Risk Factors for Disease Activity Fluctuation in Pediatric Non-Nephritis Systemic Lupus Erythematosus: A Retrospective Cohort Study at Dr. Soetomo General Academic Hospital

Abstract

Objective. This study aimed to identify the risk factors associated with disease activity fluctuation in children with non-nephritis systemic lupus erythematosus (SLE) at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Disease activity fluctuation was defined as the variation in serial SLEDAI and Mex-SLEDAI scores during 12 months of follow-up.  Methods. This retrospective cohort study analyzed 36 pediatric patients with non-nephritis SLE aged 6–18 years who met the ACR/SLICC/EULAR criteria between January 2023 and June 2024. Data were extracted from medical records, including demographic, clinical, immunologic, and treatment variables. Disease activity was assessed using SLEDAI, Mex-SLEDAI, and hospitalization frequency. Statistical analyses included bivariate testing and multivariate modeling using Partial Least Squares–Structural Equation Modeling (PLS-SEM). Results. Most patients were female (86.1%) with a median age of 14 years. Younger age, infection, and treatment non-adherence were the most significant factors influencing disease activity fluctuation (β=0.32; p<0.05). Elevated ANA and anti-dsDNA titers, high ESR, and low complement C4 were also associated with increased disease activity. PLS-SEM analysis showed that younger age, infection, and non-adherence had the strongest predictive value for SLEDAI and Mex-SLEDAI fluctuations (R²=0.222 and 0.427, respectively). Conclusions. Younger age, infection, and treatment non-adherence were the major determinants of disease activity fluctuations in pediatric non-nephritis SLE. Comprehensive infection control, close monitoring of younger patients, and interventions to enhance long-term adherence are essential for disease stabilization and improved outcomes.