Ab0663 follow-up frequency in patients with sle, ‘one size does not fit all’

Background The recommended frequency of follow-up for SLE patients ranges from monthly to yearly, although once every 3 months seems common practice. Recommendations are based on expert opinion; data on frequency of follow-up in SLE patients and its impact are very scarce. (1,2,3) Objectives To assess the frequency of follow-up visits in SLE patients and its relation to clinical and sociodemographic characteristics. Methods Patients with SLE based on the ’97 ACR criteria (4), who were treated at our regional teaching hospital between 2012 and 2021, were included in the study. Frequency of follow-up was defined by the frequency at which blood tests (Hb as a key indicator) were performed for disease assessment. This frequency was related to clinical characteristics. Kruskal–Wallis and Fisher’s exact test were performed. Results 238 SLE patients were included in the cohort; 117 patients (49%) had follow-up at an average of three months (interval 60-120 days), 59 patients (25%) had follow-up at a low intensity (interval >120), and 62 (26%) at a high intensity (interval <60 days). Characteristics of these groups are shown in Table 1. The patients with high intensity follow-up were younger, more often non-white and had more severe disease at diagnosis. Upon evaluation, these patients had a more severe disease course as demonstrated by more treatment intensifications, hospitalizations, ER visits, a higher SLICC damage index and more frequent renal involvement. Conversely, the patients that were monitored at a low intensity were older had longer disease duration and showed a more quiescent disease with less negative health outcomes. Figure 1 shows the linear relationship between the frequency of tests and the number of abnormal results in Hb. Conclusion This study shows that the frequency of follow-up varies substantially between SLE patients. A majority of patients had follow-up at a frequency of 3 months, patients that differed from this norm had distinct features. At this moment frequency of follow-up depends on clinical judgment of the physician. Potentially, this process might be captured in prognostic modelling. Patients at high risk should be identified and have a high frequency of follow-up, while in other patients resources could be spared. References [1]Mosca M, Tani C, Aringer M, Bombardieri S, Boumpas D, Brey R, et al. European league against rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. Annals of the Rheumatic Diseases. 2010;69(7):1269-74. [2]Ibañez D, Gladman DD, Touma Z, Nikpour M, Urowitz MB. Optimal frequency of visits for patients with Systemic Lupus Erythematosus to measure Disease Activity over time. Journal of Rheumatology. 2011;38(1):60-3. [3]Gladman DD, Ibañez D, Ruiz I, Urowitz MB. Recommendations for frequency of visits to monitor systemic lupus erythematosus in asymptomatic patients: data from an observational cohort study. J Rheumatol. 2013;40(5):630-3. [4]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40(9):1725 Table 1. Characteristics per follow-up group Low intensity (n = 59) Average (n = 117) High intensity (n = 62) Age, mn (SD ) 54 (16.3) 52 (14.6) 46 (14.7) 0.005 Non-white (% ) 15 (26) 48 (41) 36 (58) 0.008 Number of ACR-criteria at diagnosis, m (IQR ) 4 (4-5) 4 (4-6) 5 (4-6) 0.006 Disease duration in years at baseline, m (IQR ) 6 (1-17) 6 (1-16) 3 (0-10) 0.014 % abnormal values – Hb, mn (IQR ) 0 (0 - 25) 27 (3 - 63) 47 (15 - 76) <0.001 % abnormal values - urine, mn (IQR ) 2 (0 - 11) 8 (1 - 22) 22 (10 - 50) <0.001 Kidney biopsy, n (% ) 3 (5) 21 (18) 24 (39) <0.001 Intensification of therapy per yr, m (% ) <0.001 ≥2 1 (2) 10 (9) 13 (21) Hospitalizations per yr, m (% ) <0.001 0 55 (93) 86 (74) 33 (53) ≥2 1 (2) 4 (3) 13 (21) ER visits per yr, m (% ) <0.001 0 54 (91) 90 (77) 38 (61) ≥2 1 (2) 3 (3) 8 (13) SLICC DI, n (% ) 0.035 ≥2 11 (19) 41 (35) 22 (35) Figure 1. Relationship between frequency and number of abnormal blood tests Disclosure of Interests Selinde Snoeck Henkemans: None declared, Annelies Berden: None declared, Geeke Waverijn: None declared, Iris Verberk-Jonkers: None declared, Marc Kok: None declared, Els Zirkzee Consultant of: Yes, GSK 2018 advisory board