ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1293

Studying Clusters of Patients with SLE According to Cognitive Function, Self-reported Outcomes, Disease Activity, and Clusters Dynamic over 1 Year

Ambika Gupta1, Sindhu Johnson2, Jiandong Su3, Kathleen Bingham4, Andrea Knight5, Juan Diaz-Martinez6, Mahta Kakvan3, Maria Tartaglia3, Lesley Ruttan4, Joan Wither3, May Choi7, Marvin Fritzler8, Dennisse Bonilla3, Dorcas Beaton9, Patricia Katz10, Robin Green3 and Zahi Touma1, 1University of Toronto, Mississauga, ON, Canada, 2University of Toronto, Toronto, ON, Canada, 3University Health Network, Toronto, ON, Canada, 4University of Toronto, University Health Network, Toronto, ON, Canada, 5Hospital for Sick Children, Toronto, ON, Canada, 6UHN, Toronto, ON, Canada, 7Brigham and Women's Hospital | University of Calgary, Calgary, AB, Canada, 8University of Calgary, Calgary, AB, Canada, 9Institute for Work & Health, Toronto, ON, Canada, 10University of California San Francisco, San Francisco, CA

Meeting: ACR Convergence 2021

Keywords: , , ,

Session Information

Date: Monday, November 8, 2021

Title: SLE – Diagnosis, Manifestations, & Outcomes Poster III: Outcomes (1257–1303)

Session Type: Poster Session C

Session Time: 8:30AM-10:30AM

Background/Purpose: Systemic Lupus Erythematosus (SLE) has a high prevalence of cognitive impairment (CI) (38% (95% confidence interval: 33-43%)). Patient reported outcomes (PROs) capture patient perceptions of their health condition, mood, health related quality of life (HRQoL) and other aspects. We aimed to determine if self-reported fatigue, anxiety, depression, perceived deficits questionnaire (PDQ-20), HRQoL, disease activity scores and cognitive neuro-battery (NB) cluster into distinct groups in SLE patients. We assessed if patients changed clusters at 1 year of follow-up.

Methods: This is a retrospective analysis of consecutive consenting patients, aged 18-65 years, who attended a single center (Jul 2016 – Mar 2019) and completed baseline and 1 year follow-up visits. Patients completed a comprehensive NB evaluating six cognitive domains: manual motor speed and dexterity, simple attention and processing, visual spatial construction, verbal fluency, learning and memory (verbal and visuospatial) and executive function. We derived a total score for the NB. Patients completed the Beck anxiety, Beck depression, fatigue severity score (FSS), Short Form Health Survey (SF-36) physical (PCS) and mental scores (MCS), and the PDQ-20 (subjective cognitive function). Disease activity was assessed by SLEDAI-2K. Ward’s method was used for clustering and Principal Component Analysis (PCA) was used to confirm the number of clusters. Clusters were grouped based on symptom intensity, defined as those that had high, medium, and low PROs scores relative to one another. We assessed the stability and movement of clusters at 1 year. Stability was assessed with kappa statistic.

Results: 142 patients were included, 89.4% comprised of females. The mean age and SLE duration at enrolment were 43.1 ± 12.1 and 15.3 ± 10.1 years, respectively.

Three clusters were found: Cluster 1 had low symptom intensity, Cluster 2 had moderate symptom intensity and Cluster 3 had high symptom intensity (Figure 1). In Cluster 3, the most severe scores for fatigue, depression, anxiety, PDQ-20, and SF-36 MCS were found. NB scores in Cluster 3 were similar to Cluster 2. SLEDAI-2K was similar in Clusters 1 and 3 and more active in Cluster 2.

At 1 year follow-up, 49% of patients (69/142) remained in their baseline cluster; a fair agreement of stability (Kappa statistic 0.35;95% confidence interval 23.0-47.3) was found. Cluster 1 had the highest stability (77% of patients stayed in the same cluster), followed by Cluster 3 (51%) and Cluster 2 had the lowest stability (3%; Table 1). A minority of patients from Cluster 1 moved to Cluster 3 (19%). In Cluster 3, a larger number moved to Cluster 2 (40%) and less to Cluster 1 (9%).

Conclusion: Three distinct clusters of symptom intensity were defined by PCA in SLE patients in association with cognitive function with Cluster 3 displaying the highest symptom severity and worse cognitive function versus Cluster 1 having the lowest symptom burden and better cognitive function. Patients remained in the same cluster at one year, particularly in Cluster 1 and Cluster 3, and there was a low tendency to move between these two Clusters.

Interpretation for the table: e.g. In Cluster 1, 77% of patients remained in this cluster at year 1 while 4% moved to Cluster 2 and 19% to Cluster 3.

Disclosures: A. Gupta, None; S. Johnson, None; J. Su, None; K. Bingham, None; A. Knight, None; J. Diaz-Martinez, None; M. Kakvan, None; M. Tartaglia, None; L. Ruttan, None; J. Wither, None; M. Choi, MitogenDx, 1, 2; M. Fritzler, Inova Diagnostics Inc., 2, 6, Werfen International, 2, Alexion Canada, 6, Mitogen Diagnostics Corp., 3, 8, 9, 10; D. Bonilla, None; D. Beaton, None; P. Katz, None; R. Green, None; Z. Touma, AbbVie Inc, 2, UCB Biopharma SRL, 2, Sarkana Pharma Inc., 1, 4, Janssen Inc., 2, GlaxoSmithKline Inc., 6.

To cite this abstract in AMA style:

Gupta A, Johnson S, Su J, Bingham K, Knight A, Diaz-Martinez J, Kakvan M, Tartaglia M, Ruttan L, Wither J, Choi M, Fritzler M, Bonilla D, Beaton D, Katz P, Green R, Touma Z. Studying Clusters of Patients with SLE According to Cognitive Function, Self-reported Outcomes, Disease Activity, and Clusters Dynamic over 1 Year [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/studying-clusters-of-patients-with-sle-according-to-cognitive-function-self-reported-outcomes-disease-activity-and-clusters-dynamic-over-1-year/. Accessed .

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