Li Ning, Hoi Alberta, Luo Shue-Fen, Wu Yeong-Jian Jan, Louthrenoo Worawit, Golder Vera, Sockalingam Sargunan, Cho Jiacai, Lateef Aisha, O'Neill Sean, Lau Chak Sing, Hamijoyo Laniyati, Nikpour Mandana, Oon Shereen, Hao Yanjie, Chan Madelynn, Li Zhanguo, Navarra Sandra, Zamora Leonid, Katsumata Yasuhiro, Harigai Masayoshi, Goldblatt Fiona, Bae Sang-Cheol, Zhang Zhuoli, Takeuchi Tsutomu, Kikuchi Jun, Ng Kristine, Tugnet Nicola, Tanaka Yoshiya, Ohkubo Naoaki, Chen Yi-Hsing, Basnayake B M D B, Law Annie, Kumar Sunil, Tee Cherica, Tee Michael Lucas, Choi Jiyoon, Kandane-Rathnayake Rangi, Morand Eric
Monash University, Melbourne, Victoria, Australia
Monash University, Melbourne, Victoria, Australia.
Lupus Sci Med. 2025 Feb 12;12(1):e001335. doi: 10.1136/lupus-2024-001335.
Disease activity both between and within patients with SLE is highly variable, yet factors driving this variability remain unclear. This study aimed to identify predictors of variability in SLE disease activity over time.
We analysed data from 2930 patients with SLE across 13 countries, collected over 38 754 clinic visits between 2013 and 2020. Clinic visit records were converted to panel data with 1-year intervals. The time-adjusted mean disease activity, termed , was calculated. The yearly change in [Formula: see text], denoted as [Formula: see text], was regressed onto [Formula: see text] and other potential predictors using random-effects models. Some variables were split into a person-mean component to assess between-patient differences and a demeaned component to assess within-patient variability.
Overall, variability in SLE disease activity exhibited stabilisation over time. A significant inverse relationship emerged between a patient's disease activity in a given year and variability in disease activity in the subsequent year: a 1-point increase in person-mean disease activity was associated with a 0.27-point decrease (95% CI -0.29 to -0.26, p<0.001) in subsequent variability. Additionally, a 1-point increase in within-patient disease activity variability was associated with a 0.56-point decrease (95% CI -0.57 to -0.55, p<0.001) in the subsequent year. Furthermore, each 1-point increase in the annual average time-adjusted mean Physician Global Assessment was associated with a 0.08-point decrease (90% CI -0.13 to -0.03, p=0.002) in disease activity variability for the following year. Prednisolone dose and the duration of activity in specific organ systems exhibited negative and positive associations, respectively, with disease activity variability in the subsequent year. Patients from less affluent countries displayed greater disease activity variability compared with those from wealthier nations.
Disease activity tends to be less variable among patients with higher or more variable disease activity in the previous year. Within-patient variability in disease activity has a stronger impact on subsequent fluctuations than differences between individual patients.
系统性红斑狼疮（SLE）患者之间以及患者自身疾病活动度的差异很大，但导致这种差异的因素仍不清楚。本研究旨在确定SLE疾病活动度随时间变化的预测因素。
我们分析了来自13个国家的2930例SLE患者的数据，这些数据是在2013年至2020年期间的38754次门诊就诊中收集的。门诊就诊记录被转换为间隔1年的面板数据。计算了经时间调整的平均疾病活动度，称为 。使用随机效应模型将 的年度变化（表示为 ）与 及其他潜在预测因素进行回归分析。一些变量被拆分为个体均值成分以评估患者之间的差异，以及去均值成分以评估患者自身的变异性。
总体而言，SLE疾病活动度的变异性随时间呈现稳定趋势。在给定年份患者的疾病活动度与次年疾病活动度的变异性之间出现了显著的负相关关系：个体均值疾病活动度增加1分与次年变异性降低0.27分相关（95%置信区间 -0.29至 -0.26，p<0.001）。此外，患者自身疾病活动度变异性增加1分与次年降低0.56分相关（95%置信区间 -0.57至 -0.55，p<0.001）。此外，年度平均经时间调整的医师整体评估每增加1分，次年疾病活动度变异性就降低0.08分（90%置信区间 -0.13至 -0.03，p = 0.002）。泼尼松龙剂量和特定器官系统的活动持续时间分别与次年疾病活动度变异性呈负相关和正相关。与来自较富裕国家的患者相比，来自较不富裕国家的患者疾病活动度变异性更大。
上一年疾病活动度较高或变异性较大的患者，其疾病活动度的变异性往往较小。患者自身疾病活动度的变异性对后续波动的影响比个体患者之间的差异更强。
