A new study sought to identify the frequency and determinants of flares for with people with systemic lupus erythematosus (SLE) with persistently active disease (PAD). Researchers found that both flares and PAD significantly contribute to damage accrual in people with SLE. Both predict the accumulation of organ damage, but they differ in disease characteristics and predictive factors.

The prospective, observational study included 3,811 individuals with SLE from the Asia Pacific Lupus Collaboration. Researchers collected demographic data and SLE history of each individual at the beginning of the study, including baseline  SLEDAI scores and  medication use (such as glucocorticoids, antimalarial drugs, immunosuppressants, and biologics). Disease flares and activity were recorded at each visit. More than half of the individuals (56.2%) experienced at least one flare, and PAD was observed in nearly half (46.9%) of individuals, with 368 (9.7%) experiencing PAD without flares. Researchers found both flare and PAD significantly contribute to damage over time, even when accounting for medication use. The occurrence of flare-ups and PAD is significant under standard-of-care conditions, with some patients experiencing PAD even without having flare-ups.  

Additionally, researchers identified several predictive factors. Low gross domestic product (GDP) in country of residence, smoking, arthritis, nephritis, and low complement levels increased the risk for flares, while renal activity and higher SLEDAI scores increased the risk for PAD. Being in a low disease activity state for more than 50% of the time was a protective factor for both flares and PAD. 

This study underscores the importance of developing intervention strategies and highlights the need for further research using predictive models for SLE. Learn more about managing and preventing flares. 

Read the study