Systemic lupus erythematosus (SLE), pathology with net feminine predominance, is one of the most complex autoimmune diseases and has major impact on patients’ life. The aim is to identify patient and disease-related factors associated with self-perceived disease severity in female SLE patients. This cross-sectional study enrolled 73 women fulfilling the 2012 Systemic Lupus International Collaborating Clinic (SLICC) criteria. SLE disease activity was assessed by the Systemic Lupus Activity Measure (SLAM) score and overall damage by the SLICC/American College of Rheumatology (ACR) index. Patients’ general characteristics, associated conditions as well as SLE specific clinical involvements and therapeutic principles were also noted. Fatigue was assessed by FACIT-fatigue scale. Self-perceived disease severity was assessed using numerical rating scales (1–10 NRSs), to evaluate the disease severity at inclusion (1–10 NRS now) and worst severity anytime during disease history (1–10 NRS worst ever). In regard to worst ever lupus severity, 54.8% of patients responded with 9 or 10, while none with 1 or 2 even if only 22.9% of the patients responded with 7 or more for disease severity at inclusion (1–10 NRS now). Women with higher 1–10 NRS now answers had also higher 1–10 NRS worst ever, SLAM, SLICC, and FACIT-fatigue scores. They associated more frequently anxiety/depression diagnosis, antiphospholipid syndrome, joint involvement as well as treatments with corticosteroids. Self-reported disease severity worst ever, anxiety/depression diagnosis, fatigue, and the daily dose of corticosteroids were independently associated with patients’ perception on lupus severity at inclusion: OR (95% CI), 2.13 (1.15–3.94) p = 0.017, 6.67 (1.11–39.97) p = 0.038, 1.10 (1.02–1.19) p = 0.018, and 1.11 (1.02–1.21) p = 0.020, respectively. The vast majority of patients identified severe and very severe events during their disease history, results that raise awareness of burden concerning lupus occurrence in women’s life. Self-perceived lupus severity is multifactorial, influenced also by factors less considered in the SLE management like fatigue and the depression/anxiety disorders, but also by the previous patient’s experience.
Systemic lupus erythematosus Fatigue Women’s health Self-rated health Disease activity
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AD proposed and conceived the research. All authors contributed equal to data processing and to the article draft. All authors approved the final version and the manuscript submission.
No specific grant from any public or commercial agency was received for this study. AD benefited from a posdru scholarship throughout the duration of the data collection for this study.
Compliance with ethical standards
Conflict of interest
All authors declare that there is no direct conflict of interest regarding this research. Author AD declares that she has no conflict of interest. Author SC has received a speaker honorarium from Roche and UCB Pharma. Author CD declares that she has no conflict of interest. Author RI has received a speaker honorarium from MSD, Novartis, and Pfizer. Author CJ has received a speaker honorarium from Astra Zeneca, Boehringer Ingelheim, and Bayer. Author CB declares that she has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Availability of data and materials
Data used to support the findings of this study are included within the article. Any other additional data are available from the corresponding author upon request.
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