Systemic lupus erythematosus (SLE) is associated with multiple comorbid conditions and non-disease-specific manifestations, with SLE patients perceiving substantial impairments in physical and cognitive function. Such effects are generally considered to be geriatric syndromes. Independence-limiting restrictions may serve as important patient-centered outcomes and are being used in geriatrics and medical subspecialties, such as oncology, to support self-management and assess treatments.
In their latest research, Laura Plantinga, PhD, of the Divisions of Renal Medicine and General Medicine and Geriatrics, Department of Medicine, Emory University, and colleagues used multidomain functional assessment to estimate the prevalence of physical and cognitive impairment in SLE patients. The results of the pilot study (Approaches to Positive, Patient-centered Experiences of Aging in Lupus [APPEAL]) were published in October 2018 Arthritis Care & Research.
For the study, researchers recruited 60 adult SLE participants from the Georgians Organized Against Lupus (GOAL) cohort. During in-person visits from October 2016 to April 2017, they evaluated physical and cognitive performance. Patients also provided self-reported measures for physical functioning, activities of daily living, falls and life-space mobility.
The Results
“We observed substantial levels of potential impairment in both objective performance and self-reported functioning across multiple physical and cognitive domains, which were often similar to those seen in much older geriatric populations,” write the authors. “For many domains, there was no clear association between older age and higher levels of impairment. … Furthermore, functioning did not always differ according to disease activity and disease damage, suggesting that routine measures of disease activity may not capture the full range of physical or cognitive function in SLE patients.”
However functioning did differ according to race. “These differences were often greater than those seen with disease activity and damage, suggesting that social factors may also contribute substantially to functional impairment in SLE,” write the authors.
For physical function, researchers found that the mean balance score and gait speed score were high for SLE patients, with 88% and 80% of patients respectively achieving a score of three of more on the subscales. However, the mean lower body strength score for patients was low.
When compared with healthy individuals, researchers found cognitive performance was average for episodic and working memory in SLE patients. Additionally, it was low average for cognitive flexibility, processing speed and attention/inhibitory control in SLE patients.
The authors conclude the study by calling for more research into the value of geriatric assessment in SLE patients. The study “provides a first look at several novel individual functional domains, as well as a simultaneous, multidomain assessment of functioning in the setting of SLE,” write the authors. “Our results suggest a high prevalence of impairment across multiple domains of function in SLE patients of all ages, similar to or exceeding the prevalence seen in the general geriatric population.”
Plantinga L, Tift BD, Dunlop-Thomas C, et al. Geriatric assessment of physical and cognitive functioning in a diverse cohort of systemic lupus erythematosus patients: A pilot study. Arthritis Care Res (Hoboken). 2018 Oct;70(10):1469–1477.
