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.


Clues To Differentiate Non-Inflammatory from Inflammatory Symptoms in Patients with Systemic Lupus Erythematosus (SLE), Using a Multi-Dimensional Health Assessment Questionnaire (MDHAQ).

Pincus2,  Theodore, Castrejon5,  Isabel, Buyon6,  Jill P., Tseng4,  Chung-E., Izmirly3,  Peter M., Yazici1,  Yusuf, Askanase3,  Anca D.

Hospital for Joint Diseases, Hastings on Hudson, NY
New York University Hospital for Joint Disease, Hastings-on-Hudson, NY
NYU Hospital for Joint Diseases, New York, NY
NYU Hospital for Joint Diseases, Flushing, NY
NYU Hospital for Joint Diseases
NYU School of Medicine, New York, NY

Purpose:

To analyze whether quantitative scores on a multidimensional health assessment questionnaire (MDHAQ) provide clues to the likelihood of inflammatory versus non-inflammatory symptoms and concomitant fibromyalgia, an important challenge in clinical care, according to a global scale for non-inflammatory symptoms completed by a rheumatologist in 50 patients with SLE seen in usual care.

Methods:

A cross-sectional study was performed in 50 consecutive SLE patients of one rheumatologist seen in usual care. On arrival at the clinic, patients completed a multidimensional health assessment questionnaire (MDHAQ) which includes scales for physical function (FN), 0–10 visual analog scales for pain (PN), global estimate (PTGL) and fatigue (FT), and a review of systems symptom checklist (SX). SLE patients also completed a self-report Systemic Lupus Assessment Questionnaire (SLAQ). The rheumatologist, unaware of MDHAQ and SLAQ scores, recorded a physician global estimate (MDGL) and an estimate of non-inflammatory symptoms, each scored on a 0–3 scale in 0.1 increments, as well as four SLE indices: SLEDAI-2K (SLE Disease Activity Index), BILAG (British Isles Lupus Assessment Group index), SLAM (SLE Activity Measure) with and without laboratory tests, and ECLAM (European Consensus Lupus Activity Measurement). SLE patients with scores of <0.5 on the non-inflammatory symptom scale were regarded as "low" and those with scores >=0.5 "high" non-inflammatory symptoms; the two groups were compared using the Mann-Whitney statistic.

Results:

The study included 45 women and 5 men, mean age 38.7 years, mean disease duration 7.3 years. Of the 50 patients, 16 had high and 34 low scores for non-inflammatory symptoms. Those with high scores for non-inflammatory symptoms had significantly higher scores for FN, PN, FT, PTGL, SX, SLAQ, and SLAM without laboratory tests, as well as significantly lower CRP. No significant differences were seen patients estimated as "high" and "low" scoring patients for SLEDAI, BILAG, SLAM, ECLAM, C3, C4, antiDsDNA, or ESR. Fewer than 50% of "low" patients had FN, PN, PTGL, or FT >=2, while 100% of "high" patients had FT >2, and 94% PTGL >2. All patients with high non-inflammatory symptoms (16/16) reported more than 5 SX, compared to 15/34 (44%) "low" patients, and 12/16 (75%) "high" patients reported >10 SX, compared to 6/34 (18%) "low" patients.

Table. Differences in the mean values of the MDHAQ scores, SLAQ, SLE indices and laboratory tests between SLE patients with versus without non-inflammatory symptoms. (Mann-Whitney)

Measure/IndexSLE low non-inflammatory symptoms (n=34)SLE high non-inflammatory symptoms (n=16)P
 Mean (± SD)Median (Range)Mean (± SD)Median (Range) 
Physical function0.74 (±1.25)0 (0–5.3)2.7 (±2.4)2.7 (0–6.3)<0.01
Pain VAS2.5 (±2.6)1.7 (0–9)4.8 (±2.7)5.0 (0–9)<0.02
Patient global2.2 (±2.5)1.2 (0–9.5)5.4 (±2.2)5.5 (1.5–9)<0.01
Fatigue VAS2.8 (±2.5)2.0 (0–9)6.3 (±2.1)6.5 (3–10)<0.01
# Symptoms6.9 (±6.8)5.0 (0–31)16.9 (±8.2)17.0 (6–38)<0.001
RAPID35.4 (±5.9)3.0 (0–22.8)13.0 (±6.7)12.4 (4.5–23)<0.01
SLAQ-total7.0 (±5.3)6.5 (0–18)16.9 (±4.5)16.0 (10–27)<0.001
SLEDAI5.1 (±3.9)4 (0–16)4.8 (±3.6)4.0 (0–12)0.83
BILAG4.2 (±4.2)2.5 (0–15)5.4 (±4.5)4.0 (0–15)0.27
ECLAM1.9 (±1.3)1.5 (0–4)2.2 (±1.6)2.0 (0–6)0.65
SLAM3.7 (±3.2)3.0 (0–12)4.2 (±2.3)4.0 (1–10)0.32
SLAM-no lab1.6 (±1.6)1.0 (0–5)3.2 (±1.8)3.0 (0–7)<0.01
C3102.1 (±32.5)103 (43–174)123.3 (±35.1)110 (76–197)0.67
C420.1 (±11.3)17.5 (6–63)21.1 (±7.7)22 (9–32)0.37
ESR27.1 (±33.1)12.5 (1–112)11.2 (±10)10 (1–38)0.27
CRP5.4 (±8.1)3.1 (0.1–31)0.7 (±1.3)0.2 (0.1–5)0.015
SD= standard deviation

Conclusion:

High scores for dysfunction, pain, fatigue, global estimates, and number of symptoms are common in SLE patients with high versus low levels of non-inflammatory symptoms. SLE indices do not distinguish between patients with high versus low levels of non-inflammatory symptoms. A simple global scale to estimate non-inflammatory symptoms may be informative in therapeutic decisions, particularly if consistent with patient questionnaire patterns.

To cite this abstract, please use the following information:
Pincus, Theodore, Castrejon, Isabel, Buyon, Jill P., Tseng, Chung-E., Izmirly, Peter M., Yazici, Yusuf, et al; Clues To Differentiate Non-Inflammatory from Inflammatory Symptoms in Patients with Systemic Lupus Erythematosus (SLE), Using a Multi-Dimensional Health Assessment Questionnaire (MDHAQ). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :990
DOI: 10.1002/art.28757

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