PO:15:208 | Impact of disease control on organ damage accrual in patients with systemic lupus erythematosus with and extra-renal flares: a 12-month single-center longitudinal study
Giorgia Capozzo1, Marco Oliva1, Giancarlo Cascarano1, Chiara Cardelli1, Dina Zucchi1, Chiara Stagnaro2, Viola Signorini2, Elena Elefante2, Chiara Tani1, Marta Mosca1. | 1Università di Pisa, Dipartimento di Medicina Clinica e Sperimentale, Pisa, Italy; 2Azienda Ospedaliero Universitaria Pisana, U.O. Reumatologia, Pisa, Italy.
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Background. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by periods of flare and remission, often leading to progressive organ damage. This study aimed to describe damage accrual occurring early after a disease flare in SLE patients and to identify potential predictors.
Methods. A 12-month longitudinal study was conducted involving SLE patients who met the 2019 EULAR/ACR criteria and experiencing an extra-renal flare between 2015 and 2024. At study entry, demographic and clinical variables were collected. Disease activity was measured using the Systemic Lupus Erythematosus Disease Activity (SELENA-2K). Active organ involvement was categorized according to the BILAG domains. Disease status was evaluated using the modified Lupus Low Disease Activity State (LLDAS5), defined by a daily prednisolone dose of less than 5 mg, and the Definition of Remission in SLE (DORIS). Organ damage was quantified using the SLICC-DI at baseline (T0) and after 12 months (T12).
Results. A total of 98 extra-renal flares were recorded. At T0, the median SLEDAI score was 7 (IQR 4–10). Active manifestations manifestations were: musculoskeletal 79%, mucocutaneos 69 %, hematological 65%, serositic 27%, renal 24%, neuropsychiatric 7%. At T0, 29 patients (29.6%) had pre-existing organ damage, with a median SLICC score of 2 (IQR 1–3); of these, 21 (%) had pre-existing glucocorticoids (GCs)-related damage. At T12, althought the median SLICC score resulted similar to the baseline one (median =2, IQR 1–3), in 39 patients (39.8%) at least one item of organ damage was recorded, indicating de-novo damage development in 10 cases. Moreover, in a total of 15 patients (15.33%) an increase in the SLICC score was recorded (deltaSLICC). In 46,6 (%) of patients who developed new damage at T12, the damage was GCs-related. A comparison of patients with and without organ damage is repoted in table 2. Univariate analysis revealed that the SLEDAI-2K score at flare (OR 1,1, p=0.005) and, in particular, cardiorespiratory (OR 9,8, p=0.001) and neuropsychiatric involvement at flare (OR 11.5, p =0.05 ) were significantly associated with an increase in SLICC-DI. In the multivariable analysis, no baseline variables remained associated with the damage accrual; the cumulative GCs dose at T12 was independently associated with damage accrual (OR 1.0007, p < 0.05).
Conclusions. This study highlights the fact that damage accrual can occur early after an extra-renal flare; thus, flare prevention is of crucial importance to protect the patients from organ damage accumulation. Moreover, in this cohort, higher GC exposure was paralleled by organ damage accrual emphasizing the need for an effective disease control of the disease activity by minimizing GC exposure in flairing patients. 
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