Prediction of damage accrual in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics Frailty Index

Research output: Contribution to journalArticle


  • Alexandra Legge
  • Susan Kirkland
  • Kenneth Rockwood
  • Pantelis Andreou
  • Sang‐cheol Bae
  • Juanita Romero‐diaz
  • Jorge Sanchez‐guerrero
  • Daniel J. Wallace
  • Sasha Bernatsky
  • Ann E. Clarke
  • Joan T. Merrill
  • Ellen M. Ginzler
  • Paul R. Fortin
  • Dafna D. Gladman
  • Murray B. Urowitz
  • Ian N. Bruce
  • David A. Isenberg
  • Anisur Rahman
  • Graciela S. Alarcón
  • Michelle Petri
  • Munther A. Khamashta
  • M. A. Dooley
  • Rosalind Ramsey‐goldman
  • Susan Manzi
  • Asad A. Zoma
  • Cynthia Aranow
  • Meggan Mackay
  • Guillermo Ruiz‐irastorza
  • S. Sam Lim
  • Murat Inanc
  • Ronald F. Vollenhoven
  • Andreas Jonsen
  • Ola Nived
  • Manuel Ramos‐casals
  • Diane L. Kamen
  • Kenneth C. Kalunian
  • Soren Jacobsen
  • Christine A. Peschken
  • Anca Askanase
  • John G. Hanly

Colleges, School and Institutes

External organisations

  • Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
  • Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran Mexico City Mexico
  • Cedars‐Sinai Medical Center and David Geffen School of Medicine at University of California Los Angeles
  • McGill Center for Bioinformatics, McGill University, Montreal, Quebec, Canada
  • Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
  • Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.
  • Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA.
  • University of Toronto and Liver Center, Toronto Western Hospital, Toronto, Ontario, Canada
  • Arthritis Research UK Epidemiology UnitUniversity of ManchesterNIHR Manchester Musculoskeletal Biomedical Research Centre, and Manchester University NHS Foundation Trust Manchester UK
  • NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London WC1E 6DD, UK.
  • University of Alabama Comprehensive Cancer Center, Birmingham, Alabama.
  • Department of Radiology Johns Hopkins University School of Medicine Baltimore Maryland
  • St. Thomas Hospital and King’s College London GKT School of Medical Education London UK
  • Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina.
  • Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA.
  • Lupus Center of ExcellenceAllegheny Health Network Pittsburgh Pennsylvania
  • Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK.
  • Feinstein Institute for Medical Research, Manhasset, New York, USA.
  • Hospital Universitario CrucesUniversity of the Basque Country Barakaldo Spain
  • Emory University School of Medicine Atlanta Georgia
  • Instanbul University Istanbul Turkey
  • Karolinska Institute, Stockholm, Sweden; Clinical Research Sörmland, Eskilstuna, Sweden.
  • Department of Physics, Lund University, Lund, Sweden
  • Institut d’Investigacions Biomèdiques August Pi i Sunyer and Hospital Clínic Barcelona Barcelona Spain
  • 32 Medical University of South Carolina, Charleston, South Carolina, USA.
  • University of CaliforniaSan Diego School of Medicine
  • Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
  • University of Manitoba, Winnipeg, Manitoba, Canada.
  • Hospital for Joint DiseasesNew York University New York New York
  • Department of Medicine Queen Elizabeth II Health Sciences Center and Dalhousie University Halifax Nova Scotia Canada


Objective: The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) has been shown to predict mortality, but its association with other important outcomes is unknown. We examined the association of baseline SLICC FI values with damage accrual in the SLICC inception cohort. Methods: The baseline visit was defined as the first visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short Form 36) were assessed. Baseline SLICC FI scores were calculated. Damage accrual was measured by the increase in SDI between the baseline assessment and the last study visit. Multivariable negative binomial regression was used to estimate the association between baseline SLICC FI values and the rate of increase in the SDI during follow-up, adjusting for relevant demographic and clinical characteristics. Results: The 1,549 systemic lupus erythematosus (SLE) patients eligible for this analysis were mostly female (88.7%) with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9–1.5 years) at baseline. The mean ± SD baseline SLICC FI was 0.17 ± 0.08. Over a mean ± SD follow-up of 7.2 ± 3.7 years, 653 patients (42.2%) had an increase in SDI. Higher baseline SLICC FI values (per 0.05 increase) were associated with higher rates of increase in the SDI during follow-up (incidence rate ratio [IRR] 1.19 [95% confidence interval 1.13–1.25]), after adjusting for age, sex, ethnicity/region, education, baseline SLE Disease Activity Index 2000, baseline SDI, and baseline use of glucocorticoids, antimalarials, and immunosuppressive agents. Conclusion: Our findings indicate that the SLICC FI predicts damage accrual in incident SLE, which further supports the SLICC FI as a valid health measure in SLE.

Bibliographic note

© 2019, American College of Rheumatology.


Original languageEnglish
Pages (from-to)658-666
Number of pages9
JournalArthritis and Rheumatology
Issue number4
Early online date21 Oct 2019
Publication statusPublished - 12 Feb 2020