Objective:

To assess the cumulative burden of high disease activity and its association with damage accrual and clinical outcomes in patients with childhood-onset systemic lupus erythematosus (cSLE).

Approach:

Key Findings:

• Includespecificstatisticalvaluesforclarity.

Interpretation:

Higher time-adjusted cHDAS is associated with increased risk of damage accrual in cSLE.

Limitations:

• Adddetailonhowlimitationsaffectfindings.

Conclusion:

Greater cumulative exposure to high disease activity is associated with damage in cSLE.

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