Damage and mortality in a group of British patients with systemic lupus erythematosus followed up for over 10 years

Objective. To study damage accrual and mortality in British patients with SLE under long-term follow-up for 10 years. Methods. We analysed the clinical records of 232 patients with SLE who had at least 10 years of consistent follow-up at University College London Hospital (UCLH). We noted their SLICC/ACR Damage Index (SDI) scores and category of damage at 1 year post-diagnosis of SLE and every 5 years thereafter. For patients who had died, we determined the year and cause of death. Results. Ninety per cent of patients had no damage at 1 year post-diagnosis of SLE; however by year 10, 50 had accrued some damage. Damage accrual was mostly in the neuropsychiatric, renal and musculoskeletal categories. An increase in damage score was associated with a higher risk of death overall. Forty-four patients died during the period of follow-up. Sepsis, cancer and organ failure (cardiac, renal and liver) were the main causes of death in this group of patients. Conclusions. Damage accrual is associated with an increased risk of mortality. Infections remain an important cause of death in patients with SLE.