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Caruso Mazzolani B, Infante Smaira F, Mendes Sieczkowska S, Romero M, Toledo Ribeiro T, Cordeiro Amarante M, Pasoto S, de Sá Pinto AL, Rodrigues Lima F, Braga Benatti F, Bonfa E, Roschel H, Gualano B. Quality of life, fatigue, sleep quality, and mental health in systemic lupus erythematosus patients with a high cardiovascular risk profile. Lupus 2023; 32:1287-1295. [PMID: 37698181 DOI: 10.1177/09612033231202582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Systemic lupus erythematosus (SLE) patients report worse health-related quality of life (HRQL), fatigue, anxiety, depression, and sleep quality, when compared to the general population and other chronic diseases. Furthermore, cardiometabolic diseases are highly prevalent in SLE and are also associated with these parameters. Thus, it is plausible to suggest that SLE patients with a high cardiovascular risk may report worse results for these parameters. The aim of the study is to describe HRQL, fatigue, anxiety and depression symptoms, and sleep quality in a sample of SLE patients with a high cardiovascular risk profile (i.e., BMI between 25 and 40 kg/m2 and/or dyslipidemia, hypertension, or diabetes). This was a cross-sectional study where patients were assessed for (i) demographic, anthropometric, and disease-related parameters, (ii) HRQL, (iii) fatigue, (iv) anxiety and depression symptoms, and (v) sleep quality. One-hundred patients completed the study; however, only 87 patients were assessed for sleep quality data. Patients averaged 41.7 ± 9 years, and most patients were classified as overweight/obese (87%). SF-36 scores for physical and mental components summary were 51.3 ± 9.6 and 54.2 ± 15.6, respectively, with "bodily pain" and "role emotional" presenting the lower scores. The total SLEQOL score was 105.1 ± 42.0, with lower scores reported for "self-image" and "mood." Fatigue score was 30.8 ± 8.9, and 78% and 93% reported severe symptoms of anxiety and depression, respectively. The average sleep effectiveness was 82.9 ± 6.6%. Sleep latency, total time in bed (TTiB), and total sleep time (TST) were 8.4 ± 8.9, 495.8 ± 79.7, and 409.7 ± 69.9 min, respectively. Patients reported an average of 17.8 ± 6.2 WE, with 4.5 ± 1.5 min duration and a WASO of 77.7 ± 36.6 min. Despite similar HRQL, fatigue, and sleep quality parameters to those reported by other SLE populations, SLE patients with a high cardiovascular risk had a higher prevalence of depression and anxiety. Understanding SLE patients' quality of life and psychological symptoms is of utmost importance to improve disease management. The findings of this study highlight the need for more intensive and global care regarding mental health when considering a high cardiovascular risk in SLE.
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Affiliation(s)
- Bruna Caruso Mazzolani
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Fabiana Infante Smaira
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Sofia Mendes Sieczkowska
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Marina Romero
- School of Applied Sciences, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Thainá Toledo Ribeiro
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Milla Cordeiro Amarante
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Sandra Pasoto
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | - Ana Lúcia de Sá Pinto
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | - Fernanda Rodrigues Lima
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | - Fabiana Braga Benatti
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- School of Applied Sciences, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Eloísa Bonfa
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
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González LA, Ugarte-Gil MF, Pons-Estel GJ, Durán-Barragán S, Toloza S, Burgos PI, Bertoli A, Borgia RE, Alarcón GS. Addressing health disparities as a function of ethnicity in systemic lupus erythematosus patients. Lupus 2022; 31:1691-1705. [PMID: 36036891 DOI: 10.1177/09612033221122983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder with significant health disparities, as it disproportionately and more severely affects vulnerable and disadvantaged population groups in the United States and around the world, that is, women, ethnic minorities, individuals living in poverty, less educated, and lacking medical insurance. Both, genetic and non-genetic factors, contribute to these disparities. To overcome these health disparities and reduce poor outcomes among disadvantaged SLE populations, interventions on non-genetic amendable factors, especially on social health determinants, are necessary.
