Journal Article

605 Patterns of type 1 & type 2 systemic lupus erythematosus activity

Sadun, Rebecca, Maheswaranathan, Mithu, Rogers, Jennifer L, Doss, Jayanth, Eudy, Amanda M, Sun, Kai, Clowse, Megan EB, Wojdyla, Daniel, Criscione-Schreiber, Lisa

2024

Overview

DisclosuresAME, JLR, MEBC: Exagen, ImmunovantFundingDuke CTSA grant ( UL1TR002553 )BackgroundThe Type 1 & 2 SLE Model encompass symptoms classically attributed to inflammation, including arthritis, rash, serositis and nephritis (Type 1 SLE), and symptoms of fatigue, widespread pain, mood disturbance, and brain fog (Type 2 SLE). Our preliminary data suggest there are at least two distinct sub-types of Type 2 SLE, one related to active inflammation and another that exists regardless of inflammation. The objective of this study was to use longitudinal measures of Type 1 and Type 2 SLE activity to identify subgroups of Type 2 SLE.MethodsSLE patients meeting Systemic Lupus Collaborating Clinics (SLICC) criteria with ≥2 visits at a university rheumatology clinic over a 36-month period between February 2018 and August 2022 were included. At each visit, rheumatologists scored Type 1 and 2 SLE activity separately by Physician’s Global Assessments (PGA), visual analog scales of 0–3 (0=no activity, 3=severe activity). Growth mixture models derived classes of patients based on their Type 1 and Type 2 PGA trajectories, and posterior probabilities assigned patients to the class with the highest probability. Patients were then classified according to their classes of Type 1 and Type 2 PGA trajectories into different ‘groups’. Clinical and demographic characteristics were compared across groups.ResultsWe included 297 patients with 2,011 visits. The best model fit of trajectories for both the Type 1 and Type 2 PGA included three classes. When patients were grouped according to their Type 1 and Type 2 PGA classes, the majority (73%) fell into one of four groups: 29% had low Type 1 and Type 2 activity (Minimal); 19% had constant high Type 2 but low Type 1 activity (Type 2); 7% had constant high Type 1 but low Type 2 activity (Type 1); and 18% had constant high Type 1 and Type 2 activity (Mixed). The remaining 27% of patients had variable Type 1 and Type 2 changes over time that did not fit into a distinct group (figure 1).Patients in the Type 2 SLE group were older and more likely to be on disability (table 1). While the SLEDAI and Type 1 PGA scores were similar between the Type 1 and Mixed groups, the disease manifestations were somewhat different, with more nephritis in the Type 1 group and higher LFA-REAL Musculoskeletal PGA scores in the Mixed group. While overall Type 2 PGA scores were similar for those in the Type 2 and Mixed groups, there was more depression, pain, and symptom severity among those in the Mixed group.In a descriptive analysis to determine if Type 1 and Type 2 PGA changed concordantly, 39% of patients had Type 1 and Type 2 SLE PGAs that consistently changed together.ConclusionWe identified four main longitudinal subgroups of patient trajectories. Supporting our prior qualitative work, we found changes in Type 1 and Type 2 occurred together in almost 40% of patients. Future work is needed to understand the underlying etiology of each subgroup, allowing us to target these groups with appropriate medical and non-medical treatments.Abstract 605 Figure 1Spaghetti plots showing the individual trajectories of Type 1 and 2 PGAs for patients in each group.Abstract 605 Table 1Cohort characteristics Minimal Type 2 SLE Type 1 SLE Mixed SLE Not classified p- value n=87 n=55 n=21 n=56 n=78 Age 45.8 (13.9) 48.0 (12.8) 37.8 (13.3) 40.1 (13.4) 40.3 (12.2) 0.0005 Female 78 (89.7%) 54 (98.2%) 18 (85.7%) 53 (94.6%) 72 (92.3%) 0.2486 Black 49 (56.3%) 27 (49.1%) 13 (61.9%) 34 (60.7%) 44 (57.1%) 0.1820 Hispanic Ethnicity 1/87 (1.1%) 3/54 (5.6%) 4/21 (19.0%) 1/56 (1.8%) 4/76 (5.3%) 0.0071 Disability 13/84 (15.5%) 23/51 (45.1%) 3/19 (15.8%) 20/50 (40.0%) 22/71 (31.0%) 0.0010 Medicare/Medicaid 30/83 (36.1%) 29/51 (56.9%) 7/19 (36.8%) 29/53 (54.7%) 28/72 (38.9%) 0.0583 Depression 12/76 (15.8%) 18/46 (39.1%) 4/18 (22.2%) 28/45 (62.2%) 29/61 (47.5%) <.0001 Total areas of widespread pain across visits 1.6 (1.7) 4.4 (3.1) 1.7 (1.7) 6.0 (3.6) 3.8 (3.1) <.0001 Symptom severity score across visits 2.5 (1.7) 6.4 (2.2) 2.6 (1.7) 7.3 (2.2) 5.7 (3.0) <.0001 Total FSS (also known as PSD) across visits 4.3 (3.1) 11.2 (4.7) 4.5 (2.9) 14.5 (5.4) 10.2 (6.0) <.0001 Active lupus nephritis during study period 8/87 (9.2%) 10/55 (18.2%) 13/21 (61.9%) 19/56 (33.9%) 29/78 (37.2%) <.0001 Clinical SLEDAI across visits 0.3 (0.8) 0.5 (1.1) 1.5 (2.2) 2.3 (2.4) 3.5 (2.8) <.0001 SELENA-SLEDAI across visits 1.2 (1.4) 1.4 (1.6) 4.7 (2.1) 4.7 (2.8) 3.6 (2.5) <.0001 Musculoskeletal PGA across visits 0.0 (0.1) 0.2 (0.2) 0.2 (0.3) 0.6 (0.4) 0.3 (0.3) <.0001 Mucocutaneous PGA across visits 0.1 (0.1) 0.1 (0.1) 0.5 (0.5) 0.4 (0.5) 0.3 (0.4) <.0001 Type 1 PGA across visits 0.1 (0.1) 0.3 (0.2) 0.9 (0.3) 1.0 (0.4) 0.8 (0.3) <.0001 Type 2 PGA across visits 0.2 (0.2) 1.1 (0.4) 0.3 (0.2) 1.2 (0.4) 0.9 (0.5) <.0001 Numbers are presented as n (%) or mean (SD)

• Publisher: Lupus Foundation of America,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Epidemiology & Outcomes / Inflammation / Lupus