POS1141 ACTIVE JOINT DISEASE, PAIN AND FATIGUE ALL STRONGLY ASSOCIATE WITH POOR MENTAL HEALTH IN AN INTERNATIONAL COHORT OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM THE COVAD SURVEY
Authors: E. Elfar, G. Sukhija, K. Bechman, S. Saha, J. Knitza, C. Vinicio Caballero, P. Yaadav, D. Dzifa, I. Parodis, R. Aggarwal, V. Agarwal, L. Gupta, C. Wincup
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Psychosocial wellbeing significantly contributes to the overall health experiences of individuals with systemic lupus erythematosus (SLE). Mental health is often influenced by the intricate interplay between multifaceted factors, including the impact of disease on quality of life, pain, fatigue, drug-related side effects, and disease-specific manifestations. In view of this complexity, a comprehensive understanding of these factors collectively is required, particularly as some factors may be modified. <h3>Objectives:</h3> This study aims to identify the key variables contributing to overall mental health in SLE and uncover associations with risks of poor mental health in a global patient population. <h3>Methods:</h3> Data was extracted from the COVAD database of more than 20,000 survey respondents with autoimmune diseases and healthy controls (HC). Variables including age; ethnicity; disease duration; treatment including glucocorticoids (GC) and immunosuppressive medication (IS); comorbidities; and recent disease flares (particularly relating to the cutaneous and musculoskeletal domains) were evaluated for their association with poor mental health. Mental health was assessed using the <i>Patient-Reported Outcomes Measurement Information System</i> (PROMIS) Global Mental Health, a validated measure of overall mental health accounting for emotional wellbeing, social connections and general life satisfaction. This generates a numerical score (0-20) with a lower score suggestive of worse mental health. We defined poor mental health as a PROMIS Global Mental Health score of ≤11. This was based on data obtained from 3323 HCs included in the study, in which the mean PROMIS Global Mental Health score was 14.80 minus 1 standard deviation (3.31). Differences in characteristics between patients with and without poor mental health were tested for statistical significance using χ<sup>2</sup>, Mann-Whitney or <i>t</i>-test, as appropriate. A logistic regression model was constructed to evaluate predictors of poor mental health and included age, gender, ethnicity, comorbidity burden, hydroxychloroquine use and flares including rash and/or joint manifestations of SLE. Outputs of the multivariable logistic regression were presented as odds ratios (OR) with 95% confidence intervals (CIs), with graphical representation of marginal probabilities of poor mental health by age band and disease activity. <h3>Results:</h3> A total of 1292 SLE patients were identified of whom 36.7% (n=474) fulfilled the definition of poor mental health. Table 1 summarises differences in demographics, treatment and comorbidities. Those with poor mental health were older (median 42 years, IQR 32-53 vs 38 years, IQR 31-48, p&lt;0.001), more likely to be female (p=0.029) and reported higher levels of pain (median Pain VAS 5, IQR 3-7 vs 2, IQR 0-4, p&lt;0.001) and fatigue (Fatigue 4a 14, IQR 11-16 vs 8, IQR 7-12, p&lt;0.001). Figure 1A shows the results of the logistic regression model and illustrates that when compared with individuals of black ethnicity (the group with the lowest incidence of poor mental health), white ethnicity exhibited an increased risk of poor mental health (adjusted OR 2.59, CI 1.58-4.25), followed by Hispanic (OR 2.30, CI 1.33-3.96) and Asian ethnicity (OR 2.10, CI 1.29-3.42). Increasing numbers of physical comorbidities also associated with higher risk of poor mental health in the adjusted model (adj OR 1.61, CI 1.31-1.98). Interestingly, active cutaneous disease did not appear to significantly associate with poor mental health (adj OR 1.05, CI 0.53-2.08), whereas those with active joint disease had markedly higher risk of poor mental health (adj OR 3.65, CI 2.38-5.61). Figure 1B shows the probability of poor mental health was greater in those with active lupus disease compared to inactive, and this effect persisted across all age groups. <h3>Conclusion:</h3> Our findings highlight that more than one third of patients with SLE suffer from poor mental health. We identify important risk factors associating with poor mental health in SLE, such as pain (particularly in the setting of recent flare of joint disease) and fatigue. Effective management of these symptoms may improve mental health outcomes in people with SLE. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Eman Elfar: None declared, Gagandeep Sukhija: None declared, Katie Bechman: None declared, Sreoshy Saha: None declared, Johannes Knitza: None declared, Carlo Vinicio Caballero: None declared, Praggya Yaadav: None declared, Dey Dzifa: None declared, Ioannis Parodis IP has received research funding and/or honoraria from Amgen, AstraZeneca, Aurinia Pharmaceuticals, Elli Lilly and Company, Gilead Sciences, GlaxoSmithKline, Janssen Pharmaceuticals, Novartis and F. Hoffmann-La Roche AG., Rohit Aggarwal RA has a consultancy relationship with and/or has received research funding from the following companies: Bristol Myers-Squibb, Pfizer, Genentech, Octapharma, CSL Behring, Mallinckrodt, AstraZeneca, Corbus, Kezar, Abbvie, Janssen, Kyverna Alexion, Argenx, Q32, EMD-Serono, Boehringer Ingelheim, Roivant, Merck, Galapagos, Actigraph, Scipher, Horizon Therepeutics, Teva, Beigene, ANI Pharmaceuticals, Biogen, Nuvig, Capella Bioscience, and CabalettaBio., Vikas Agarwal: None declared, Latika Gupta: None declared, Chris Wincup: None declared.