A LARGE multicentre study from Japan has found that clinical inertia—the failure to intensify treatment despite active disease—can significantly worsen long-term outcomes for patients with systemic lupus erythematosus (SLE).
Drawing on data from the LUNA cohort, researchers followed 365 patients with active disease. They compared outcomes between those whose treatment was escalated and those whose therapy was not adjusted. Nearly one-third of patients (116) fell into the “clinical inertia” group, where active disease persisted without treatment intensification.
Findings revealed that both non-intensification and clinical inertia were strongly associated with increased glucocorticoid-related damage and overall organ damage. Patients in these groups also reported a decline in quality of life across several domains. Predictors of clinical inertia included female sex and greater baseline damage, while hydroxychloroquine use and fewer additional immunosuppressants were linked to non-intensification. Older age showed a trend toward higher risk of inertia, though not statistically significant.
“Because clinical inertia drives damage accrual and worsens quality of life, avoiding it must be a therapeutic priority,” the authors stressed. They called for more proactive treatment strategies, with regular reassessment for patients at higher risk—including women, older patients, and those with existing organ damage.
The findings highlight the importance of timely treatment escalation in SLE management to prevent irreversible harm and maintain quality of life.
Reference
Miyake H et al. Factors and outcomes related to clinical inertia in systemic lupus erythematosus: a multicentre LUNA cohort study. Rheumatology. 2025; DOI: 10.1093/rheumatology/keaf504.
