Lim et al evaluated the damage trajectory shown by patients with juvenile-onset systemic lupus erythematosus (SLE). The authors are from multiple institutions in Canada.
Patient selection: juvenile-onset SLE
Common types of damage (full list below):
(1) cataracts
(2) avascular necrosis
(3) osteoporosis
Life-threatening major organ damage:
(1) lupus nephritis class III or IV
(2) cerebrovascular accident (stroke)
(3) major organ vasculitis
(4) pulmonary hemorrhage
(5) myocarditis or myocardial infarction
Predictors of greater early damage:
(1) greater number of ACR criteria at baseline (11 in 1997 revised criteria)
(2) Afro-Caribbean ethnicity
(3) presence of life-threatening organ damage, especially at baseline
Predictors of a greater damage trajectory:
(1) acute confusional state
(2) lupus headache
(3) fever
(4) higher prednisone dose
(5) therapy with cyclophosphamide
(6) absence of antimalarial therapy (receipt of antimalarial therapy protective)
List of damage that may occur (Table 2):
(1) cataract
(2) retinal changes or optic atrophy
(3) cognitive impairment
(4) seizures
(5) cerebrovascular accident
(6) cranial and/or peripheral neuropathy
(7) transverse myelitis
(8) angina, coronary artery disease or myocardial infarction
(9) cardiomyopathy
(10) valvular disease
(11) pericarditis
(12) claudication
(13) venous thromboembolism
(14) vasculitis with tissue loss
(15) pulmonary hypertension
(16) pulmonary fibrosis
(17) shrinking lung
(18) pleural fibrosis
(19) pulmonary infarction
(20) renal failure
(21) proteinuria
(22) intestinal infarction
(23) mesenteric insufficiency
(24) chronic peritonitis
(25) intestinal stricture
(26) pancreatic insufficiency
(27) myopathy or muscle atrophy
(28) arthritis
(29) osteoporosis
(30) avascular necrosis
(31) osteomyelitis
(32) ruptured tendon
(33) alopecia
(34) skin scarring
(35) skin ulcer
(36) premature ovarian failure (in women)
(37) diabetes mellitus
(38) malignancy
