Hospital Visits Increase in Young Lupus Patients One Year Prior to Diagnosis, Study Finds

Young patients diagnosed with systemic lupus erythematosus (SLE) show a high number of visits to healthcare facilities in the year before their diagnosis, research shows.

The study, “High Health Care Utilization Preceding Diagnosis of Systemic Lupus Erythematosus in Youth,” was published in the journal Arthritis Care & Research.

While advances in treatment options have led to an increase in survival among lupus patients, delays in diagnosis are still among the most important risk factors for poor outcomes.

Autoantibodies and clinical symptoms are usually seen years before diagnosis, but doctors still struggle to identify clinical features that can be used for an early lupus diagnosis.

In an attempt to help characterize the path from symptoms onset to diagnosis, and improve early diagnosis of lupus, researchers explored patterns of healthcare use before a definitive diagnosis was made.

Joyce Chang and colleagues at the Perelman School of Medicine at the University of Pennsylvania and The Children’s Hospital of Philadelphia looked at whether young lupus patients had evidence of a higher use of healthcare facilities in the year preceding their diagnosis. They also aimed to determine the causes of healthcare visits and to identify the characteristics associated with a higher facility use.

The team identified 682 young lupus patients, ages 10 to 24,  diagnosed between 2000 and 2013. They then compared the health records – ambulatory, emergency, and inpatient visits – to those of 1,364 age and sex-matched healthy controls.

“We hypothesized that youth with SLE have increased ambulatory and acute care utilization in the year preceding SLE diagnosis compared with their peers, and that these early presentations to care would be associated with diagnosis codes suggestive of initial manifestations of SLE,” they wrote.

Results showed that, indeed, lupus patients had a higher number of visits than healthy controls. Ambulatory visits were 2.5 times more common in lupus patients, and emergency visits happened 3.4 times more often in lupus patients. Also, lupus patients had inpatient visits three times more often than healthy controls.

The most common causes for the hospital visits among the lupus patients were venous thromboembolism (blood clots in the deep veins), thrombocytopenia (low blood platelet count), chest pain, fever, and acute kidney failure.

Also, psychiatric disorders preceding a lupus diagnosis were associated with a high use of heathcare facilities.

Overall, these results show that “youth with SLE have high healthcare utilization throughout the year preceding SLE diagnosis,” the researchers wrote.

“Examining variable diagnostic trajectories of youth presenting for acute care preceding SLE diagnosis, and increased attention to psychiatric morbidity may help improve care for youth with new-onset SLE,” the study concluded.