Analysis of related factors for systemic lupus erythematosus flare after SARS-Cov-2 infection: A retrospective cohort study

Objective: Since COVID-19 infections are more common in systemic lupus erythematosus (SLE) patients, most recent research has focused on the outcome of COVID-19, with fewer studies on disease activity in SLE. This research aims to evaluate flares in SLE with COVID-19 infection while investigating predictive factors.

Methods: A questionnaire survey was conducted to collect information on patients with previously diagnosed SLE from multi-center. SLE patients infected with COVID-19 after December 7, 2022, were selected. Detailed information covering demographic characteristics, SLE and COVID-19 clinical features, disease activity, and medication was collected through an electronic questionnaire. A multivariate logistic regression model was constructed to evaluate the predictive factors for SLE disease onset after COVID-19 infection.

Results: A total of 240 patients were finally included in our analysis. Thirty (12.5%) of those enrolled reported an SLE flare. Multivariate analysis with logistic models confirmed that SLE in the active stage (OR 2.617, 95% CI 1.008-6.514, p = .041) and COVID-19 duration (OR 4.140, 95% CI 1.412-11.694, p = .008) were predictors for flare in SLE patients with Covid-19 infection. In contrast, immunosuppressants were associated with a low incidence of flare of SLE (OR 0.138, 95% CI 0.042-0.46, p = .005).

Conclusions: The active phase of SLE and the progression of COVID-19 were the main risk factors for disease exacerbation in SLE patients, while the use of immunosuppressive medications was associated with a lower risk of flare-ups. These findings provide valuable insights for managing SLE patients during the COVID-19 pandemic.