Date Published: January 23, 2017
Publisher: Public Library of Science
Author(s): I. Etchegaray-Morales, S. Méndez-Martínez, C. Jiménez-Hernández, C. Mendoza-Pinto, N. E. Alonso-García, A. Montiel-Jarquín, A. López-Colombo, A. García-Villaseñor, M. H. Cardiel, M. García-Carrasco, Xu-jie Zhou.
Health-related quality of life (HRQOL) is affected by numerous clinical variables, including disease activity, damage, fibromyalgia, depression and anxiety. However, these associations have not yet been described in Mexican patients with systemic lupus erythematosus (SLE).
To evaluate the relationship between disease activity, damage, depression and fibromyalgia and HRQOL measured by the LupusQoL-instrument in Mexican patients with SLE.
A cross-sectional study was conducted in women fulfilling the 1997 ACR classification criteria for SLE. HRQOL was evaluated using a disease-specific instrument for SLE, the LupusQoL (validated for the Spanish-speaking population). Patients were evaluated clinically to determine the degree of disease activity and damage using the Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) and Systemic Lupus International Collaborating Clinics-Damage Index (SLICC), respectively. Fibromyalgia and depression were assessed using the ACR criteria and the CES-D scale, respectively. The relationship between HRQOL and these variables was measured using Spearman’s rank correlation coefficient and linear regression analysis.
A total of 138 women with SLE, age 40.3±11 years, disease duration 8.8±6.4 years, with disease activity in 51.4%, depression in 50%, damage in 43% and fibromyalgia in 19.6% were included. Poorer HRQOL correlated with depression (r = -0.61; p< 0.005), fibromyalgia (r = -0.42; p< 0.005), disease activity (r = -0.37; p < 0.005) and damage (r = -0.31; p < 0.005). In the multivariate linear regression analysis, damage (β = -3.756, p<0.005), fibromyalgia (β = -0.920, p<0.005), depression (β = -0.911, p<0.005) and disease activity (β = -0.911, p<0.005) were associated with poor HRQOL. SLE disease activity, damage, fibromyalgia and depression were associated with poor HRQOL in our sample of Mexican SLE patients.
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by a complex pathogenesis with episodes of relapses and remissions . SLE can cause substantial organic and functional disability, including debilitating fatigue, cognitive impairment, chronic renal disease and severe articular involvement . Recent advances in medical care have considerably extended life expectancy in patients with SLE , although it remains lower than that of the general population, especially in patients with lupus nephritis . In addition, some existing therapies are ineffective and poorly tolerated in a high proportion of SLE patients , and this has a substantial negative impact on the quality of life.
Disease-specific HRQOL plays an important role in the evaluation of patients with SLE. The LupusQoL scores of our patients were generally good, except for the burden to others domain. Some studies have reported that, in SLE patients, HRQOL is worsened by disease activity. Other studies have reported that depression is an important predictor of low HRQOL in SLE patients [18, 27]. Our study confirms these results, showing that SLE patients with active disease and/or depression had worse HRQOL scores. The components most affected in our patients were: burden to others, fatigue and emotional health, similar to the results of other studies [3, 7, 19]. Disease activity, damage, fibromyalgia and depression all negatively affected HRQOL, although disease activity and damage was low, similar to that reported by most studies [3, 7, 13, 16].