Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Distinguishing Levels of Disease Flare in Patients with Systemic Lupus Erythematosus Using Administrative Claims Data.

Engel-Nitz5,  Nicole, Burke5,  James, Garris3,  Cindy P., Jhingran1,  Priti, Bass2,  Damon L., Dennis4,  Gregory J.

GlaxoSmithKline, King of Prussia, PA
GlaxoSmithKline, RTP, NC
Human Genome Sciences
i3 Innovus


Systemic lupus erythematosus (SLE) is a chronic, autoimmune disorder affecting multiple organ systems of the body, characterized by acute exacerbations (flares) and remissions. Disease activity indices have been shown to be reliable when used in clinical trials but have limited application with claims data.


To differentiate between patients with mild, moderate, and severe SLE flares using a claims-based flare severity algorithm.


This retrospective observational study used administrative claims from a large managed care health plan (1/2004 - 12/2008). SLE patients 18–64 years of age were included in the analysis if they had continuous enrollment in the health plan for at least 3 years with medical and pharmacy benefits. A diagnosis of SLE was defined by any of the following criteria: a) 3 or more rheumatologist visits on separate dates (no time requirement) with a diagnostic code for SLE (ICD-9 code 710.0x); b) 2 or more rheumatologist visits >=60 days apart with a diagnostic code for SLE; or c) 2 or more rheumatologist visits on separate dates with a diagnostic code for SLE AND 1 or more filled prescriptions for a medication typically used for the treatment of SLE. Claims-based algorithms consisting of disease activity and medications prescribed were developed and used to identify and classify disease severity (mild, moderate, high) and flares by severity (mild, moderate, severe) for each patient over a 2-year period. Patients with multiple flares could be counted more than once in each flare severity group during the period of observation. Cost of a flare episode was analyzed by flare severity.


A total of 2,990 patients met the inclusion criteria of which 22% were classified as having high severity, 52% with moderate and 26% with mild disease severity. Over the 2 year period, 86%, 99% and 99.5% of patients with high, moderate, and disease severity, respectively, had at least 1 flare (p<0.001). Of patients in the high disease severity group, 61% experienced at least 1 severe flare, compared to 13% of patients with moderate and 1% of patients with mild disease severity (p<0.001) over the 2 year period. Mean number of flares over 2 years was 4.1, 7.0 and 8.0 for patients with mild, moderate and high disease severity, respectively (p<0.001). The cost of a severe flare is approximately 18 times higher than a mild flare and 11 times higher than a moderate flare.


Nearly all patients with SLE had at least one flare identified in the claims data. The mean number of flares was higher for patients with moderate and severe disease compared with mild disease. The cost of a severe flare is substantially higher than moderate or mild flares. Averting a severe flare may be associated with significant cost savings.

To cite this abstract, please use the following information:
Engel-Nitz, Nicole, Burke, James, Garris, Cindy P., Jhingran, Priti, Bass, Damon L., Dennis, Gregory J.; Distinguishing Levels of Disease Flare in Patients with Systemic Lupus Erythematosus Using Administrative Claims Data. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :764
DOI: 10.1002/art.28532

Abstract Supplement

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