Background The assessment of disease activity in systemic lupus erythematosus (SLE) patients is appreciated by clinical and paraclinical data as well as by calculating the disease activity scores. All these methods are however laborious and time consuming.
Objectives The aim of this study was to determine if the answers of the patients regarding the severity of their disease, as reflected by their general state, are related to disease activity, organ damage or fatigue degree.
Methods Patients diagnosed with SLE according to the 2012 Systemic Lupus International Collaborating Clinic (SLICC) SLE's criteria were consecutively included.
Using a numerical rating scale (NRS) from 1 to 10 (1 - no disease; 10 – most severe disease), the patients answered at two questions: first, “How severe you think was your illness in the worst moment from the SLE diagnosis?” and second, “How severe you think is your illness in this moment?”. In order to reduce the subjectivity of the patient, we introduce also as variable the ratio of these two questions' results.
In all patients, the disease activity was assessed using the Systemic Lupus Activity Measure (SLAM) Score, the cumulative organ damage using the SLICC-ACR Damage Index, and the fatigue degree using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT fatigue) Scale.
Results The lot consisted in 108 patients, 89.8% of feminine sex. The mean age at inclusion was 47.5±12.9 years, and the mean age at the SLE diagnosis 37.0±13.0 years.
The results of the two questions regarding illness severity anytime and severity in present were 8.4±1.8 (3;10), respectively 4.6±2.5 (1;10).
For the second question, a statistical significant difference was found between the patients with active disease and the patients with stable disease (cut-off for SLAM Score of 10 points): 6.6 (1;10) vs 4.3 (1;10), p-value 0.004 (Mann-Whitney test).
In univariate analysis (Kendall test), the judge of illness severity in present was significant correlated with the results of SLAM Score, FACIT fatigue Scale (p-value <0.01), respectively with SLICC Damage Index (p-value <0.05). The judge of illness severity anytime was correlated only with the SLICC Damage Index result (p-value <0.05).
Analyzing by ROC curve, the best predictor for a high SLAM Score (more or equal with 10 points) was the ratio between NRS illness severity in present reported and the NRS illness severity anytime [AUC (95%CI) 0.788 (0.658-0.918)], followed by the results of NRS illness severity in present, and by the FACIT fatigue Scale [AUC (95%CI) 0.755 (0.625-0.886), respectively 0.741 (0.617-0.865)].
Conclusions The simply patients' self report of disease severity in the moment of presentation, on a NRS from one to ten, can give to the physician an additional information on SLE activity.
Acknowledgements This paper is supported by the POSDRU/159/1.5/S/137390.
Disclosure of Interest None declared