Clinical Profile and Precipitating factors of Acute Flare in Patients with Systemic Lupus Erythematosus: A Retrospective Study from South India

Abstract Background: Systemic lupus erythematosus (SLE) is characterized by a relapsing-remitting course. Identifying predictors of acute flares is essential to reducing morbidity and preventing organ damage. Materials and Methods: A retrospective chart review of adult patients (>16 years) admitted to the Department of General Medicine, Christian Medical College, Vellore, with an acute SLE flare between October 2019 and September 2024. Disease flare was defined as a Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score ≥4. Flares were classified as mild-moderate (SLEDAI 4–12) or severe (SLEDAI >12). Clinical domains, precipitating factors, treatment at admission, and outcomes were analyzed. Results: Of 8538 screened admissions, 13 patients were identified with acute SLE flares. All patients were female, with a mean (±standard deviation) age of 33.2 (±13.5) years. 76.9% of flares occurred within 4 years of diagnosis. Immunological activity was the most common domain (92.3%), followed by renal (53.8%), hematological (46.2%), constitutional (30.8%), serosal (30.8%), mucocutaneous (23.1%), and musculoskeletal (7.7%). Infections accounted for 46.2% of precipitating factors, followed by medication noncompliance (23.1%). The distribution of second-line immunosuppressive agents was broadly similar across the mild-moderate and severe flare groups. Conclusions: Acute flares in SLE predominantly occur in young women within the first 4 years after diagnosis. Infections are the leading trigger, followed by medication noncompliance. Renal involvement is the most common clinical manifestation. Aggressive infection screening and structured adherence monitoring may help reduce flare-related morbidity.