Abstract / Summary
IntroductionSystemic lupus erythematosus (SLE) is a chronic autoimmune disease with a wide range of clinical manifestations and an unpredictable course.Although disease activity can fluctuate over time, some organ injury becomes permanent and contributes substantially to the long-term burden of SLE.The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI or SDI) provides a standardized way to capture such irreversible damage.Data describing the burden and clinical correlates of SDI-defined damage in Bangladesh remain limited.This study therefore examined the pattern of established organ damage and the clinical and laboratory factors associated with it among Bangladeshi patients with SLE. MethodologyThis single-center, cross-sectional observational study included 168 consecutive patients with SLE who fulfilled the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria.Irreversible damage was assessed using the SDI, with a score of ≥1 defining established damage.Demographic, clinical, disease activity, and laboratory characteristics were compared between patients with and without established damage.Multivariable logistic regression was used to identify factors independently associated with damage.A sensitivity analysis excluded patients with a disease duration of <1 year.Because antiphospholipid antibody (aPL) results were available for only 48 participants, aPL status was examined separately in an exploratory nested analysis. ResultsWe identified established organ damage in 51 (30.4%) patients.Among those with damage, 39 (76.5%) had an SDI score of 1. Skin involvement was the most frequently recorded damage domain, affecting 30 (17.9%) patients and 30 (58.8%) of those with established damage.In the primary multivariable model, longer disease duration (adjusted odds ratio (aOR) 1.11 per year, 95% confidence interval (CI) 1.02-1.20;P = 0.019), anemia (aOR 2.58, 95% CI 1.22-5.46;P = 0.013), and vasculitis (aOR 4.68, 95% CI 1.70-12.91;P = 0.003) were independently associated with established damage.The Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) was not independently associated with damage after adjustment (aOR 1.05 per point, 95% CI 0.99-1.11;P = 0.086).After excluding 20 patients with a disease duration of <1 year, anemia and vasculitis remained associated with damage, whereas disease duration and SELENA-SLEDAI did not.In the exploratory analysis of 48 patients with available aPL results, aPL positivity was associated with established damage (aOR 5.95, 95% CI 1.44-24.55;P = 0.014), but the small sample and incomplete testing limit the strength of this finding. ConclusionsEstablished SDI-defined organ damage was present in approximately one-third of patients in this Bangladeshi SLE population, with skin damage being the most common domain.Anemia and vasculitis showed the most consistent associations with established damage, including after exclusion of patients with very early disease.Because the study was cross-sectional, these findings represent associations rather than causal relationships.The exploratory association between aPL positivity and damage should be tested in larger studies with systematic antibody assessment.