Jornal Vascular Brasileiro
http://www.jvb.periodikos.com.br/article/doi/10.1590/1677-5449.202600562
Jornal Vascular Brasileiro
Original Article

Order of resolution and recurrence of inflammatory symptoms in lipedema: a longitudinal study of 1,300 patients

Ordem de resolução e recorrência de sintomas inflamatórios no lipedema: um estudo longitudinal com 1.300 pacientes

Alexandre Campos Moraes Amato; Juliana Lelis Spirandeli Amato; Daniel Augusto Benitti

http://dx.doi.org/10.1590/1677-5449.202600562 J Vasc Bras, vol.25, e20260056, 2026
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Abstract

Background: The Questionário de avaliação sintomática do lipedema (QuASiL – Lipedema Symptom Assessment Questionnaire) assesses 13 distinct inflammatory symptoms of lipedema, but whether these symptoms resolve and recur simultaneously or follow a consistent order remains unknown.

Objectives: To characterize the persistence hierarchy of the 13 QuASiL inflammatory symptoms in a retrospective lipedema cohort under heterogeneous conservative treatment, using 6 complementary rank-order analyses and testing the null hypothesis that symptoms resolve with equal magnitude.

Methods: This retrospective longitudinal study included 1,300 patients who were clinically diagnosed with lipedema by a vascular surgeon and who completed the QuASiL on at least 2 occasions (minimum 14-day interval; median follow-up 181 days, IQR 92–380, maximum 1,787 days). A consensus ranking was computed across all analyses. A sensitivity analysis was conducted using the conventional T0 = first visit, T1 = last visit convention, and a Kaplan-Meier survival analysis estimated the time (in absolute days) to ≥ 50% reduction from baseline per symptom.

Results: The symptoms did not resolve simultaneously (Friedman χ2 (12) = 168.08, p < 0.001). All 13 symptoms improved during follow-up, showing a consistent order across the 6 analyses. A slower-resolving core was identified: bruising (consensus rank 1.7), swelling (2.0), touch sensitivity (4.3), leg heaviness (4.7), and fatigue (4.7). A rapidly-responding group comprised skin irritation (66.4% proportional reduction), itching (62.0%), and walking difficulty (62.6%). Even the most resistant symptom (bruising) achieved a mean 39.1% proportional reduction, with half of patients reaching ≥ 50% improvement. During worsening, swelling and pressure/tension re-emerged first. The sensitivity analysis (T0 = first, T1 = last) produced an essentially identical ranking (Spearman ρ = 0.945, p < 10−5). The Kaplan-Meier analysis estimated a median of 546 days for bruising vs 207 days for itching to reach ≥ 50% reduction from baseline (log-rank χ2 = 44.6, p < 10−10); the fastest-resolving symptom was heat/burning at 203 days.

Conclusions: In this retrospective cohort of patients under heterogeneous conservative treatment, the 13 QuASiL inflammatory symptoms improved following a consistent order across 6 independent analyses, with bruising and swelling as the most persistent symptoms.7

Supplementary material accompanies this paper: Table S1 | Table S2 | Table S3 | Table S4 | Figure S1 | Figure S2 | Figure S3

Keywords

lipedema; inflammatory symptoms; resolution order; bruising; patient-reported outcomes; longitudinal study

Resumo

Contexto: O Questionário de avaliação sintomática do lipedema (QuASiL) avalia 13 sintomas inflamatórios distintos do lipedema, porém desconhece-se se esses sintomas se resolvem e recidivam simultaneamente ou se seguem uma ordem consistente.

Objetivos: Caracterizar a hierarquia de persistência dos 13 sintomas inflamatórios do QuASiL em uma coorte retrospectiva de pacientes com lipedema submetidos a tratamento conservador heterogêneo, utilizando seis análises complementares de ordenação e testando a hipótese nula de que os sintomas são resolvidos com a mesma magnitude.

Métodos: Este estudo longitudinal retrospectivo foi desenvolvido com 1.300 pacientes com diagnóstico clínico de lipedema realizado por cirurgião vascular e que completaram o QuASiL em pelo menos duas ocasiões (intervalo mínimo de 14 dias; mediana de acompanhamento de 181 dias, intervalo interquartil de 92–380, máximo 1.787 dias). Uma classificação de consenso foi calculada a partir de todas as análises. Realizou-se uma análise de sensibilidade com a definição convencional T0 = primeira visita, T1 = última visita, e uma análise de sobrevida de Kaplan-Meier estimou o tempo (em dias absolutos) para uma redução ≥ 50% em relação ao valor inicial para cada sintoma.

Resultados: Os sintomas não cessaram simultaneamente (teste de Friedman χ2 (12) = 168,08, p < 0,001). Todos os 13 sintomas apresentaram melhora durante o acompanhamento, exibindo uma ordem consistente nas seis análises. Identificou-se o grupo de resolução mais lenta: equimose (classificação de consenso 1,7), edema (2,0), sensibilidade ao toque (4,3), sensação de peso nas pernas (4,7) e fadiga (4,7). O outro grupo apresentou resposta rápida, irritação da pele (redução proporcional de 66,4%), prurido (62,0%) e dificuldade para caminhar (62,6%). Mesmo o sintoma mais resistente (equimose) apresentou redução proporcional média de 39,1%, com metade dos pacientes atingindo uma melhora ≥ 50%. Durante episódios de piora, o edema e a sensação de pressão/tensão reapareceram primeiro. A análise de sensibilidade (T0 = primeira visita, T1 = última visita) produziu uma classificação essencialmente idêntica (ρ de Spearman = 0,945; p < 10−5). A análise de Kaplan-Meier estimou uma mediana de 546 dias para a equimose e de 207 dias para o prurido até se atingir uma redução ≥ 50% em relação ao valor inicial (log-rank χ2 = 44,6; p < 10−10); o sintoma com resolução mais rápida foi a sensação de calor/queimação, com 203 dias.

Conclusões: Nesta coorte retrospectiva de pacientes submetidos a tratamento conservador heterogêneo, os 13 sintomas da escala QuASiL apresentaram melhora seguindo uma ordem consistente nas seis análises independentes, sendo a equimose e o edema os sintomas mais persistentes.

Este artigo acompanha material suplementar: Tabela S1 | Tabela S2 | Tabela S3 | Tabela S4 | Figura S1 | Figura S2 | Figura S3

Palavras-chave

lipedema; sintomas inflamatórios; ordem de resolução; equimose; desfechos relatados pelo paciente; estudo longitudinal

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Submitted date:
03/28/2026

Accepted date:
06/23/2026

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