{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T11:54:46Z","timestamp":1793361286030,"version":"4.5.0"},"reference-count":48,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,9,26]],"date-time":"2017-09-26T00:00:00Z","timestamp":1506384000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100006126","name":"Hospital for Sick Children","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006126","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the longitudinal damage trajectory of patients with juvenile\u2010onset systemic lupus erythematosus (<jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content>), and to identify baseline and disease course predictors of damage trajectory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective inception cohort. Longitudinal pediatric\u2010age data were obtained from a juvenile\u2010onset <jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content> research database, while adult\u2010age data were obtained from either a research database or patients' charts. Baseline factors were tested as predictors. Time\u2010varying factors were lagged 6\u201324 months before a visit for testing their predictive effects. The longitudinal damage trajectory was modeled using a weighted generalized estimating equation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study cohort consisted of 473 subjects, with followup to 26 years. A total of 65% of patients were ages &gt;18 years at last followup. Cataracts (14%), avascular necrosis (10%), and osteoporosis (5%) were the most common items of damage. Two patients had myocardial infarctions. Baseline features, self\u2010reported ethnicity (Afro\u2010Caribbean), earlier time periods of diagnosis, and the presence of a life\u2010threatening major organ manifestation (lupus nephritis class <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\u2013V, cerebrovascular accidents, major organ vasculitis, pulmonary hemorrhage, or myocarditis), were associated with greater damage. Throughout the disease course, an acute confusional state, lupus headache, and fever predicted subsequent increases in the damage trajectory. A higher prednisone dose and exposure to cyclophosphamide also predicted subsequent increases in the damage trajectory. Antimalarial exposure was protective against an increase in damage trajectory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with juvenile\u2010onset <jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content> accrue damage steadily into adulthood. Baseline factors predict greater damage and\/or influence the evolution of the damage trajectory. Additionally, <jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content> clinical features and therapies during the course of disease predict additional changes in the damage trajectory.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23199","type":"journal-article","created":{"date-parts":[[2017,1,24]],"date-time":"2017-01-24T13:47:21Z","timestamp":1485265641000},"page":"1627-1635","source":"Crossref","is-referenced-by-count":53,"title":["From Childhood to Adulthood: The Trajectory of Damage in Patients With Juvenile\u2010Onset Systemic Lupus Erythematosus"],"prefix":"10.1002","volume":"69","author":[{"given":"Lily S. 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