Study: SLE disease severity not consistently assessed in US

Clinicians in the U.S. did not consistently assess disease severity in patients with systemic lupus erythematosus, according to study findings presented recently.

Data were collected from the multi-sponsor Adelphi 2013 Lupus Disease-Specific Program, a multinational survey of clinical practice. Selected records included data from 97 U.S. clinical rheumatologists and 498 patients.

Vibeke Strand

Physicians completed patient record forms (PRFs) and disease severity was based on physician assessments. Patients with systemic lupus erythematosus (SLE) self-reported data including the EQ-5D, a two-page questionnaire with a VAS to assess mobility, pain and other issues related to quality of life. Patients also completed the Work Productivity and Activity Impairment Index for SLE, which were included in patient self-completion records.

Disease severity was classified as mild in 355 (71%) of patients with SLE, as moderate-to-severe in 139 (28%) and unspecified in 1% of PRFs. Physician assessment of disease severity was mostly based on the importance placed on the affected organs by 37% of rheumatologists and on the affected symptoms by 40% of rheumatologists, according to the researchers.

Only 11% of rheumatologists reported that test results and clinical assessments were important for assessing disease severity. No single disease activity index was shown to be widely used, and 68% of the physicians surveyed reported using their own systematic assessment.

In 54% of patients with moderate-to-severe symptoms, disease activity was controlled, compared with 29% of patients with mild disease activity. Those in the moderate-to-severe symptoms category, only 13 of whom had skin-only SLE at diagnosis, presented with more organ involvement and more flares per 12-month period than patients considered to have mild activity.

Patients with moderate-to-severe disease activity reported a greater impact on health-related quality of life, comparable to other rheumatic conditions, according to the researchers. Fewer of the same patients reported employment, and a higher proportion required assistance with care.

Obesity was the most common comorbidity in both categories, but patients in the moderate-to-severe category had twice as many patients with obesity.

A need for a simple, universal tool to assess disease activity in SLE patients is needed, the researchers concluded. – by Shirley Pulawski

Reference:

Strand V, et al. Paper #1077. Presented at: American College of Rheumatology Annual Meeting. Nov. 14-19, 2014; Boston.