (58% vs 43%, p = 0.0004) and neuropsychiatric domain (21% vs 7%, p < 0.0001) of 2019-EULAR/ACR criteria in patients with damage (SDI >= 1) compared to those without damage (SDI = 0). Patients scoring renal or neuropsychiatric domains of the 2019-EULAR/ACR criteria at diagnosis were associated with renal damage (odds ratio 9.701, 95% confidence interval 3.773-24.941, p < 0.001) or neuropsychiatric damage (OR 9.480, 95% CI 5.481-16.399, p<0.0001) at latest visit, respectively. cSLE patients with positive anti-dsDNA at diagnosis were also associated with renal damage by the latest visit (OR 2.438, 95% CI 1.114-5.3381, p = 0.021). Constitutional, hematologic, mucocutaneous, serosal, and musculoskeletal domains and specific criteria as well as other immunologic criteria were not associated with damage accrual. Median of SLEDAI-2K was significantly higher in patients with global damage (19.5 (2-51) vs 14 (0-51), p<0.001). 2019-EULAR/ACR score >25 was associated with more overall (SDI >= 1) (38% vs 25%, p = 0.0002) and renal damage (11% vs 5%, p = 0.023). Conclusions The 2019-EULAR/ACR criteria at diagnosis were associated with a higher rate of early damage in cSLE patients, especially for renal and neuropsychiatric damage. Of note, damage was particularly associated with high disease activity at diagnosis and 2019-EULAR/ACR score >25. (AU)

• Processo FAPESP: 15/03756-4 - Avaliação da relevância dos níveis sanguíneos de drogas utilizadas em doenças autoimunes reumatológicas no acompanhamento da segurança, eficácia e aderência à terapêutica
• Beneficiário: Eloisa Silva Dutra de Oliveira Bonfá
• Modalidade de apoio: Auxílio à Pesquisa - Temático