OP0308 QUALITY OF CARE PREDICTS OUTCOME IN SYSTEMIC LUPUS ERYTHEMATOSUS – CROSS SECTIONAL ANALYSIS OF A GERMAN LONG-TERM STUDY (LULA COHORT, 2011–2015)
Authors: Anna Kernder, Jutta Richter, Rebecca Fischer-Betz, Borgi Winkler-Rohlfing, Matthias Schneider, Gamal Chehab
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Systemic lupus erythematosus (SLE) is a chronic disease, which is still associated with significant morbidity and mortality<sup>1</sup>. Recommendations for the management of SLE patients exist<sup>2-5</sup>, but information on its implementation and the resulting impact on long-term outcome remain unclear. <h3>Objectives</h3> Our aim was to study the quality of SLE medical care in Germany to understand gaps and to analyze the association to long-term outcome parameters. <h3>Methods</h3> In the LuLa-study information on demographics, clinical and medical care parameters are assessed annually by self-reported questionnaires among a representative sample of SLE patients in Germany (LuLa cohort, n=572). In 2013 additional questions on the management of care, as mentioned in current guidelines and recommendations, were surveyed. Ten items predicting a good clinical care (quality measures) were evaluated and an overall score with a minimum of 0 points and a maximum of 10 points was calculated. The ten items are taking antimalarials, osteoporosis protection at a dose above 7.5mg prednisolone equivalent per day or taking ≤ 7.5mg per day, vaccination, blood pressure, fat metabolism counseling, urine examination and blood test once a year, treatment of comorbidity fat metabolism disorder, osteoporosis and hypertension. Health related quality of life (Short Form Survey, SF-12/36), damage (Brief Index of Lupus Damage, BILD) and disease activity (Systemic Lupus Activity Questionnaire, SLAQ) were chosen as relevant proxies for long-term outcome. Using linear regression, we examined the relationship between the quality measures and outcome parameters, adjusted for age, disease duration and gender. <h3>Results</h3> 65.5% of the patients consulted a rheumatologist as a main contact for their disease. On average 6.1 points of the 10 quality measures were met (SD 1.7). The fulfillment of these quality measures varied between 22.8% (fat metabolism counseling) and 97.6% (osteoporosis protection at a dose above 7.5mg prednisolone equivalent per day or ≤ 7.5mg per day). Fulfilling more clinical care items in 2013 was predictive for high disease-related quality of life (SF-36, p=0.004), low progress in disease-related damage (BILD, p=0.048) and low disease activity (SLAQ, p=0.046) in the subsequent years. <h3>Conclusion</h3> Our study illustrates a strong link between the quality of care and important SLE outcome parameters: quality of life, disease-related damage and disease activity assessed by a self-reported questionnaire. Consistent considerations of these care parameters, which are recommended in several management guidelines, yield a positive effect on outcome. An interdisciplinary approach with general practitioners and other specialists is certainly beneficial and warranted. German Clinical Trial Register, www.germanctr.de, DRKS00011052 <h3>References</h3> [1] Borchers, A. T., Keen, C. L., Shoenfeld, Y. &amp; Gershwin, M. E. Surviving the butterfly and the wolf: mortality trends in systemic lupus erythematosus. Autoimmun. Rev. 3, 423–453 (2004). [2] Bertsias,G. et al.&nbsp;EULAR&nbsp;recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann. Rheum. Dis. 67, 195–205 (2008). [3] Mosca, M. et al. European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. Ann. Rheum. Dis. 69, 1269–1274 (2010). [4] Guidelines for referral and management of systemic lupus erythematosus in adults. American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines. Arthritis Rheum. 42, 1785–1796 (1999). <h3>Disclosure of Interests</h3> Anna Kernder Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Jutta Richter Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Rebecca Fischer-Betz Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Borgi Winkler-Rohlfing: None declared, Matthias Schneider Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Speakers bureau: Chugai, Gamal Chehab Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study.