Categorization of patients with systemic lupus erythematosus using disease activity, patient-reported outcomes, and transcriptomic signatures

Abstract

Patients with systemic lupus erythematosus (SLE) display symptoms that are not always related to disease activity and may distort clinical trial results. Recently, a clinical categorization based on the presence of type 1 (in ammatory manifestations) and/or type 2 (widespread pain, fatigue, depression) symptoms has been proposed in SLE. Our aim was to develop a type 2 score derived from the Short-Form health survey (SF-36) to categorize SLE patients and to compare immunological and transcriptomic pro les between groups. MethodsSeventeen items from the SF-36 were selected to build a type 2 score for 50 SLE patients (100 visits; LUPUCE cohort) and the SLEDAI was used to de ne type 1 symptoms. Patients were categorized in four groups: minimal (no symptoms), type 1, type 2 and mixed (both type 1 and type 2 symptoms). Clinical, immunological and transcriptomic pro les were compared between the groups. ResultsType 2 scores ranged from 0 to 31, with a cut-off value of 14 (75th percentile). The sample categorization was: minimal in 39%, type 1 in 37%, type 2 in 9% and mixed in 15%. Type 2 patients were older than minimal patients and had a longer disease duration than type 1 and mixed patients. Immunological data and modular interferon signatures did not differ between the groups. ConclusionPatients with SLE can be categorized into four clinical groups using the SLEDAI score and our SF-36derived type 2 score. This categorization is non-redundant with immunological or transcriptomic pro les and could prove useful to stratify patients in clinical trials. Signi cance And InnovationsA score derived from selected items of the SF-36 can be used to identify SLE patients with type 2 symptoms according to the Duke University categorization.Using the SLEDAI and this type 2 score, SLE patients can be categorized in four clinical groups. This categorization is not related to immunological activity or blood transcriptome pro les (and not to the interferon signature in particular).

Weaning Maintenance Therapy in Lupus Nephritis: For Whom, When, and How?

“…The presence of type 2 symptoms (fibromyalgia, chronic pain, and fatigue), not directly related to SLE activity and not improved by IST, should also be considered when evaluating the need for classical medications. 54 , 55 , 56 …”