Clinical Characteristics And Risk Factors For Systemic Lupus Erythematosus Flares

Objective:This study investigated the clinical characteristics and explored the risk factors for flare in patients with systemic lupus erythematosus(SLE)to provide a scientific basis for early prevention and timely intervention in high-risk groups with flare and to improve the prognosis of patients with SLE.Methods:This cohort used date from a prospectively collected database named the Chinese rheumatism data center(CRDC).The patients who were diagnosed with SLE and were treated at the Rheumatology Department of the Second Affiliated Hospital of Nanchang University were recruited from January 2016 to July 2018.One hundred and ninety-seven patients with SLE who were followed up for more than 3years were included in the study until July 2021.The patients were divided into a flare group(77 cases)and a non-flare group(120 cases)according to whether there was flare or not during the follow-up.The differences between the two groups in terms of demography,clinical manifestations,laboratory results,disease activity,and treatment were compared in order to investigate the clinical characteristics and explore the risk factors for flare in patients with SLE.Results:1.The onset age of the patients in the flare group was 24(20,36)years,and the onset age of the patients in the non-flare group was 31(23.25,39.75)years.The patients in the flare group was younger than the non-flare group(P<0.05).2.The1,2,and 3-yearly flare proportion rate of the patients with SLE were 7.1±1.8%,18.3±2.8%,and 29.9±3.4%,respectively.3.The univariate analysis with KaplanMeier curves identified that younger onset age(≤20 years),irregular medication,and irregular follow-up were associated with SLE flare(P < 0.05).Multivariate analysis with COX regression models confirmed that younger onset age(≤20 years)(HR=1.895,95 %CI 1.165-3.082,P=0.010)and irregular drug use(HR=2.267,95%CI 1.303-3.944,P=0.004)were two independent predictors for SLE flare.4.The patients were divided into the mild to moderate relapse group and the severe relapse group according to the degree of attack,and were included in subgroup analysis.The multivariate logistic regression analysis showed that the patients with low level of C4 at baseline were more likely to have severe exacerbation with significant difference(OR=7.65,95%CI 1.42-41.31,P=0.018).5.The pulmonary infection rate in the flare group(20.78%)was higher than that in the non-flare group(5.83%)(P<0.05),and the low disease activity compliance rate in the flare group(41.56%)was lower than that in the non-flare group(69.17%)(P<0.05).Conclusion:The 1,2,and 3-yearly flare proportion rate of the patients with SLE were7.1±1.8%,18.3±2.8%,and 29.9±3.4%,respectively.In this study,younger onset age(≤20 years)and irregular drug use were independent predictors for SLE flare,and the low level of C4 at baseline was the main risk factor for severe flare in the patients with SLE.Therefore,during the treatment of the patients with SLE,patient education should be strengthened,the importance of standardized medication should be emphasized,and the patients with high risk factors of flare should be followed up closely to maximize the prognosis of them.