¹Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
²Department of Internal Medicine I, Department of Nephrology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
³Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
⁴Rheumatology Center Rhineland-Palatinate, Bad Kreuznach

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Introduction: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease characterized by multi-organ involvement, circulating autoantibodies, and relapsing-remitting progression. Effective management is particularly challenging for less experienced clinicians [1]. The Mainz Lupus Score (MLS) was developed as a practical tool to support therapy management, emphasizing both objective measures and subjective patient-reported outcomes (PROs). This study aimed to evaluate the MLS by comparing its performance to established indices such as the SLEDAI, ECLAM, and SLICC, while also exploring correlations with subjective measures including the Fatigue Severity Scale (FSMC), Beck Depression Inventory (BDI) and Workability Index.

Methods: Data from 458 SLE patients at the University Medical Center Mainz were analysed, including 93 patients with at least three visits and 422 visits in total. The MLS incorporates four items: new lupus symptoms, quality of life (QoL), laboratory abnormalities, and organ damage. Correlations between the MLS and established indices were assessed using Spearman correlation and Kruskal-Wallis tests. In order to proof the applicability of the MLS in daily clinically routine the MLS score was compared to medical doctor’s (MD) treatment between the all visits by a paired Wilcoxon Signed Rank Test focussing on the outcome remission.

Results: Significant correlations were observed between the MLS and SLEDAI (r = 0.403), SLICC (r = 0.427), and ECLAM (r = 0.537; p < 0.0001). The MLS demonstrated strong associations with therapy escalation and remission rates, aligning with treat-to-target goals. Although correlations with subjective scores like FSMC, BDI and WAI were weak to moderate, the integration of PROs offered valuable insights for therapy adjustments. When testing the MLS during everyday clinical routine no significant difference in remission change (p = 0,9398) was found between MLS based and medical doctor’s (MD) based therapy desicion, reflecting the previous decision.

Conclusion: The MLS provides a clinically practical and validated approach to managing SLE, balancing objective metrics with patient-centered evaluations. While effective in distinguishing disease states and guiding therapy, broader multicenter validation is recommended to enhance its applicability.

References

[1] Fanouriakis A, Kostopoulou M, Andersen J, Aringer M, Arnaud L, Bae SC, Boletis J, Bruce IN, Cervera R, Doria A, Dörner T, Furie RA, Gladman DD, Houssiau FA, Inês LS, Jayne D, Kouloumas M, Kovács L, Mok CC, Morand EF, Moroni G, Mosca M, Mucke J, Mukhtyar CB, Nagy G, Navarra S, Parodis I, Pego-Reigosa JM, Petri M, Pons-Estel BA, Schneider M, Smolen JS, Svenungsson E, Tanaka Y, Tektonidou MG, Teng YO, Tincani A, Vital EM, van Vollenhoven RF, Wincup C, Bertsias G, Boumpas DT. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis. 2024 Jan 2;83(1):15-29. DOI: 10.1136/ard-2023-224762