Utilizing clinical characteristics and patient-reported outcome measures to categorize lupus subtypes.

OBJECTIVE: The Type 1 and Type 2 SLE categorization system was recently proposed in order to validate the patients' perspective of disease and to capture a more comprehensive spectrum of symptoms. The objective of this study was to characterize the clinical manifestations of SLE subtypes and to determine the correlation between the patient- and physician-reported measures used in the model. METHODS: This was a cross-sectional study of SLE patients in a university clinic. Patients completed the Systemic Lupus Activity Questionnaire (SLAQ) and 2011 ACR Fibromyalgia (FM) criteria. Active SLE was defined as SLEDAI >/=6, clinical SLEDAI >/=4, or active lupus nephritis. We identified 4 groups: Type 1 SLE (active SLE without FM), Type 2 SLE (inactive SLE with FM), Mixed SLE (active SLE with FM), Minimal SLE (inactive SLE without FM). RESULTS: In this cohort of 212 patients (92% female, mean age 45 years), 30% had Type 1 SLE, 8% had Type 2 SLE, 13% had Mixed SLE and 49% had minimal SLE. Regardless of SLE disease activity, patients with FM (21%), reported higher SLAQ scores, patient global assessment scores, and self-reported lupus flare which resulted in discordance between patient- and physician- reported measures. CONCLUSION: Fatigue, widespread pain, sleep dysfunction, and mood disorders are common symptoms in SLE. Identifying these symptoms as Type 2 SLE may be a method to improve patient communication and understanding. The level of Type 2 SLE impacts patients' perception of disease and self-reported symptoms. The SLAQ may need to be re-interpreted based on the fibromyalgia severity scale.