Effect of disease activity and damage on quality of life in patients with systemic lupus erythematosus: a 2-year prospective study

• Published in: Scandinavian journal of rheumatology 2009-01, Vol.38 (2), p.121-127
• Main Authors: Mok, C. C., Ho, L. Y., Cheung, M. Y., Yu, K. L., To, C. H.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Diseases of the osteoarticular system; Female; Health Status; Humans; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - pathology; Lupus Erythematosus, Systemic - physiopathology; Male; Medical sciences; Prospective Studies; Quality of Life; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Severity of Illness Index; Sickness Impact Profile
• ISSN: 0300-9742; 1502-7732
• DOI: 10.1080/03009740802415527

Objectives: To examine the effect of disease activity and damage on health-related quality of life (HRQoL) in patients with systemic lupus erythematosus (SLE). Methods: Consecutive SLE patients and matched controls were recruited for a study of HRQoL using the Medical Outcomes Study Short Form-36 (SF-36). SLE activity and damage was assessed by the Safety of Oestrogens in Lupus Erythematosus National Assessment SLE Disease Activity Index (SELENA-SLEDAI) and the American College of Rheumatology Systemic Lupus International Collaborating Clinics (ACR SLICC) Damage Index (SDI), respectively. Patients were prospectively followed for repeat HRQoL assessment at 2 years. The effects of cumulative disease activity and new damage on changes in SF-36 scores were evaluated. Results: One hundred and fifty-five patients were studied (94% women; age 37.8±11.3 years; SLE duration 7.2±5.4 years). Fifty (32%) patients had active disease and 75 (48%) had organ damage at baseline. Compared with age- and gender-matched controls, SLE patients had lower SF-36 scores, and the difference remained significant after adjustment for income and education level. SF-36 scores in SLE patients correlated inversely with SDI but not with SELENA-SLEDAI scores. After 2 years, there was a significant drop in the mental component score of the SF-36. Regression analysis revealed that new damage was the only determinant for a reduction in SF-36 scores. Patients with higher cumulative disease activity had a greater drop in bodily pain and general health subscores. Conclusions: Impaired HRQoL is more common in SLE patients than controls, regardless of age, sex, education and poverty. Pre-existing organ damage is associated with poorer HRQoL and new damage predicts a further decline in HRQoL. Persistent disease activity is associated with deterioration in certain domains of the SF-36.