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Objective. To evaluate the association between the Systemic Lupus International Collaborating Clinics frailty index (SLICC-FI) and damage accrual in systemic lupus erythematosus (SLE) patients.Methods. Patients from the multiethnic, multicenter LUpus in MInorities, NAture versus nurture (LUMINA) cohort were included. Damage was ascertained with the SLICC/American College of Rheumatology Damage Index (SDI) at last visit (range 0-51). The first visit in which the SLICC-FI score could be derived was considered as the baseline (range 0-1). Univariable and multivariable negative binomial regression models were performed to determine the association between the baseline SLICC-FI score (per 0.05 increase) and the change in the SDI score (difference between last and baseline SDI score), adjusted for sex, age at diagnosis, ethnicity, insurance, prednisone daily dose, and antimalarial and immunosuppressive drug use at baseline. Age and sex were included a priori in the multivariable model; the other variables were included if they reached P < 0.10 in the univariable models.Results. Of the 503 patients included, 454 (90.3%) were female, with a mean ± SD age of 37.1 ± 12.5 years at diagnosis. The mean ± SD baseline SLICC-FI score was 0.26 ± 0.06. The mean ± SD baseline SDI score was 0.6 ± 1.0, and the mean ± SD change in the SDI score was 1.9 ± 2.2. Higher SLICC-FI scores at baseline (per 0.05 increase) were associated with greater damage accrual in the multivariable model after adjustment for possible confounders (incidence rate ratio 1.20 [95% confidence interval 1.08-1.33], P = 0.0015).Conclusion. The SLICC-FI is associated with damage accrual in SLE patients from a multiethnic cohort, supporting the importance of this index in the evaluation of SLE patients, combining several aspects of their disease.

Background:The Systemic Lupus International Collaborating Clinics (SLICC) Frailty Index (SLICC-FI) has been developed as a predictor of outcomes in SLE patients1-3. It combines disease activity, damage, comorbidities and health-related quality of life measures.Objectives:To evaluate the SLICC-FI as a predictor of damage accrual in systemic lupus erythematosus (SLE) patients.Methods:Patients from a multi-ethnic, multi-center US lupus cohort were included. Damage was ascertained with the SLICC/American College of Rheumatology (ACR) damage index (SDI) at last visit. The first visit in which the SLICC-FI could be derived was considered as the baseline visit. Univariable and multivariable Poisson regression models were performed to determine the association between the baseline SLICC-FI and last SDI, adjusted for sex, age at diagnosis, ethnicity, insurance, prednisone daily dose, antimalarial and immunosuppressive drug use at baseline. Age and gender were included a priori in the multivariable model, the other variables were included if they had a p<0.10 in the univariable models.Results:Of the 503 patients included, 454 (90.3%) were female with mean (SD) age 37.1 (12.5) years at diagnosis; 174 (34.6%) were African-American, 144 (28.6%) were Caucasians, 86 (17.1%) Hispanics (Texas), and 99 (19.7%) were Hispanics (Puerto Rico). The mean (SD) baseline SLICC-FI was 0.26 (0.06). The final mean (SD) SDI score was 1.9 (2.2). Higher SLICC-FI scores at baseline predicted greater damage accrual in the univariable analysis [Estimate=5.058, (SE=0.498); p<0.0001]. The SLICC-FI remained associated with damage accrual in the multivariable model, after adjustment for possible confounders [Estimate= 3.561 (SE=0.538); p<0.0001].Conclusion:The SLICC-FI predicts damage accrual in SLE patients from a multi-ethnic cohort, supporting the importance of this index in the evaluation of SLE patients, combining several aspects of the disease.References:[1]Legge A, Kirkland S, Rockwood K, et al. Construction of a Frailty Index as a Novel Health Measure in Systemic Lupus Erythematosus. J Rheumatol. 2020; 47: 72-81[2]Legge A, Kirkland S, Rockwood K, et al. Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol. 2019; 71: 1297-107[3]Legge A, Kirkland S, Rockwood K, et al. Prediction of Damage Accrual in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI). Arthitis Rheumatol. Epub ahead of print 2019 Oct 21.Disclosure of Interests:Manuel F. Ugarte-Gil Grant/research support from: Jannsen, Pfizer, Jyoti Dubey: None declared, Gerald McGwin: None declared, Luis Vila: None declared, Graciela S Alarcon: None declared