Younger Age, History of Lupus Nephritis Predict Severe Flares in Patients With SLE

One of the main predictors of severe SLE flares was younger age.

Patients with systemic lupus erythematosus (SLE) who are of younger age, have a history of lupus nephritis (LN), and have a  high score on disease activity indices (DAI) are at greater risk for severe flares, according to study results published in BMC Rheumatology.

Predicting and recognizing SLE flares remains a challenge in a clinical setting.

Using clinical, laboratory, and medication-based parameters, researchers aimed to identify predictors of severe flare in patients with SLE.

Patients who met the American College of Rheumatology (ACR) criteria for SLE were included in the study and followed-up with from June 2019 to April 2021 on an “as needed” basis. Clinical manifestations, presence of disease flares, associations between flares and medication use, anti-double stranded DNA (anti-ds-DNA) antibody levels, blood counts, and other laboratory measures were recorded.

Presence of severe flares was evaluated by the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI. Multivariable backward linear regression analyses were conducted to predict risk factors for severe flares.

Larger and longer and multicenter follow-up studies could achieve a better understanding of the predictors of severe lupus fare.

A total of 120 patients (104 women) were included in the study; 47 patients reported severe lupus flares at follow-up and 73 reported no flares. Mean patient age and disease duration were 35.5 years and 10.5 years, respectively.

Differences in sex distribution, history of/presence of active LN at baseline visit, and positive anti-ds-DNA antibody at baseline were present between those with vs without severe lupus flares.

Patients who were men were more likely to report disease flares, with 10 of the 16 men in the study reporting severe flares. Overall, of the 35 patients reporting an episode of a severe flare, 23% were men. A total of 25% of the 12 patients reporting more than 1 severe flare were also men. However, this association was not statistically significant after final multivariable regression models were applied.

History of LN was also associated with lupus flares, as 74.5% of these patients reported 1 episode and 83.5% reported more than 1 severe flare.

A total of 74.5% of patients who had anti-ds-DNA antibody at baseline testing reported 1 episode of severe flare vs 83.5% who reported more than 1 flare.

According to backwards multivariable logistic regression, younger age (P =.0001), high SLEDAI scores at baseline (P =.0001), and a history of LN (P =.0006) were predictors of severe flares.

Presence of flares at subsequent visits, according to SLEDAI scores, was predicted by anti-ds-DNA antibody, 24-hour urine protein levels, and presence of arthritis.

The study was limited by its single-center design and the exclusion of additional autoantibodies when analyzing predictors of flares.

Researchers concluded, “In summary, a previous history of LN, younger age and higher SLEDAI were independent predictors for severe SLE fare. Larger and longer and multicenter follow-up studies could achieve a better understanding of the predictors of severe lupus fare.”


Fatemi A, Keivani-Boroujeni E, Smiley A. Predictors of severe lupus flare: a prospective follow-up study. BMC Rheumatol. 2023;7(1):10. doi:10.1186/s41927-023-00333-y