Date: Monday, November 9, 2020
Session Type: Poster Session D
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients with childhood-onset systemic lupus erythematosus (cSLE) are at high risk for early morbidity and mortality, but predictors of moderate/high cSLE disease activity have not been well-studied. Our objective was to determine sociodemographic and clinical predictors for moderate/high disease activity scores in a cohort of North American cSLE patients. Our hypothesis was minority race/ethnicity, lower household income, lower parental education, and non-private insurance status would be associated with moderate/high disease activity at follow-up.
Methods: The Childhood Arthritis and Rheumatic Disease Research Alliance (CARRA) Registry enrolls patients with cSLE from >65 North American pediatric rheumatology centers. We performed a cross-sectional analysis of CARRA Registry data collected prospectively from March 2017 to December 2019. Patients with cSLE or probable cSLE with at least two study visits at least 6 months apart were included. Disease activity at most recent follow-up visit was measured using Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K, range 0-105) and dichotomized as low disease activity, SLEDAI-2K ≤ 4, or moderate/high disease activity, SLEDAI-2K > 4. Chi-square and two-sample Student t tests were performed to compare sociodemographic and clinical characteristics between patients with low vs. moderate/high disease activity at most recent follow-up. Multivariable logistic regression was conducted to determine predictors for SLEDAI-2K > 4 at most recent follow-up.
Results: There were 423 eligible patients with cSLE (Table 1). The mean ± SD time from diagnosis to most recent follow-up was 27.1 ± 22.2 months. The cohort was 85% female, 27% Black, 25% White, 24% Hispanic, and 17% Asian with a mean ± SD age at diagnosis of 13.8 ± 2.9 years. Lupus nephritis was present in 41% and neuropsychiatric lupus in 28%. At the most recent visit, the range of SLEDAI-2K scores was 0-25, and 27% of patients had SLEDAI-2K > 4. Results of univariate analyses showed there were not statistically significant differences in sociodemographic variables between patients with low vs. moderate/high disease activity (Table 1). However, patients with moderate/high disease activity at most recent follow-up had statistically higher number of ACR and SLICC criteria, SLEDAI-2K at enrollment, and physician global assessment (PGA) at enrollment and shorter time from diagnosis to enrollment (Table 1). Using multivariable logistic regression adjusted for disease duration, SLEDAI-2K at enrollment (OR=1.04, 95% CI=1.003–1.086) and PGA at enrollment (OR=1.16, 95% CI=1.029–1.310) remained independently associated with moderate/high disease activity.
Conclusion: This analysis demonstrates a substantial proportion of patients with cSLE in the CARRA Registry have moderate/high disease activity at most recent follow-up. Disease activity at registry enrollment, measured by SLEDAI-2K and PGA, was the only predictor of moderate/high disease activity. Interestingly, sociodemographic characteristics did not predict moderate/high disease activity. Improved understanding of modifiers of cSLE disease activity is needed for the development of targeted interventions to improve outcomes.
To cite this abstract in AMA style:Smitherman E, Chahine R, Beukelman T, Knight A, Rahman A, Son M, Curtis J, Hersh A. Sociodemographic and Clinical Predictors of Childhood-Onset SLE Disease Activity in the Childhood Arthritis and Rheumatology Research Alliance Registry [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/sociodemographic-and-clinical-predictors-of-childhood-onset-sle-disease-activity-in-the-childhood-arthritis-and-rheumatology-research-alliance-registry/. Accessed April 11, 2021.
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