High disease activity is associated with high disease damage in an Iranian inception cohort of patients with lupus nephritis

Objectives This paper aims to determine disease activity and damage in patients with lupus nephritis (LN) and to evaluate the correlation among these domains and sociodemographic features. Methods This study was carried out on 71 lupus patients who were candidate for kidney biopsy due to their clinical renal manifestations. Clinical and sociodemographic data were collected and the Systemic Lupus Erythaematosus Disease Activity Index (SLEDAI-2K updated version), European Consensus Lupus Activity Measurement (ECLAM) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) were assessed after 10 days of admission, the day prior to performing renal biopsy. Results Sixty-five females (91.5%) and six males (8.5%) were studied. Their age was 24 (21-32) yr and disease duration was 1.5 (0.8-4) yr (median [IQR]). SLEDAI-2K, ECLAM and SDI scores were 25.5 +/- 12.3, 6.21 +/- 2.45, 2.0 +/- 2.3 (mean +/- SD) respectively. A great relationship between SLEDAI-2K and ECLAM (r = 0.827, p<0.001) was found. SDI was significantly associated with SLEDAI-2K (r = 0.742, p<0.001) and ECLAM (r = 0.699, p<0.001). Age, gender and disease duration had no significant impact on SLEDAI-2K and ECLAM, while SDI was significantly higher in subjects with longer disease duration particularly in those of more than 3 years. Patients with lower education attainment had less medication adherence and higher disease activity and damage. Conclusion There is a highly significant correlation of high disease activity with cumulative damage in patients with LN, particularly in those with newly-onset disease. Considering that the first years of SLE are an active critical period which can lead to severe damage, this highlights the necessity of aggressive treatment, tight-organised follow-ups and more patient compliance with the physician orders.