Care Model Linked to Remission and Low Disease Activity, But Not Quality of Life, in SLE

The use of a comprehensive care model among patients with systemic lupus erythematosus (SLE) is associated with the likelihood of attaining remission and Lupus Low Disease Activity State (LLDAS), but has no significant effect on health-related quality of life (HRQOL), according to results of a study published in Lupus.

The researchers sought to evaluate whether the use of a regular vs comprehensive care model has an impact on disease-related clinical outcomes among patients with SLE.

The cross-sectional study was conducted at 2 Peruvian hospitals between August 2019 and January 2020. Patients who had received comprehensive care at the Hospital Guillermo Almenara Irigoyen in Lima, Perú, and were participants of the Almenara Lupus Cohort, and those who had received regular care at the Hospital III Essalud in Iquitos, Perú, were included in the study. All participants were aged older than 18 years and fulfilled the 1997 revised American College of Rheumatology (ACR) criteria for SLE.

Disease activity was determined using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and the Physician Global Assessment. Remission was defined using the 2021 Definition of Remission in SLE and LLDAS was defined using the Asia Pacific Lupus Consortium. Patients’ HRQOL was established using the LupusQoL, which obtains a score by domains ranging from 0 to 100 (worst to best HRQOL).

A total of 266 patients were included in the study.

According to univariable analyses, use of the regular vs comprehensive care model was associated with a lower probability of attaining remission (odds ratio [OR], 0.396; 95% CI, 0.191-0.821; P =.013) and LLDAS (OR, 0.324; 95% CI, 0.162-0.648; P <.001). Multivariable analyses also showed that use of the regular vs comprehensive care model was associated with a lower probability of attaining remission (odds ratio [OR], 0.381; 95% CI, 0.163-0.887; P =.025) and LLDAS (OR, 0.363; 95% CI, 0.157-0.835; P =.017).

The regular care model was associated with improved HRQOL in the domains of pain and emotional health. No association was observed between the use of the care model and the other HRQOL domains.

Limitations included the cross-sectional nature of the study, potential bias while accounting for the differences between the 2 models, and the inability to extrapolate the results of the study to other public and private health systems.

The researchers concluded, “These preliminary results should encourage the conduct of longitudinal studies to evaluate the true impact of potential interventions in the care model which may lead to improved clinical outcomes in [patients with] SLE.”

Reference  

Perea-Seoane L, Agapito-Vera E, Gamboa-Cardenas RV, et al. Relationship between care model and disease activity states and health-related quality of life in systemic lupus erythematosus patients. Lupus. Published online December 30, 2021. doi:10.1177/09612033211063798