Predicting flares in patients with stable systemic lupus erythematosus

Area of Science:

• Rheumatology
• Immunology
• Clinical Medicine

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with significant heterogeneity in disease presentation and progression.
• Flares, or exacerbations of disease activity, are a major cause of morbidity in SLE patients.
• Data on flare predictors in Asian populations, particularly Southeast Asians, are limited.

Purpose of the Study:

• To identify baseline predictors of disease flares in a cohort of Southeast Asian patients with SLE.
• To provide insights into managing SLE in diverse ethnic groups.

Main Methods:

• A prospective cohort study enrolled adult patients with prevalent SLE meeting ACR or SLICC criteria.
• Clinical and laboratory data were collected at three-monthly visits.
• Flares were assessed using the SELENA-SLEDAI Flare Index (SFI).
• Cox proportional hazards models identified baseline predictors of flare in patients with stable disease (SLEDAI-2K ≤ 4).

Main Results:

• Of 210 patients, 148 were Chinese; median SLEDAI-2K was 2, median disease duration was 10 years.
• 152 patients had stable disease at baseline.
• After a median follow-up of 31.5 months, 51.9% of patients experienced flares.
• Younger age, thrombocytopenia, hypocomplementemia, and higher baseline prednisolone doses were associated with increased flare risk.
• Longer disease duration was associated with a reduced risk of flares.

Conclusions:

• Flares are frequent in Asian SLE patients, even those with initially stable disease.
• Close monitoring is crucial for patients identified with risk factors.
• Predictive factors include younger age, longer disease duration, thrombocytopenia, hypocomplementemia, and higher baseline prednisolone doses.