Background/Purpose: Systemic Lupus Erythematosus (SLE) a chronic disease, predominantly of young women, which may involve various organs, and is marked by periods of disease flares, activity and damage. It may interfere with training, work, social life, and performance of important roles in life. Its treatment may involve use of corticosteroids and immunosuppressive medications which may cause side effects. SLE can adversely impact various aspects of one’s life and may significantly impair quality of life of patients and their loved ones.  With the aim of improving patient care, we sought to determine significant modifiable and non-modifiable correlates of satisfaction with care (SC) in SLE.

Methods: Fifty consenting SLE patients fulfilling ACR classification criteria were given self-administered surveys (FACIT-Fatigue, Self-reported Fibromyalgia Tender Point, Pain, Insomnia Severity Index for Sleep, Perceived Stress Scale-4, Patient Health Questionnaire-9 for depression, LupusPRO) at routine care visits.  Disease activity and damage were assessed using SELENA-SLEDAI (SS) and SLICC/ACR (SDI). Non-modifiable variables of interest were age, gender, education, marital status, disease duration, number of ACR criteria, damage, lupus nephritis (LN) diagnosis and fibromyalgia (FM) diagnosis. Modifiable variables of interest included disease activity, current use and current dose of corticosteroids, specific SLE medications, self-reported FM tender point count, pain, insomnia, fatigue, depression and stress. SC was measured using the LupusPRO SC domain items. Univariate and multivariate regression modeling was done, with SC as a dependent variable and with the above variables of interest. P value of ≤0.05 on two tailed test was significant. Bonferroni correction was used for the final model, and a p ≤0.006 was significant on two tailed test.

Results: Mean (SD) age was 41.4+13 years, 90% participants were women. Ethnic background was as follows: 56% Blacks, 24% Whites, 10% Asians and 10% Others. Median (IQR) values of Physician Global Assessment (PGA), total SS, and SDI were 0.5 (0.8), 4.0(6.0) and 1.0(1.0), respectively.  Age, education, disease duration, damage, FM diagnosis and LN diagnosis were the non-modifiable, while disease activity, current corticosteroid dose and fatigue were the modifiable correlates of SC (Table 1). Greater disease activity, disease duration and FM were associated with better SC. Together these 8 variables accounted for 51% variance in SC. After Bonferroni correction, age, education and FM were not significant in the model, but rest remained significant.

Conclusion: Fatigue and current daily dose of steroids are significant and modifiable correlates of satisfaction with care in SLE, even after adjusting for FM.  We suggest proactive assessment and interventions targeted towards addressing fatigue and steroid dose reduction at each visit for SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/modifiable-and-non-modifiable-correlates-of-satisfaction-with-care-in-systemic-lupus-erythematosus/