Ab0615 complex relationships between inflammatory/type 1 and type 2 symptoms in systemic lupus erythematosus and other rheumatic diseases: a literature review and analysis

Background A better clinical stratification of patient is essential in order to propose personalized therapeutic management for patients with complex autoimmune conditions [1]. Recently, a new stratification has been proposed in Systemic Lupus Erythematous (SLE), which distinguishes different types of symptoms: those directly related to the inflammatory process or type 1 symptoms and type 2 symptoms including fatigue, pain and anxiety-depression [2]. Objectives Our aim was to characterize the nature of the relation between type 1 symptoms, through disease activity, and type 2 symptoms, including their impact on health-related quality of life (HRQoL), in SLE, as well as in other rheumatic diseases such as rheumatoid arthritis (RA), primary Sjögren’s syndrome (pSS) and systemic sclerosis (SSc). Methods A narrative literature review was conducted on disease activity and type 2 symptoms. The appropriate medical subject heading (MESH) term was used for each disease and combined with the MESH terms for fatigue, depression, anxiety, pain and quality of life as well as the term “disease activity” to give the proper search keywords. Articles in English published after 2000 and related to adult patients were located on Medline via Pubmed. The selected articles had to evaluate at least one type 2 symptom and/or HRQoL using a validated scale. Similarly, disease activity had to be assessed by a validated method (usually a clinical score). Within each study, the relationship between disease activity (type 1) and type 2 symptoms or HRQoL was analyzed and classified depending on whether the correlation was present, absent, or weak. Results Overall, 287 articles were analysed, corresponding to 157 765 patients. For SLE (n=115 studies including 21 randomized controlled trials), we found that inflammatory activity/type 1 symptoms were mostly uncorrelated with type 2 symptoms and/or HRQoL, with several studies even showing an inverse correlation. No correlation was observed in 67.7% (64.7%), 60% (51.5%), 25% (11.2%), and 60% (53.6%) of studies (patients), and a weak correlation in 17.6% (27.9%), 16.7% (22.9%), 12.5% (61.9%), and 17.5% (34.4%) of studies (patients) for fatigue, anxiety-depression, pain, and HRQoL, respectively. These results were consistent in the other rheumatic diseases studied. Indeed, type 2 symptoms were mostly uncorrelated with disease activity/type 1 symptoms and this seemed even more pronounced for pain. There was no correlation in 45.2-92% (55.9-95%), 56.4-100% (54-100%), 66.7-100% (94-100%), 23-75% (43.4-55%) of studies (patients) and a weak correlation in 0-28.6% (0-34.4%), 0-31.2% (0-43%), 0-33.3% (0-6%), 25-28.6% (16-45%) of studies (patients) for fatigue, anxiety-depression, pain and HROQL respectively. Conclusion Type 2 symptoms are poorly correlated with inflammatory activity/type 1 symptoms in SLE as well as in other autoimmune rheumatic diseases. These results have important implications for clinical care and therapeutic evaluation. References [1]Escoda T, et al. Rev Med Interne. 2022 Feb;43(2):71-74. [2]Pisetsky DS, et al. Arthritis Care Res. 2019 Jun;71(6):735–41. Acknowledgements: NIL. Disclosure of Interests None Declared.