More than one-third of adults with systemic lupus erythematosus reported urinary incontinence; notably, 17% of adults aged 18 to 34 years were affected, according to a recent study.
Urinary incontinence was associated with higher disease activity in a population-based US cohort. Among 425 adults with validated systemic lupus erythematosus, 36.2% reported urinary leakage occurring at least monthly, and higher disease activity was independently associated with nearly threefold higher odds of urinary incontinence (UI). Mixed-type UI was the predominant subtype, and a substantial proportion of patients reported clinically meaningful effects on daily functioning.
This cross-sectional analysis was conducted within the Approaches to Positive, Patient-Centered Experiences of Aging in Lupus study, nested in the Georgians Organized Against Lupus cohort. Participants completed a single study visit between October 2019 and May 2022. UI was assessed using a questionnaire adapted from the National Health and Nutrition Examination Survey and defined as any urine leakage occurring at least a few times per month over the preceding 12 months. Disease activity was measured using the Systemic Lupus Activity Questionnaire, and cumulative disease damage was assessed with the Brief Index of Lupus Damage. Both measures were dichotomized at the cohort median. Multivariable logistic regression models adjusted for age, sex, education, body mass index, and disease duration were used to evaluate associations.
Among participants reporting UI, 57.8% had mixed-type symptoms, 19.5% had urge only UI, and 18.8% had stress only UI. More than one-quarter experienced at least moderate symptom severity, and 8.7% reported severe or very severe UI. Leakage occurred at least a few times per week in 60.8% of affected participants, and 46.1% reported losing more than small drops of urine during episodes. UI was described as very bothersome or greatly bothersome by 39.0% of participants with symptoms, and 16.2% reported a substantial impact on activities of daily living. The researchers noted, “UI remains a stigmatized condition, and it is not often considered to be part of the clinical picture of SLE; thus, it may be underreported by patients to their rheumatologists and other providers, underscoring the importance of identifying and addressing UI as part of SLE management, particularly among those experiencing active disease states or neuropsychiatric symptoms.”
After adjustment, higher disease activity was associated with increased odds of any UI and mixed-type UI. Higher cumulative disease damage was associated with modestly increased odds that did not reach statistical significance in primary analyses. Neuropsychiatric damage was independently associated with more than twofold higher odds of UI.
The researchers identified several limitations. The cross-sectional design precluded causal inference. Key variables, including urinary symptoms and neuropsychiatric damage, were self-reported and subject to potential misclassification. Menopausal status, pelvic floor dysfunction, lupus cystitis, and certain neurologic comorbidities were not directly assessed, and childbirth history could only be estimated. In addition, cumulative damage may have been incompletely captured by the Brief Index of Lupus Damage. The predominantly Black patient, single-state cohort may also limit generalizability.
Full disclosures can be found in the published study.
Source: ACR Open Rheumatology