THE USE OF POLYSIMPTOMATIC DISTRESS SCALE IN A MULTICENTRIC COHORT OF SLE PATIENTS TO IDENTIFY PATIENTS WITH HIGH LEVELS TYPE 2 SYMPTOMS

PV173 / #295 Poster Topic: AS19 - Patient-Reported Outcome Measures Background/Purpose SLE is a chronic inflammatory systemic disease characterized by a complex clinical picture. It has been demonstrated that achieving remission or low disease activity is crucial to improve long-term outcomes. However, in daily clinical practice, it is not rare to observe a relevant discordance between patient and physician global assessment, because of different illness perceptions. Recently, it has been proposed a different way to categorize SLE manifestations: classic inflammatory signs and symptoms has been labeled as type 1, whereas other frequent symptoms as fatigue, widespread pain, sleep disorder, brain fog with an unclear relationship to inflammation as type 2.[1] The presence and severity of type 2 manifestations can be assessed with the use of Polysymptomatic distress (PSD) scale, derived from 2016 ACR Fibromyalgia Criteria.[2] The aim of the present collaborative study was to assess the prevalence of type 2 in a multicenter cohort of SLE patients, to evaluate correlations with other PROs and to evaluate differences in clinical manifestations, disease activity, treatment and PROs performance in patients with or without high level type 2 SLE Methods Adult SLE patients consecutively followed in 2 Lupus Clinic from March to July 2024 were included. PSD score is obtained by summing the Widespread Pain Index and Symptom Severity Scale (range score 0-31), and high level type 2 is defined as ≥ 12 (2). Fatigue was assessed through FACIT-Fatigue, quality of life with EuroQoL 5 Dimensions 3 Levels (EQ-5D-3L) and Short-Form-36 Health Survey (SF-36). Medical records including demographic data, clinical characteristics and outcomes measures were collected Results The study included 238 patients (92% women), Caucasian in 95%, with a median age of 47 years and a mean disease duration of 199 months. Concerning level of education 28.1% had a primary/middle school education, high school in 38.6% and 33.3% postsecondary education. The majority of patients were employed (68.7%), followed by retired in 17.8%, unemployed 10% and 3.5% were students. 30 (12.7%) patients had a diagnosis of fibromyalgia. At the last evaluation mean SLEDAI was 1.48 (±1.77), mean SLE-DAS 1.34 (±1.94); 193 (81.4%) and 184 (80.3%) met the criteria for SLE-DAS or DORIS remission. We reported a mean PSD of 7.99 (±6.08) and, as shown in Table 1, PSD score strongly correlated negatively with SF-36 domains, FACIT and EQ-5D-3L and patient global assessment, whereas it does not correlate with physician global assessment, disease activity or damage scores. Moreover, a significant positive correlation was found with BMI and disease duration. A high-level type 2 (PSD≥12) was found in 58 patients (24.3%), and comparison between patients with and without high level type 2 is reported in Table 2. No differences were found in cumulative clinical manifestations, disease activity or damage and ongoing SLE treatment, whereas patients with higher PSD were older, with a higher BMI and more frequently had a primary/secondary education. Moreover, they had a worse performance in all the PROs. Table 1. Table 2. Conclusions High level type 2 SLE symptoms occurred in nearly 25% and its occurrence was not related to classic disease manifestation or objective disease activity, but with other features as weight, age, concomitant depression/anxiety. Moreover, PSD performance strongly correlates with other PROs and has the advantage of being completed in a short time and therefore its use in daily practice could be more feasible. References: [1.] Pisetsky DS. Arthritis Care Res (Hoboken) 2019;71(6):735-41. [2.] Wolfe F. Semin Arthritis Rheum 2016;46:319-29.

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