Patients With SLE Need To Be Seen Every 3 Months

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Patients With Systemic Lupus Erythematosus Need To Be Seen Every 3 Months

WASHINGTON, DC -- November 16, 2006 -- The effect of missed doctor's visits by patients with systemic lupus erythematosus (SLE) was determined and results presented here, at the American College of Rheumatology - Association of Rheumatology Health Professionals Annual Scientific Meeting (ACR-ARHP).

Dominique Ibañez, MsC, biostatistician, Toronto Western Hospital, Toronto, Ontario, Canada, set out to determine the effect of missed visits for SLE, both as a group and in individual patients. She also assessed whether variability in the SLE Disease Activity Index 2000 (SLEDAI-2K) and adjusted mean would better predict major outcomes in SLE than the adjusted mean alone.

Patients in the Lupus Clinic and Toronto Western Hospital are seen at 2- to 6-month intervals. Ibañez created artificial gaps in visits for over 10 years. She evaluated gaps of 1, 2, 3, 4 and 5 years.

Outcomes associated with SLE under study were death, organ damage, coronary artery disease (CAD) and osteonecrosis (ON). The predictability of each of the outcomes was evaluated through time-dependent covariate survival analyses. Regression models included other known major risk factors such as sex, age at diagnosis, SLEDAI-2K at presentation, and disease duration.

A total of 575 patients seen from 1970 to 2002 were included in the group analysis. The average time between visits was 4.0 +/- 2.2 months. Eighty-three patients died, 320 developed damage, 55 had CAD and 68 had ON. None of the 6 variability measures added more statistical significance in the prediction of any of the 4 outcomes.

In the artificially created analysis of group effect, gaps of 3 years did not affect the group average, but at 4 years, the SLEDAI-2K evaluation worsened for the entire group.

A total of 250 patients were included in the study of individual effects of a gap in visits. A total of 8,310 visits and a mean of 33 visits per patients over an average of 9.2 +/- 4.0 years were studied.

In the study of missed visits on individual patients, 1.5-year gaps affected the calculated mean adjusted mean.

Ibañez concluded that the adjusted mean, independent of variability of the SLEDAI-2K, is an important predictor of major outcomes in patients with SLE, and that it is critical that patients be seen every 3 months.
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