Background/Purpose: Childhood onset systemic lupus erythematosus (SLE) is a chronic autoimmune condition with high morbidity that requires long-lasting care through adulthood. Transition from pediatric to adult care is difficult and poor transition can be associated with worse outcomes. Resilience is the ability to respond positively to adversity. It is a mutable trait that can be improved through interventions. In other chronic conditions, resilience has been found to be an important predictor of transition readiness. The purpose of this study is to evaluate if resilience is predictive of transition readiness. A secondary aim is to explore other factors that may influence transition readiness in SLE.

Methods: Sixty-two adolescent SLE patients from the Stanford Children’s Health Pediatric Rheumatology clinic were enrolled in a cross-sectional study. Inclusion criteria included diagnosis of SLE confirmed using American College of Rheumatology or Systemic Lupus International Collaborating Clinics (SLICC) classification criteria before age 18 and disease duration more than 6 months. Participants completed questionnaires on transition readiness, resilience, depression, anxiety and fatigue. Resilience was evaluated using Resilience Scale (RS-14), a validated measure in adolescents and adults. Transition readiness was evaluated using Transition Readiness Assessment Questionnaire (TRAQ), a validated scale in adolescents with chronic disease. Data regarding SLE disease characteristics, disease duration, disease activity and socioeconomic status was obtained. A multivariable linear regression model was created to evaluate association between transition readiness and resilience.

Results: The majority of participants were mostly (87%) and Asian (47%). The mean age was 18.6 years and mean disease duration was 5.1 years. TRAQ scores were significantly correlated with resilience, RS-14 (ρ=0.39, p=0.002) and current age (ρ=0.47, p<0.001). There was no correlation with disease duration, fatigue, anxiety, depressive symptoms, disease damage (SLICC Damage Index) or disease activity (SLEDAI score). A Wilcoxon rank sum test indicated that the TRAQ score was greater for individuals with public insurance (Median=87.5) than for privately insured patients (Median=75), p=0.002. There was no difference in scores between genders, or in individuals with depression or anxiety or history of severe disease. A multiple regression analysis model was calculated to predict TRAQ score based on resilience, controlling for insurance status, age and disease duration. Resilience (β=0.33, p=0.002), age (β=0.49, p=0.001), and insurance status (β=0.31, p=0.004) were significant predictors in this model. The overall model fit was R² of 0.44 (p<0.0001).

Conclusion: In adolescent SLE patients, preparation for transition is important. Correcting for age, and other confounding factors, resilience score appears predictive of transition readiness. In addition to current care, it may be important to include resilience building into transition programs to assist with improved outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/resilience-and-transition-readiness-in-pediatric-sle-patients/