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

Abstract

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.