Table 3. Independent associations between flares and damage accrual (ΔSDI>0) at t_n.

	HR*	(95% CI)	P value
Flares at tn−1
Flare absent	1.00
Any (M/M/S) flare present	1.42	(1.17 to 1.72)	<0.001
Flare absent	1.00
M/M flare present	1.32	(1.03 to 1.70)	0.029
Severe flare present	1.58	(1.18 to 2.11)	0.002
Cumulative number of flares at tn−1
Any (M/M/S) flares	1.07	(1.02 to 1.13)	0.011
M/M flares	1.08	(1.01 to 1.14)	0.015
Severe flares	1.05	(0.98 to 1.13)	0.13

^*HRs adjusted for patient age at t_n−1, disease duration at t_n−1, gross domestic product of patients’ country, cumulative prednisolone dose at t_n−1, immunosuppressant use at t_n−1, time-adjusted SLEDAI score at t_n−1, and for the presence of existing organ damage at t_n−1. See See Supplementary Table 3online supplemental table 3 for details.

Damageorgan damageM/M/Smild/moderate/severeSDISystemic Lupus International Collaborating Clinics/American College of Rheumatology Damage IndexSLEDAISLE Disease Activity Indext_n-1, previous visitt_n, any given visit