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Affiliation(s)
- Luis A González
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, 161932Universidad de Antioquia, Medellin, Antioquia, Colombia
| | - Manuel F Ugarte-Gil
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,Grupo Peruano de Estudio de Enfermedades Autoimmunes Sistémicas. Universidad Científica Del Sur, Lima, Perú
| | - Guillermo J Pons-Estel
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Sergio Durán-Barragán
- Clínica de Investigación en Reumatología y Obesidad S.C, Guadalajara, Jalisco, México.,Instituto de Investigación en Reumatología y Del Sistema Musculoesquelético, Departamento de Clínicas Médicas, 28033Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Sergio Toloza
- Department of Medicine, Rheumatology Unit, 297792Hospital San Juan Bautista, San Fernando del Valle de Catamarca, Catamarca, Argentina
| | - Paula I Burgos
- Department of Clinical Immunology and Rheumatology, School of Medicine, 3463Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Bertoli
- Sevicio de Reumatología, Clínica Universitaria Reina Fabiola, 9967Universidad Católica de Córdoba, Argentina
| | - R Ezequiel Borgia
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, College of Medicine, 3463University of Florida, Gainesville, FL, USA.,Department of Health Outcomes and Biomedical Informatics, 3463College of Medicine University of Florida, Gainesville, FL, USA
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano, Heredia, Lima, Perú
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Ugarte-Gil MF, Gamboa-Cardenas RV, Reátegui-Sokolova C, Pimentel-Quiroz VR, Medina M, Elera-Fitzcarrald C, Zevallos F, Pastor-Asurza CA, Zazzetti F, Karyekar CS, Alarcón GS, Perich-Campos RA. Severe flares are associated with a poorer health-related quality of life (HRQoL) in patients with SLE: data from the Almenara Lupus Cohort. Lupus Sci Med 2022; 9:9/1/e000641. [PMID: 35351811 PMCID: PMC8966564 DOI: 10.1136/lupus-2021-000641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/17/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Flares in patients with SLE, regardless of their severity, have been associated with damage accrual. However, their impact on health-related quality of life (HRQoL) has not been fully evaluated. In fact, disease activity is only minimally associated with HRQoL. OBJECTIVE To determine the association between flares and HRQoL. METHODS Patients from the Almenara Lupus Cohort were included. Visits occurring between December 2015 and February 2020 were evaluated. Flares were defined as an increase on the SLE Disease Activity Index 2000 (SLEDAI-2K) of at least 4 points; severe flares were those with a final SLEDAI-2K ≥12 and mild-moderate flares all the others. HRQoL was measured using the LupusQoL. Univariable and multivariable generalised estimating regression equations were performed, adjusting for possible confounders. Confounders were determined at one visit, whereas the outcome was determined on the subsequent visit; flares were determined based on the variation of the SLEDAI-2K between these visits. RESULTS Two hundred and seventy-seven patients were included; 256 (92.4%) were female, mean age at diagnosis was 36.0 (SD: 13.3) years and mean disease duration at baseline was 9.1 (SD: 7.1) years. Patients had mean of 4.8 (SD: 1.9) visits and a mean follow-up of 2.7 (1.1) years. Out of 1098 visits, 115 (10.5%) flares were defined, 17 were severe and 98 mild-moderate. After adjustment for possible confounders, only severe flares were associated with a poorer HRQoL in planning, pain, emotional health and fatigue. CONCLUSIONS Severe flares, but not mild-moderate, flares are associated with poorer HRQoL.
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Affiliation(s)
- Manuel Francisco Ugarte-Gil
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
| | - Rocio Violeta Gamboa-Cardenas
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
| | - Cristina Reátegui-Sokolova
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Unidad de Investigación Para La Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Victor Román Pimentel-Quiroz
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
| | - Mariela Medina
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Claudia Elera-Fitzcarrald
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
| | - Francisco Zevallos
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Cesar Augusto Pastor-Asurza
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | | | - Graciela S Alarcón
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Risto Alfredo Perich-Campos
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Quality of life in lupus erythematosus female patients with cutaneous lesions in Antananarivo, Madagascar. Int J Womens Dermatol 2022; 7:743-746. [PMID: 35028375 PMCID: PMC8714573 DOI: 10.1016/j.ijwd.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/11/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Lupus erythematosus (LE) is a chronic autoimmune disease that affects more women than men. The quality of life (QoL) of patients with lupus erythematosus and skin manifestations is impaired, but little is known about Malagasy patients. Objective: This study aimed to assess the impact of cutaneous lesions on the QoL of patients who present with LE. Methods: A transversal study, during 3 months, was conducted in patients who presented with LE and cutaneous lesions at the University Hospital Antananarivo. QoL was assessed using the Dermatology Life Quality Index (DLQI) scales. Results: The impact of cutaneous lesions on the QoL was assessed in 37 patients with LE, of whom 34 were women. The mean age of patients was 37.32 years. The mean DLQI was 5.43 ± 4.67 (range, 0–21). Of the patients, 2.7% had a very important effect (DLQI >21), 18.9% reported a great effect of skin symptoms of LE in their QoL (DLQI: 11–20), 18.9% had a moderate effect (DLQI: 6–10), 40.4% had a small effect (DLQI: 2–5), and 18.9% had no effect of cutaneous lesions on their QoL. Daily activities, symptoms, and feelings were the most altered dimensions. The alteration in patients’ QOL was influenced by high monthly income, severe medical history, and localization of the cutaneous lesions on the face and neckline. No correlation was found between sex and QoL. Conclusion: This study shows that significant impairment of QoL was found in patients with LE and cutaneous manifestations, which affected their sense of well-being.
