Predictors of Organ Damage in Systemic Lupus Erythematosus in the Asia Pacific Region: A Systematic Review

Abstract

ObjectivesIrreversible organ damage is common in patients with systemic lupus erythematosus (SLE). Despite evidence of increased prevalence and severity of SLE in Asia Pacific, organ damage is less well studied in this region. This systematic review aims to identify predictors of organ damage in SLE in the Asia Pacific region.MethodsWe searched Medline, PubMed, Embase and Web of Science for observational studies on organ damage in adult SLE patients in Asia Pacific from August 31st ‐ September 5th 2022. Study selection and data extraction was completed by two independent reviewers using Covidence systematic review software. Risk of bias was assessed using the Newcastle‐Ottawa Scale and Joanna‐Briggs Institute tool. Significant results from univariable and multivariable analyses were synthesized from included studies.ResultsThirty‐eight eligible studies were selected from 1999 – 2022; 22 (58%) of these reported organ damage at study enrolment and 19 (50%) reported damage accrual, as measured by the Systemic Lupus International Collaborating Clinic/American College of Rheumatology Damage Index. Factors predictive of organ damage included older age, glucocorticoid use, longer disease duration and disease activity. Lupus nephritis was a risk factor for renal and overall damage accrual. Hydroxychloroquine was protective against overall organ damage.ConclusionPredictors of organ damage in SLE in Asia Pacific are similar to other regions. Whilst glucocorticoid use is a modifiable risk factor for organ damage, the impact of immunosuppressives and biological therapies needs further investigation. Effective strategies in early disease are needed to minimise initial organ damage as it predicts subsequent damage accrual.