Document resource
Objectives This study explores discrepancies between physicians’ and patients’ reported Lupus disease activity and aims to identify key influencing factors.Methods Data from patients monitored consecutively between March and July 2024 at two Lupus Clinics were collected. Disease activity was assessed using a 0–3 visual analog scale for both Patient and Physician Global Assessment (PGA, PhGA).Results The study included 280 adult SLE patients (92.5% women, 93% Caucasian). Median age at enrollment was 46 years (IQR 37–58), and at diagnosis 29 years (IQR 20–38.5); 29% had primary schooling, 41% high school, and 30% a university degree. Most patients were employed; 10% students, 11% unemployed, 17% retired. ACLE was observed in 50%, SCLE in 9%, and 22% had CCLE. Mucosal, tumid, or hypertrophic SLE occurred in 1%. Ulcers affected 29%, alopecia 24%, arthritis 55%, pleuritis 9%, pericarditis 16%. Renal involvement occurred in 37%, neurological 9%, hemolytic anemia 10%, leukopenia/lymphopenia 60%, thrombocytopenia 22%. Concomitant conditions included antiphospholipid syndrome (10%), fibromyalgia (11%), and depression (14%).The last median SLEDAI was 2 (IQR 0–2), SLEDAS 0.37 (IQR 0.37–1.5). Steroids were used by 45%, DMARDs 94%, biologics 22%, and antidepressants/anxiolytics 32%. Median SDI was 0. Median PGA and PhGA scores were 0.58 and 0. Scores differed by > 0.5 in 52% of cases, with PGA generally higher (PhGA exceeded PGA in only 8). Strong concordance was observed (p<0.001, figure 1).Certain factors significantly influenced PGA, PhGA, or both (table 1). Higher PGA was associated with corticosteroids (p=0.040), higher steroid dose (p=0.004), methotrexate (p=0.020), biologics (p=0.001), antidepressants (p=0.003), older age (p=0.002), elevated SLEDAS (p=0.028), and higher PSD (p<0.001). Higher PhGA was linked to methotrexate (p=0.025), azathioprine (p=0.011), and biologics (p<0.001). Better quality-of-life scores were linked to lower PGA (p<0.001).Abstract PO:13:340 Figure 1Concordance between patient global assessment (PGA) and physician global assessment (PhGA) scores was evaluated by Bland-Altman plot with 2 DS as concordance limits, along with their mean differenceAbstract PO:13:340 Table 1Clinical and epidemiological factors that influence patient global assessment (PGA) and physician global assessment (PhGA) scores, resulting in significant increases or decreasesConclusions Contrary to existing literature, this study found concordance between physicians’ and patients‘ assessments of disease activity, likely due to the high remission rates and specialized care in Lupus Clinics. Nevertheless factors such as skin involvement, hemolytic anemia, steroids, depression, fibromyalgia, and lower education were linked to higher scores, while renal involvement, employment, higher education correlated with lower scores.