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Severe Flares in Patients With SLE Linked to Poorer Quality of Life

Disease flares in systemic lupus erythematosus are associated with damage. However, the impact of flares on health-related quality of life have not been analyzed.

Severe flares were associated with poorer health-related quality of life (HRQoL) in patients with systemic lupus erythematosus (SLE), according to a study published in Lupus Science and Medicine.1

“Flares in patients with SLE, regardless of their severity, have been associated with damage accrual,” investigators explained. “However, their impact on HRQoL has not been fully evaluated. In fact, disease activity is only minimally associated with HRQoL.”

Data from the Almenara Lupus Cohort was analyzed, focusing on visits between December 2015 and February 2020 at the Rheumatology Department of the Hospital Guillermo Almenara Irigoyen in Lima, Peru. Flares were defined as increases in the SLE Disease Activity Index 2000 (SLEDAI-2K) of 4 or more points. Demographics, such as age, sex, diagnosis, socioeconomic status, and education were recorded.

Severe flares were defined as SLEDAI-2K of 12 or more points. Confounders were accounted for via univariable and multivariable regression equations, while outcome was determined on subsequent visits. The SLEDAI-2K score difference between visits evaluated flares.

Of the 277 patients included in the study, 92.4% (n = 256) patients were female, the mean age at diagnosis was 36 years, and disease duration at baseline was 9.1 years. On average, patients had 4.8 visits and a follow-up of 2.7 years. Of the 1098 visits, 10.5% (n = 115) flares were reported, with 17 defined as severe and 98 mild-to-moderate. Incidence was calculated as 15.3 per 100 patient-years; equating to 2.3 per 100 patient-years for sever flares and 13.1 per 100 patient-years for other categories.

Adjustments showed severe flares, not mild-to-moderate, were associated with a poorer HRQoL in pain, emotional wellness, planning, and fatigue.

The limitations of the study included the small sample size, which hindered the impact of specific types of flares on HRQoL. As this was a prevalent cohort, investigators could not exclude impact of disease characteristics before inclusion in the study. Lastly, the patients assessed had a low prevalence of comorbidities and therefore investigators were not able to determine their impact on HRQoL. However, the study was strengthened by the ability to evaluate impact of flares in this specific Mestizo Latin American patient population.

“Severe flares, but not mild-moderate, flares are associated with poorer HRQoL, mainly on planning, pain, emotional health and fatigue domains,” investigators concluded.

Reference:

Ugarte-Gil MF, Gamboa-Cardenas RV, Reátegui-Sokolova C, et al. Severe flares are associated with a poorer health-related quality of life (HRQoL) in patients with SLE: data from the Almenara Lupus Cohort. Lupus Sci Med. 2022;9(1):e000641. doi:10.1136/lupus-2021-000641