POS1023 HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS OVER TIME: A LARGE MONOCENTRIC COHORT ANALYSIS
Authors: E. Elefante, L. Gualtieri, F. Cruz-Sanabria, D. Schilirò, C. Stagnaro, V. Signorini, D. Zucchi, C. Cardelli, L. Carli, F. Ferro, C. Tani, M. Mosca
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> the relationship between disease activity and Health-Related Quality of Life (HRQoL) in Systemic Lupus Erythematosus (SLE) is controversial. Data in the literature show that disease activity and different aspects of HRQoL may follow distinct trajectories over time. <h3>Objectives:</h3> to evaluate the change of HRQoL, between two consecutive evaluations, in a monocentric cohort of SLE patients. <h3>Methods:</h3> this is a retrospective study of prospectively collected data of consecutive outpatients with SLE. For each patient, the following data were collected: demographics, laboratory and clinical data, SELENA-SLEDAI for disease activity and SLICC-DI for organ damage, comorbidities and ongoing treatment. At each visit, patients completed the following Patient Reported Outcomes (PROs): SF-36, FACIT-Fatigue, Lupus Impact Tracker (LIT), SLAQ, Hospital Anxiety and Depression Scale (HADS). For each patient two consecutive evaluations (T1 and T2), performed at a time interval ranging from 6 to 18 months between each other, were analysed. Comparisons between T1 and T2 were performed through the paired Wilcoxon test for continuous variables and the chi-square test for categorical ones. The difference in scores obtained in each questionnaire between the two observations (T2-T1 = Delta value) was calculated to determine how they evolved over time. The Spearman correlation test was used to explore the correlations of delta values between questionnaires and clinical variables to evaluate the congruence in the changes observed over time. <h3>Results:</h3> 205 SLE patients were enrolled, mainly female (91.7%); mean age at enrolment was 44.8±12.5 years, with a mean disease duration of 13.5±10 years. Overall, patients enrolled presented a low disease activity (mean SLEDAI 2.03±2.2) and organ damage (mean SLICC-DI 0.72±1.23), without a significant difference between the two consecutive evaluations. The majority of patients were in remission in both the timepoints (T1 70.2% - T2 76.9%, p=0.2), while 31 (15.12%) presented an active disease at T1, with cutaneous (13.3%) and haematological (8.8%) being the most frequent active manifestations. 28 patients (14%) had concomitant fibromyalgia. 104 patients (57.5%) were on a low dose of glucocorticoids (GC) (mean 2.48 mg/daily of 6-methylprednisolone), 76 (42%) were on immunosuppressive therapy and 164 (90.6%) on hydroxychloroquine. 27 patients (14.9%) were on treatment with belimumab. There was no significant difference in the results of PROs between the two consecutive evaluations in the entire cohort. We then analysed the subgroup of 31 patients with active disease at T1 (Table 1). They presented a significant reduction of the SLEDAI at T2 (T1 5 [4-6] - T2 2 [0-4], p&lt;0.001). Concordantly, we found a significant increase of patients in remission (T1 0 - T2 62.1%, p&lt;0.001), a reduction in the GC daily dose (T1 4 [4-8] - T2 4 [2-4] mg/daily, p&lt;0.01) and an increase of patients on belimumab (T1 19.4% - T2 50%, p&lt;0.05). Within this subgroup of active patients, some of the PROs results showed a significant improvement between the two timepoints. In particular, they showed a significant improvement in fatigue (FACIT, p&lt;0.05), disease burden (LIT, &lt;0.05) and some of the SF-36 domains (MCS p&lt;0.05; PF p=0.001; RE p&lt;0.01). Importantly, variations over time (Delta values) of the scores of SLAQ, FACIT, LIT, and some SF-36 domains (PF, RP, BP, SF, RE) resulted significantly correlated and congruent with variations of the SLEDAI score between the two evaluations (Table 2). <h3>Conclusion:</h3> our study demonstrates that, in a large cohort of SLE patients, with an overall stable and well-controlled disease, PROs tend to remain stable over time. However, among patients with active disease at enrolment, we observed that the improvement of disease activity, in the short term, can have a positive impact mainly on the physical aspects of HRQoL and disease burden. On the contrary, mental health seems to be an independent domain, maybe influenced by different factors. Therefore, understanding the trajectories of change in HRQoL outcomes over time may help to develop tailored interventions for the management of SLE patients. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>