Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease. It can affect different organs and systems. Symptoms can vary in severity and last for different lengths of time. Although urinary symptoms are often reported by people with SLE and may substantially affect quality of life, little is known about the burden of urinary incontinence (UI) in people with SLE. Incontinence is a condition that refers to accidental or unintentional urination. It’s a very common condition that is most prevalent in women and can be triggered by exercising, laughing, sneezing and any sudden movement. SLE affects bladder function deeply, mainly through immune and inflammatory processes. The exact mechanism of bladder inflammation in SLE is not fully understood, however, histopathological studies suggest a possible role of immune complex-mediated small vessel vasculitis. Immune complexes in bladder tissues cause inflammation. This leads to smaller bladder capacity. Understanding UI in SLE patients is key to their health.

Objectives: The aim of this study is to investigate the association of SLE activity and UI and estimate its burden, frequency, and effect on individuals.

Methods: Two hundred and twenty six female patients (pts) fulfilled the American College of Rheumatology revised criteria for the classification of SLE were included in trhe study. SLE pts self-reported symptoms including urinary frequency, urgency and presence (needing to pee more often, feeling a strong urge to pee, leaking urine when the pts has an urge, leaking when pts has cough, sneeze, or do other activities, waking up to pee at night, not being able to empty his bladder fully, not being able to pee fully, having a mix of these symptoms) as well as amount of bother from UI and its effect on activities of daily living (ADLs). Pts with active bacterial cystitis and male patients were not included, in consideration of the possible confouding effects of infravesical obstruction on lower urinary tract symptoms (UTS) im men. The clinical Status of SLE was determined according to the SLE Disease Activity Index (SLEDAI), and bladder function was evaluated by lower UTS and urodynamic studies. Cumulative SLE-associated overall organ, neuropsychiatric, and musculoskeletal damage were determined via the Brief Index of Lupus Damage (BILD). We evaluated the associations of SLEDAI and BILD scores, as well as musculoskeletal and neuropsychiatric damage, with UI (defined as any leakage at least a few times a month over the last 6 months) using multivariable logistic regression adjusting for demographic (age, sex, education) and clinical (disease duration, body mass index) characteristics and reported adjusted odds ratios [aOR] and 95% CIs. Standard urodynamic studies were performed in 18 patients who reported a constant specific urinary symptoms. Uroflometry characterized peak and mean flow rates as well as postvoid residual volumes. The essential requirements for this evaluation were a minimum voided volume of 150 ml and the patient’s confirmation that micturitions took place with usual force. A peak urinary flow rate of < 12 ml/seconds was considered subnormal and a postvoid residual volume of > 30% was considered remarkable. We used commercial software for all statistical analyses.

Results: We studied 226 pts with SLE (mean age 35,2 ±10,02 yrs; median participant BILD score - 2). All pts were suffering from SLE for 2-25 yrs under immunosuppressant therapy. 64 of these pts (27,35%) reported for the UI. Predominant UTS in all pts are urgency of void. 34 ts report pain or discomfort located in the suprapubic area. Pollakiuria and lower abdominal pain are present in 41 pts with urinary bladder manifestations. Nocturia and dysuria occur in 54 pts. Urine analysis show proteinuria – in 34 pts, haematuria – in 10, leucocyturia without sinificant bacteriuria– in 21 pts. Most pts (42) with UI experienced leakage at least a few times a week, with nearly half (31) noting more than small drops with urine leakage. Participants with UI reported that it bothered them (39) and affected their ADLs (45) very much or greatly. Higher disease activity was associated with 2.0-fold higher odds of UI, while SLE-associated organ damage was associated with 36% higher odds of UI. Neuropsychiatric (but not musculoskeletal) damage was statistically significantly associated with increased odds of UI (aOR 2,64, 95% CI 1,44-5.96). We find several factors are linked to UI in lupus pts as age - older lupus pts have more ofen UI (p=0,001), previous UTI history (p=0,002), Antinuclear Antibodies (ANA) >1/160 IU/ml (p = 0,04); thrombocytopenia (p = 0,02), elevated serum creatinine (p = 0,0001). All pts performed standart urodynamic studies had urodynamic abnormalities, including a small cystometric bladder capacity (<150 ml; n = 7 patients), followed by a decreased urinary flow rate (<12 ml/second; n = 6 pts), increased sensation to void (10 pts), detrusor hyperreflexia - in 5, detrusor-sphincter dyssynergia - in 8.

Conclusion: Our data demonstrate that a substantial number of patients with SLE have various types of voiding dysfunction related to the disease, which has a significant impact on their quality of life and necessitates medical attention. It appears that various etiologic mechanisms are at play, and that multidisciplinary approaches are required to elucidate these mechanisms. Early recognition of voiding dysfunction in some pts and appropriate tretmant may improve quality of life and prevent irreversible complications. Clinicians should consider screening for UI among SLE pts, particularly those with greater disease activity or neuropsychiatric damage. Further research is necessary to identify at-risk individuals and effective strategies for managing UI and its associated burden for individuals with SLE.

REFERENCES: NIL.

Acknowledgements: NIL .

Disclosure of Interests: Daniela Monova: None declared, Nikolay Halachev: None declared, Botjo Zozikov: None declared, Simeon Monov Pfizer, Abbvie.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.