Division of Rheumatology and Immunology, Duke University School of Medicine, Box 3544 DUMC, Durham, NC, 27710, USA.
Durham VA Medical Center, Durham, NC, USA.
Clin Rheumatol. 2024 Apr;43(4):1319-1326. doi: 10.1007/s10067-024-06909-4. Epub 2024 Feb 26.
Type 2 systemic lupus erythematosus (SLE) symptoms, including fatigue, fibromyalgia, and brain fog, contribute to poor health-related quality of life (HRQoL) in patients with lupus. To test the hypothesis that Type 1 (classical inflammatory lupus) activity is associated with Type 2 SLE activity, we characterized the features of Type 2 SLE in patients with a range of lupus nephritis (LN) activity.
This was a cross-sectional study of SLE patients [American College of Rheumatology (ACR) 1997 or Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria] from June 2018 to March 2020. Patients completed the Systemic Lupus Activity Questionnaire (SLAQ) and the Polysymptomatic Distress Scale. Patients were divided into groups based on their renal status. Active nephritis was defined using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) lupus nephritis parameter. Differences across groups were analyzed by Fisher's exact test and ANOVA.
In this cohort of 244 patients (93% female, mean age 43 years, 58% Black), 10% had active nephritis, 35% had historical nephritis, and 55% never had nephritis (non-nephritis). Active nephritis and non-nephritis patients had a similar burden of Type 2 SLE symptoms, despite a difference in Type 1 SLE activity. Patients with active nephritis had higher Type 2 PGA (Physician Global Assessment) scores and reported more Type 2 SLE symptoms than inactive nephritis patients. Patients with inactive nephritis had the lowest Type 2 SLE activity.
While Type 2 SLE symptoms are common in SLE, our findings suggest that patients with active nephritis experience significant Type 2 SLE symptoms that may be ameliorated as nephritis improves. We also observed that non-nephritis patients had a similar burden of Type 2 SLE symptoms as patients with active nephritis, despite having on average lower Type 1 SLE activity. Therefore, the etiology of Type 2 SLE symptoms is likely multifactorial and may be driven by inflammatory and non-inflammatory biopsychosocial factors. Key Points • Patients with active nephritis experienced significant Type 2 symptoms that may be ameliorated as nephritis improves. • Non-nephritis patients had a similar burden of Type 2 SLE symptoms as patients with active nephritis, despite having on average lower Type 1 SLE activity. • Because etiology of Type 2 SLE symptoms is likely multifactorial and may be driven by inflammatory and non-inflammatory biopsychosocial factors.
2 型系统性红斑狼疮（SLE）的症状，包括疲劳、纤维肌痛和大脑模糊，会导致狼疮患者的健康相关生活质量（HRQoL）下降。为了验证 1 型（经典炎症性狼疮）活动与 2 型 SLE 活动相关的假设，我们对不同狼疮肾炎（LN）活动程度的患者的 2 型 SLE 特征进行了描述。
这是一项横断面研究，纳入了 2018 年 6 月至 2020 年 3 月期间符合美国风湿病学会（ACR）1997 年或系统性红斑狼疮国际协作临床组（SLICC）2012 年分类标准的 SLE 患者。患者完成了系统性红斑狼疮活动问卷（SLAQ）和多症状困扰量表。根据肾脏状况将患者分为不同组。采用系统性红斑狼疮疾病活动指数（SLEDAI）狼疮肾炎参数来定义活动性肾炎。采用 Fisher 确切检验和方差分析对各组间的差异进行分析。
在这 244 例患者（93%为女性，平均年龄 43 岁，58%为黑人）中，10%有活动性肾炎，35%有既往肾炎，55%从未有过肾炎（非肾炎）。尽管 1 型 SLE 活动存在差异，但活动性肾炎和非肾炎患者的 2 型 SLE 症状负担相似。有活动性肾炎的患者的 2 型 PGA（医生总体评估）评分更高，且报告的 2 型 SLE 症状比无活动性肾炎的患者更多。无活动性肾炎的患者的 2 型 SLE 活动度最低。
尽管 2 型 SLE 症状在 SLE 中很常见，但我们的研究结果表明，有活动性肾炎的患者会经历显著的 2 型 SLE 症状，这些症状可能随着肾炎的改善而减轻。我们还观察到，非肾炎患者的 2 型 SLE 症状负担与有活动性肾炎的患者相似，尽管他们的平均 1 型 SLE 活动度较低。因此，2 型 SLE 症状的病因可能是多因素的，可能由炎症和非炎症的生物心理社会因素驱动。关键点• 有活动性肾炎的患者经历显著的 2 型症状，这些症状可能随着肾炎的改善而减轻。• 非肾炎患者的 2 型 SLE 症状负担与有活动性肾炎的患者相似，尽管他们的平均 1 型 SLE 活动度较低。• 由于 2 型 SLE 症状的病因可能是多因素的，并且可能由炎症和非炎症的生物心理社会因素驱动。