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Hoge C, Bowling CB, Lim SS, Drenkard C, Plantinga LC. Association of Poverty Income Ratio with Physical Functioning in a Cohort of Patients with Systemic Lupus Erythematosus. J Rheumatol 2020; 47:983-990. [PMID: 32115428 DOI: 10.3899/jrheum.190991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the association of income relative to the poverty threshold [poverty income ratio (PIR)] with self-reported physical functioning (PF) in a cohort of patients with systemic lupus erythematosus. METHODS We used cross-sectional data on 744 participants from Georgians Organized Against Lupus (GOAL), and secondary analyses used data on 56 participants from a nested pilot study. Primary analyses used multivariable linear regression to estimate the association between PIR (categorized as < 1.00, 1.00-1.99, 2.00-3.99, and ≥ 4.00; lower PIR indicate higher poverty) and PF (scaled subscore from the Medical Outcomes Study Short Form-12 survey; range 0-100, higher scores indicate better functioning). Secondary analyses summarized complementary measures of PF as means or percentages by PIR (categorized as < 1.00, 1.00-1.99, and ≥ 2.00). RESULTS The mean age of participants was 48.0 years; 6.7% were male; 80.9% were black; and 37.5%, 21.0%, 29.6%, and 12.0% had PIR of < 1.00, 1.00-1.99, 2.00-3.99, and ≥ 4.00, respectively. The overall mean PF score was 45.8 (36.2, 40.7, 55.5, and 61.2 for PIR of < 1.00, 1.00-1.99, 2.00-3.99, and ≥ 4.00). With adjustment, higher PIR remained associated with higher PF scores [2.00-3.99 vs 1.00-1.99: β = 10.9 (95% CI 3.3-18.6); ≥ 4.00 vs 1.00-1.99: β = 16.2 (95% CI 6.4-26.0)]. In secondary analyses, higher PIR was also associated with higher scores for objective physical performance. CONCLUSION Our results show that higher income relative to the poverty threshold is associated with better PF across multiple domains, warranting further research into multicomponent functional assessments to develop individual treatment plans and potentially improve socioeconomic disparities in outcomes.
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Affiliation(s)
- Courtney Hoge
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - C Barrett Bowling
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - S Sam Lim
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - Cristina Drenkard
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - Laura C Plantinga
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA. .,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University.
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Gu M, Cheng Q, Wang X, Yuan F, Sam NB, Pan H, Li B, Ye D. The impact of SLE on health-related quality of life assessed with SF-36: a systemic review and meta-analysis. Lupus 2019; 28:371-382. [PMID: 30813871 DOI: 10.1177/0961203319828519] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the impact of systemic lupus erythematosus (SLE) on health-related quality of life (HRQoL) assessed with SF-36 and explore factors associated with HRQoL in SLE patients. METHODS A random-effect meta-analysis was performed to calculate extracted data. Sensitivity and subgroup analyses were performed to distinguish sources of heterogeneity. RESULTS A total of 36 articles were finally included in this meta-analysis, including 6510 patients. The pooled mean scores of SF-36 physical component summary and mental component summary were 46.10 (95% confidence interval (CI): 43.09-49.10) and 50.37 (95% CI: 47.78-52.87), respectively. Spearman's correlation analysis found that mean age, proportion of female participants, and publication decades were negatively associated with some of the SF-36 domains. Sample size and SLEDAI were positively associated with some of the SF-36 domains. Patients with SLE have lower HRQoL in comparison to the general population. CONCLUSIONS SLE has a significant impact on HRQoL, which proves that the necessity of improving HRQoL in SLE patients cannot be ignored. Measuring HRQoL should be considered as an indispensable part of the overall evaluation of health conditions of SLE patients.
