PO:17:253 | Unveiling the gap: a multicenter study on factors driving patient-physician discrepancies in assessing disease activity in systemic lupus erythematosus

Giorgia Ingrid Gozzoli¹, Micaela Fredi¹, Federica Bonaso¹, Silvia Ebe Lucia Della Pina¹, Claudia Barison¹, Irene Lorenzini⁴, Raffaele Pericotti⁴, Anna Mattiuzzo⁴, Marcelo Neto², Sofia Azevedo³, Cláudia Oliveira³, Cesare Tomasi⁴, Luís Sousa Inês², Franco Franceschini¹. | ¹Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy; ²Rheumatology Department, Centro Hospitalar Universitário de Coimbra - ULS Coimbra, Coimbra, Portugal; ³Rheumatology  Department, ULS Aveiro, Aveiro, Portugal; ⁴Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

Methods. Systemic lupus erythematosus (SLE) involves flares and remissions. This study explores discrepancies between physicians’ and patients’ reported disease activity and aims to identify key influencing factors.

Methods. Data from SLE patients monitored consecutively between March and July 2024 at two Lupus Clinics were collected. Disease activity was assessed using a 0–3 visual analog scale for both Patient and Physician Global Assessment (PGA, PhGA).

Results. The study included 280 adult SLE patients(92.5% women, 93% Caucasian). The median age at enrollment was 46 years(IQR 37–58), with a median age at diagnosis of 29 years(IQR 20–38.5). The median follow-up duration was 169 months(IQR 107–296). Twenty-nine percent had primary schooling, 36% completed high school, and 30% held a university degree. Most patients were employed, 10% students, 11% unemployed, 17% retired. Over the course of disease, ACLE was observed in 50% of patients, SCLE in 9% and 22% had CCLE. Mucosal, tumid, or hypertrophic SLE occurred in 1% of cases. Ulcers were present in 29% of patients, nonscarring alopecia in 24%, arthritis in 55%, pleuritis in 9% and pericarditis in 16%. Renal involvement occurred in 37% of patients(biopsy-confirmed glomerulonephritis class III/IV in 23% and class II/V in 10%). Neurological manifestations affected 9% of patients, hemolytic anemia 10%, leukopenia/lymphopenia 60% and thrombocytopenia 22%. Concomitant conditions included antiphospholipid syndrome(10%), overlap connectivitis(6%), fibromyalgia(11%) and depressive syndrome(14%). The last median SLEDAI was 2 (IQR 0–2) and the median SLEDAS was 0.37 (IQR 0.37–1.5). Steroid therapy was used by 45% of patients, DMARDs by 94%, biologic drugs by 22% and antidepressants/anxiolytics by 32%. The median SLICC Damage Index was 0 (range 0–8). The median PGA and PhGA scores were 0.58 and 0: 82% of patients achieved SLEDAS Low Disease Activity, while remission criteria were met by 73% (DORIS) and 77.5% (SLEDAS). PGA and PhGA showed strong concordance(p<0.001, Figure 1), yet scores differed by >0.5 points in 52% of cases, with PGA generally higher(PhGA exceeded PGA in only 8 patients). Certain factors significantly influenced PGA, PhGA or both (Table 1). An increase in PGA is also associated with corticosteroids (p = 0.040), higher daily steroids dose (p=0.004), methotrexate (p = 0.020), biologics (p = 0.001), antidepressants (p = 0.003), older age (p=0.002), elevated SLEDAS (p=0.028) and higher PSD scores (p<0.001), while an increase in PhGA is linked to the use of methotrexate (p = 0.025), azathioprine (p = 0.011) and biologics (p < 0.001). Better quality-of-life scores were linked to lower PGA (p<0.001).

Conclusions. Contrary to existing literature, this study found concordance between patients’ and physicians’ assessments of SLE activity, likely due to the high remission rates and specialized care in Lupus Clinics. Nevertheless factors such as skin involvement, hemolytic anemia, steroid use, depression, fibromyalgia, and lower education were associated with higher scores, while renal involvement, employment, and higher education correlated with lower scores.