PO:15:214 | Identification of SLE patients with high-levels Type 2 SLE through the polysymptomatic distress scale (PSD): correlations with other PROs and differences in clinical phenotypes in a multicentric cohort

Micaela Fredi^1|2, Giorgia Gozzoli^1|2, Federica Bonaso^1|2, Silvia Ebe Della Pina^1|2, Claudia Barison^1|2, Irene Lorenzini², Anna Mattiuzzo², Raffaele Pericotti², Marcelo Neto³, Sofia Avedo⁴, Clàudia Oliveira⁴, Luis Sousa Ines³, Franco Franceschini^1|2 | ¹Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia, ERN-ReCONNET Center, Brescia, Italy; ²Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; ³Rheumatology Department, Centro Hospitalar Universitário de Coimbra - ULS Coimbra, Coimbra, Portugal; ⁴Rheumatology Department, ULS Aveiro, Aveiro, Portugal

Aim. SLE is a chronic inflammatory systemic disease characterized by a complex clinical picture. It has been proposed a different way to categorize SLE manifestations: classic inflammatory signs and symptoms as Type 1, whereas other frequent symptoms as fatigue, widespread pain, sleep disorder, brain fog with an unclear relationship to inflammation as Type2 (1). The presence and severity of type 2 manifestations can be assessed with the Polysymptomatic distress scale (PSD), derived from ACR Fibromyalgia Criteria (2). The aim was to assess the prevalence of Type 2 in a multicenter cohort, to evaluate correlations with PROs and differences in patients with or without high level Type 2 SLE.

Materials and Methods. Adult SLE patients consecutively followed in two Lupus Clinic from March-July 2024 were included. High-level Type 2 is defined as PSD equal-more than 12(2), whereas high Type 1 symptom severity as a SLEDAI-2K more than 6(3). 4 groups were defined: high Type 1, high Type 2, both high Type 1-Type 2 symptoms (Mixed SLE) and no Type 1-Type 2 symptoms (Minimal SLE)(3). Fatigue was assessed through FACIT-Fatigue, quality of life with EQ-5D-3L and SF-36.

Results. The study included 277 patients, (256 women), Caucasian in 92.8%,with a median age at enrolment of 46 years (min-max 19-82). 30(12.7%) patients had a diagnosis of fibromyalgia. At the last evaluation mean SLEDAI-2K was 1.48 (±1.77); 184(80.3%) met the criteria for DORIS remission. We reported a mean PSD of 7.99(±6.08) and, as shown in table 1, PSD score strongly correlated negatively with other PROs but not with disease activity or damage scores. Moreover, a significant positive correlation was found with BMI and disease duration. PSD equal-more than12 was found in 63 (22.7%) patients, and we divided our cohorts in 4 groups: minimal SLE (205,73.9%), high-level Type2 SLE (60,21.6%), high-level Type 1 (9,3.2%) and 3 mixed. Comparison between patients with and without high-level Type 2 is reported in table 2. No differences were found in cumulative clinical manifestations, disease activity or damage and ongoing SLE treatment, whereas patients with higher PSD were older, with a higher BMI and more frequently had a primary/secondary education. Moreover, they had a worse performance in all PROs.

Conclusions. High level Type 2 SLE symptoms occurred in nearly 25% and its occurrence was not related to classic disease manifestation or objective disease activity, but with other features as weight, age, concomitant depression/anxiety. Moreover, PSD performance strongly correlates with other PROs and has the advantage of being completed in a short time and therefore its use in daily practice could be more feasible. References (1)Pisetsky DS et al. Arthritis Care Res (Hoboken). 2019 (2)Wolfe F et al Semin Arthritis Rheum 2016; (3)Eudy AM et al. Lupus. 2024