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Measuring Disease Damage and its Severity in Childhood-Onset Systemic Lupus Erythematosus

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2017, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Objectives: To describe the frequency and distribution of disease damage in childhood-onset systemic lupus erythematosus (cSLE) as measured by the 41-item Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), and to assess the SDI’s relationship to damage severity. Methods: SDI item and summary-scores from 1,048 cSLE patients in three existing cohorts were included. In one cohort of 559 patients, treating physicians also rated damage severity, using a visual analog scale (MD-VASdamage). Damage item frequency was determined, and the association between SDI scores and available MD-VASdamage ratings measured. Finally, an international consensus conference, utilizing nominal group technique, considered the SDI’s capture of cSLE damage severity. Results: After a mean disease duration of 3.8 years, some damage (SDI summary-score > 0) was present in 44.2% (463/1048) of patients, with a maximum SDI summary-score of 14. The most common SDI items were: proteinuria, alopecia, cognitive impairment, and musculoskeletal atrophy. In those patients with MD-VASdamage ratings and known damage (SDI > 0), there was a moderately strong association between SDI summary-scores and MD-VASdamage (rSpearman = 0.49; p<0.0001). Mixed effect analysis revealed that only four SDI items, all occurring in <2% of patients, were significantly associated with MD-VASdamage. After consideration of these results, unanimous consensus was achieved that a new instrument or approach is needed to measure cSLE damage severity. Conclusion: Despite the relatively short mean disease duration, damage measured by the SDI was common in cSLE. Physician-perceived damage severity was not well captured by SDI summary-scores, and improved measures are needed.
Erin Haynes, Dr.P.H. (Committee Chair)
Hermine Brunner, M.D. (Committee Member)
Richard Ittenbach (Committee Member)
Daniel Lovell, M.D. (Committee Member)
Esi Morgan (Committee Member)
27 p.

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Citations

  • Holland, M. J. (2017). Measuring Disease Damage and its Severity in Childhood-Onset Systemic Lupus Erythematosus [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1527606864223975

    APA Style (7th edition)

  • Holland, Michael. Measuring Disease Damage and its Severity in Childhood-Onset Systemic Lupus Erythematosus. 2017. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1527606864223975.

    MLA Style (8th edition)

  • Holland, Michael. "Measuring Disease Damage and its Severity in Childhood-Onset Systemic Lupus Erythematosus." Master's thesis, University of Cincinnati, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1527606864223975

    Chicago Manual of Style (17th edition)