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Using Clinical Characteristics and Patient‐Reported Outcome Measures to Categorize Systemic Lupus Erythematosus Subtypes
Author(s) -
Rogers Jennifer L.,
Eudy Amanda M.,
Pisetsky David,
Criscione-Schreiber Lisa G.,
Sun Kai,
Doss Jayanth,
Clowse Megan E. B.
Publication year - 2021
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.24135
Subject(s) - medicine , rheumatology , systemic lupus erythematosus , fibromyalgia , lupus nephritis , cohort , lupus erythematosus , disease , physical therapy , immunology , antibody
Objective The type 1 and type 2 systemic lupus erythematosus (SLE) categorization system was recently proposed to validate the patients’ perspective of disease and to capture a more comprehensive spectrum of symptoms. The objective of this study was to characterize the clinical manifestations of SLE subtypes and to determine the correlation between the patient‐ and physician‐reported measures used in the model. Methods This was a cross‐sectional study of patients with SLE in a university clinic. Patients completed the Systemic Lupus Activity Questionnaire (SLAQ) and 2011 American College of Rheumatology fibromyalgia (FM) criteria. Active SLE was defined as Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score ≥6, clinical SLEDAI score ≥4, or active lupus nephritis. We identified 4 groups: type 1 SLE (active SLE without FM), type 2 SLE (inactive SLE with FM), mixed SLE (active SLE with FM), and minimal SLE (inactive SLE without FM). Results In this cohort of 212 patients (92% female, mean age 45 years), 30% had type 1 SLE, 8% had type 2 SLE, 13% had mixed SLE, and 49% had minimal SLE. Regardless of SLE disease activity, patients with FM (21%), reported higher SLAQ scores, patient global assessment scores, and self‐reported lupus flare that resulted in discordance between patient‐ and physician‐reported measures. Conclusion Fatigue, widespread pain, sleep dysfunction, and mood disorders are common symptoms in SLE. Identifying these symptoms as type 2 SLE may be a method to improve patient communication and understanding. The level of type 2 SLE impacts patients’ perception of disease and self‐reported symptoms. The SLAQ may need to be reinterpreted based on the FM severity scale.