Urinary Incontinence Among Adults With Systemic Lupus Erythematosus

The epidemiology of urinary incontinence (UI) in systemic lupus erythematosus (SLE) remains understudied. We estimated the prevalence and life burden of UI and examined associations of UI with SLE activity and disease damage in a population-based US SLE cohort.

Participants (N = 425; mean age, 46.3 years; 82.8% Black; 92.0% women) were recruited from an ongoing adult SLE cohort (October 2019 to May 2022) for a single study visit. UI was assessed via questionnaire and defined as any urinary leakage occurring at least monthly. SLE activity and cumulative organ damage were measured using the Systemic Lupus Activity Questionnaire and Brief Index of Lupus Damage and dichotomized (higher vs lower) at the median score. Logistic regression models adjusted for age, sex, education, and body mass index were used to evaluate associations of SLE activity and cumulative disease damage with UI.

Overall, 36.2% reported UI at least monthly. Of those with UI, 57.7%, 18.8%, and 19.6% reported mixed-type, stress, and urge UI; 39.0% reported that UI was a substantial bother, and 16.2% reported that UI had a substantial impact on daily activities. UI prevalence was higher in women and in participants who were older and who had obesity. Higher disease activity was independently associated with 3-fold higher prevalence odds of UI (odds ratio = 3.02, 95% confidence interval: 1.91-4.76). Higher cumulative disease damage was associated with 36% higher odds of UI, but the association was not statistically significant.

UI is common in those with SLE and associated with higher disease activity, highlighting the need for updated clinical UI screening and management strategies in this unique population.