Full Papers
Association of rurality with disease severity and social outcomes in systemic lupus erythematosus: a regional cohort study
G. De Marchi1, L. Occhipinti2, P. Tomietto3, F. Trentin4, M. Regis5, A. Nano6, N. Franzolini7, E. Mansutti8, M. Battellino9, P. Agostinis10, A. Perin11, G. Emmi12, L. Quartuccio13
- Division of Rheumatology, Department of Medicine (DMED), University of Udine, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy.
- Division of Rheumatology, Department of Medicine (DMED), University of Udine, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy.
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
- Departmental Rheumatology Unit, Western Friuli Health Authority, Pordenone, Italy.
- Internal Medicine Unit, Giuliano Isontina University Health Authority, Gorizia, Italy.
- Division of Rheumatology, Department of Medicine (DMED), University of Udine, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy.
- Rheumatology Outpatient Clinic, San Daniele District, Udine, Italy.
- Rheumatology Outpatient Clinic, Cividale District, Udine, Italy.
- Internal Medicine Unit, Central Friuli University Health Authority, Tolmezzo, Udine, Italy.
- Internal Medicine Unit, Central Friuli University Health Authority, Tolmezzo, Udine, Italy.
- Departmental Rheumatology Unit, Western Friuli Health Authority, Pordenone, Italy.
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy; Centre Hospitalier Universitaire Vaudois (CHUV), Department of Medicine and Laboratory Medicine and Pathology, Immunology and Allergy Service, University of Lausanne, Switzerland; and Centre for Inflammatory Diseases, Department of Medicine, Monash University, Monash Medical Centre, Melbourne, Australia.
- Division of Rheumatology, Department of Medicine (DMED), University of Udine, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy. luca.quartuccio@uniud.it
CER34
Full Papers
Received: 26/08/2026
Accepted : 07/10/2026
In Press: 13/10/2026
Abstract
OBJECTIVES:
To investigate the association between rurality and an operational disease-severity classification in systemic lupus erythematosus (SLE), and its relationship with selected clinical and social outcomes.
METHODS:
This retrospective multicentre cohort included adults fulfilling the 2019 EULAR/ACR SLE classification criteria and residing in Friuli Venezia Giulia, Italy. Disease severity was operationally classified as mild, moderate or severe according to the most severe SLE-related manifestation documented during the disease course, adapting the clinical severity categories used in the 2019 EULAR management recommendations. Rurality was defined by distance from the referral centre, population density and residence in a mountainous municipality. A composite Rurality Score (0-3) was analysed as a continuous variable. Primary multivariable models were adjusted for age at disease onset and sex; sensitivity analyses additionally accounted for participating centre and disease duration.
RESULTS:
Among 428 patients (87.9% female; mean age at onset 37±16 years), 32.9% met the operational severe category. Each 1-point increase in Rurality Score was associated with higher odds of the severe category after adjustment for age at disease onset and sex (OR 1.35, 95% CI 1.01-1.81; p=0.042), and the association persisted after additional adjustment for participating centre and disease duration (OR 1.49, 95% CI 1.09-2.03; p=0.013). In secondary exploratory analyses, Rurality Score was associated with certified disability (OR 1.98, 95% CI 1.20-3.25; p=0.007), based on 23 events. Rurality Score was not significantly associated with SLEDAI-2K at the last visit or with organ damage.
CONCLUSIONS:
A higher composite Rurality Score was associated with increased odds of having experienced severe SLE manifestations during the disease course. An exploratory association with certified disability was also observed, although event numbers were small. Geographic context may represent an additional contextual determinant of disease burden in SLE.
