Predictors of Disability Assessed in Childhood-Onset Systemic Lupus Erythematosus

In patients with childhood-onset systemic lupus erythematosus (SLE), disability is common and is associated with low household income, arthritis, and higher pain scores, according to the results of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry, published in Lupus.

Participants from the CARRA Legacy Registry, a large cross-sectional multicenter registry of children with rheumatic disease, were enrolled between May 2010 and October 2014. The Childhood Health Assessment Questionnaire (CHAQ) was used to evaluate disability and physical functioning in the participants on a scale from 0 (normal) to 3 (worst). Participants were also asked to rate their quality of life as “excellent,” “very good,” “good,” “poor,” or “very poor.” Disease activity at baseline and follow-up was measured with the Systemic Lupus Erythematosus Disease Activity Index and a Physician Global Assessment was obtained at each visit.

A total of 939 patients with childhood-onset SLE were enrolled in the study. Mean patient age at enrollment was 15.6±3.2 years, and the median age at symptom onset was 12.3±3.2 years. Median and mean CHAQ scores were 0 and 0.25, respectively. Overall, 41% of the cohort was classified as having at least mild disability. Arthritis and higher pain scores were significantly associated with disability compared with patients without disability (P <.001).

In multivariate logistic regression analysis, low annual income (odds ratio [OR], 2.02; 95% CI, 1.21-3.4; P =.007), arthritis (OR, 1.58; 95% CI, 1.03-2.42; P =.035), and pain score (OR, 1.48; 95% CI, 1.36 to 1.61; P ≤.001) were all significantly associated with disability at baseline.

The investigators concluded that disability, defined as a CHAQ score of >0, was fairly common in the childhood-onset SLE cohort from the CARRA Legacy Registry. Recognizing factors that are significantly associated with higher rates of disability in this population may be informative when managing these patients. Additional studies are warranted to better delineate predictors of disability in patients with childhood-onset SLE and possible interventions.

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Reference

Hersh AO, Case SM, Son MB; CARRA Registry Investigators. Predictors of disability in a childhood-onset systemic lupus erythematosus cohort: results from the CARRA Legacy Registry [published online January 1, 2018]. Lupus. doi:10.1177/0961203317747713