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1702 Patients enrolled in the accelerating medicines partnership (AMP) RA/SLE network with isolated renal disease report minimal quality of life impairment on PROMIS-29 compared to patients with extrarenal symptoms
  1. Philip Carlucci1,
  2. Jessica Li2,
  3. Heather T Gold1,
  4. Kristina Deonaraine1,
  5. Andrea Fava2,
  6. Jill Buyon1,
  7. Judith A James3,
  8. Chaim Putterman4,
  9. Deepak Rao5,
  10. Betty Diamond6,
  11. Derek Fine2,
  12. Jose Monroy-Trujillo2,
  13. Kristin Haag2,
  14. William Apruzzese5,
  15. H Michael Belmont1,
  16. Sean Connery7,
  17. Fernanda Payan-Schober7,
  18. Richard Furie8,
  19. Celine Berthier9,
  20. Maria Dall’Era10,
  21. Kerry Cho11,
  22. Diane Kamen12,
  23. Kenneth Kalunian13,
  24. Jennifer Anolik14,
  25. Susana Serrate-Sztein15,
  26. the Accelerating Medicines Partnership in SLE network,
  27. Peter Izmirly1 and
  28. Michelle Petri2
  1. 1New York University School of Medicine, New York, NY, USA
  2. 2Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
  3. 3Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
  4. 4Division of Rheumatology and Department of Microbiology and Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
  5. 5Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  6. 6Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
  7. 7Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
  8. 8Division of Rheumatology, Northwell Health, Great Neck, NY, USA
  9. 9University of Michigan Medical School, Ann Arbor, MI, USA
  10. 10Rheumatology Division and Russell/Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA, USA
  11. 11Nephrology Division, University of California San Francisco, San Francisco, CA, USA
  12. 12Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC, USA
  13. 13University of California San Diego School of Medicine, La Jolla, CA, USA
  14. 14Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA
  15. 15National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA


Background Lupus nephritis can occur as an isolated component of disease activity or be accompanied by diverse extrarenal symptoms that can adversely affect a patient’s quality of life (QOL). Whether renal disease absent other activity is sufficient to decrease QOL is unknown. A lack of reported QOL impairment may place patients at risk for delayed diagnosis of nephritis or medication noncompliance yet nephritis trials have largely neglected QOL. As such, this study leveraged the multi-center multi-racial Accelerating Medicines Partnership (AMP) lupus nephritis cohort to assess QOL measured by PROMIS-29.

Methods Patients (n=182) fulfilling ACR or SLICC criteria for SLE with a uPCR > .5 and biopsy Class III, IV, V, or mixed were consecutively enrolled in AMP at the time of renal biopsy and clinical history, PROMIS-29, and disease activity as assessed by the hybrid SELENA-SLEDAI were recorded. Patients were determined to have extrarenal clinical activity if, after excluding all laboratory parameters from the SLEDAI, the score remained > 1. Raw PROMIS-29 scores were transformed to t-scores with the mean of 50 + 10 representing the US population and a difference of 5 points considered clinically meaningful. PROMIS-29 physical and mental health summary scores were calculated according to published formulas.

Results Forty-three percent of patients (n=78) had extrarenal clinical manifestations including vasculitis (4%), arthritis (39%), rash (45%), alopecia (42%), mucosal ulcers (13%), pleurisy (12%), pericarditis (8%), and fever (4%). Patients with isolated renal disease (n=104, 57%) did not have PROMIS-29 scores that differed clinically from the US population whereas patients with extrarenal disease reported deficits in physical functioning, fatigue, social functioning, and pain (table 1). Patients with extrarenal disease had significantly lower physical health summary scores compared to patients with isolated disease (median [IQR]: 40.31 [35.79, 47.02] p<0.001 vs. 48.6 [40.14, 57.08]) and significantly lower mental health summary scores (44.12 [38.63, 51.39], p=0.024 vs. 48.67 [40.51, 55.07]). Female and African American patients and those with nephrotic range proteinuria or undergoing first biopsy had significantly lower physical health summary scores, but mental health summary scores did not differ by these variables. Patients on greater than 20 mg of prednisone had both significantly lower physical and mental health summary scores compared to those on lower doses. PROMIS-29 scores did not differ by low complements, anti-dsDNA, or anti-Ro antibodies. Stepwise multivariable linear regression analysis demonstrated that the association between extrarenal disease and lower PROMIS-29 summary scores was primarily driven by arthritis and independent of potential confounders (tables 2 and 3).

Conclusion The majority of patients had isolated renal disease and report a QOL similar to that of the general population. In contrast, those with extrarenal manifestations report significantly worse QOL outcomes. These results reinforce the critical importance of routine laboratory surveillance and medication compliance for nephritis even in patients with seemingly quiescent clinical disease since lupus nephritis is often asymptomatic.

Abstract 1702 Table 1

PROMIS-29 scores among patients with isolated renal vs extrarenal disease.

Abstract 1702 Table 2

Stepwise multivariable linear regression analysis of extrarenal manifestations and PROMIS-29 physical health summary scores

Abstract 1702 Table 3

Stepwise multivariable linear regression analysis of extrarenal manifestations and PROMIS-29 mental health summary scores

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