After multivariate calibration, the most important predictors of damage were age and steroid hormone use dose The SLE International Collaborative Clinic/American College of Rheumatology (ACR) Damage Index (SDI) is a widely accepted method for the evaluation of permanent organ damage in systemic lupus erythematosus (SLE). In response, Professor Michelle Petri et al. from Johns Hopkins University School of Medicine, Maryland, USA, analyzed data from a large SLE cohort study to clarify the variables associated with cumulative damage rates as rated by the SDI. The results of the study were published online in the December 12, 2012 issue of ARTHRITIS & RHEUMATISM. The authors found that the most important predictors of cumulative damage were age and steroid hormone use dose. The study included 2,054 patients with SLE (92% female, 56% white, and 37% African-American), and the mean age at diagnosis of the subjects was 33 years. SDI scores were calculated from the time of patient inclusion in the cohort study and during follow-up. The relationship between the patient’s non-time-varying characteristics and cumulative impairment rate was evaluated based on the impairment score at the last available visit. The relationship between patient time-varying characteristics and cumulative impairment was calculated when cumulative impairment occurred during the follow-up. The results of the study showed that the SDI score increased at an annual rate of 0.13. Patients who were older, male, African-American, with low income and education, hypertensive, positive for lupus anticoagulant, and positive for urine protein had a higher rate of impairment. During follow-up, patients who were older, had high disease activity, low complement levels, positive anti-dsDNA, met more diagnostic criteria bars for ACR, and received glucocorticoid therapy had a higher risk of injury. Patients treated with prednisone had a low risk of injury. After calibration with other variables, age, hypertension, and steroid hormone therapy, were the most important predictors of cumulative injury. The study found that injury rates varied by population subgroup, but hypertension and steroid hormone use appeared more variable. These data point to the need for strict control of the condition and strategic application of hormones.