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Affiliation(s)
- M Gu
- 1 Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Q Cheng
- 1 Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - X Wang
- 1 Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - F Yuan
- 1 Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - N B Sam
- 1 Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - H Pan
- 1 Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - B Li
- 1 Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - D Ye
- 1 Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
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Raymond WD, Eilertsen GØ, Shanmugakumar S, Nossent JC. The Impact of Cytokines on the Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus. J Clin Med 2019; 8:jcm8060857. [PMID: 31208069 PMCID: PMC6617124 DOI: 10.3390/jcm8060857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction: Systemic lupus erythematosus (SLE) reduces the health-related quality of life (HRQoL), even during periods of disease quiescence. We investigated whether subclinical inflammation as reflected by cytokine levels is linked with reduced HRQoL. Methods: A cross-sectional study of SLE patients (n = 52, mean age 47.3, 86.5% female) who completed a Short Form Health Survey-36 (SF-36) questionnaire. The clinical and demographic data, scores for the disease activity (SLEDAI-2K), organ damage (SDI), and laboratory data were collected simultaneously. The autoantibody and cytokine levels (IFN-γ, IL-1β, IL-4, IL-6, IL-10, IL-12, IL-17, BAFF, TNF-α, TGF-β1, MIP-1α, MIP-1β and MCP-1 (levels in pg/mL) were quantified by sandwich ELISA. The comparisons and associations were assessed non-parametrically, and a multiple regression determined the effect sizes (ES) of the variables on the SF-36 domain and summary scores. Results: The SF-36 summary and domain scores for SLE patients were significantly (20–40%) lower than in a comparable control group, with the exception of the Mental Health scores (p = 0.06). SLE patients had a normal body mass index (BMI) (median, 24.2 kg/m2), a high rate of smoking (69.2%), and usage of social security benefits (90.4%). TGF-β1 (ES 0.06), IL-12 (ES −0.11), IFN-γ (ES 0.07) and MCP-1 (ES 0.06) influenced the SF-36 domain scores; and MCP-1 (ES 0.04) influenced the Mental Health Summary Score (MCS). Obvious manifestations, including patient visual analogue scale (VAS) (ES −2.84 to −6.29), alopecia (ES −14.89), malar rash (ES −14.26), and analgesic requirement (ES −19.38), independently influenced the SF-36 items; however, the SF-36 scores were not reflected by the physician VAS or disease activity (SLEDAI-2K). Conclusions: Cytokines had a minimal impact on HRQoL in SLE patients, especially compared to visible skin manifestations, central nervous system (CNS) damage, and pain. Better tools are needed to capture HRQoL in measures of disease activity.
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Affiliation(s)
- Warren David Raymond
- Rheumatology Group, School of Medicine, The University of Western Australia, Perth 6009, Australia.
| | - Gro Østli Eilertsen
- Molecular Inflammation Research Group, Department of Clinical Medicine, Arctic University, 9037 Tromsø, Norway.
| | - Sharanyaa Shanmugakumar
- Rheumatology Group, School of Medicine, The University of Western Australia, Perth 6009, Australia.
| | - Johannes Cornelis Nossent
- Rheumatology Group, School of Medicine, The University of Western Australia, Perth 6009, Australia.
- Molecular Inflammation Research Group, Department of Clinical Medicine, Arctic University, 9037 Tromsø, Norway.
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth 6009, Australia.
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Elera-Fitzcarrald C, Fuentes A, González LA, Burgos PI, Alarcón GS, Ugarte-Gil MF. Factors affecting quality of life in patients with systemic lupus erythematosus: important considerations and potential interventions. Expert Rev Clin Immunol 2018; 14:915-931. [DOI: 10.1080/1744666x.2018.1529566] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Claudia Elera-Fitzcarrald
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
| | - Alejandro Fuentes
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Alonso González
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Paula I. Burgos
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Graciela S. Alarcón
- The University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Manuel F. Ugarte-Gil
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
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9
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Devilliers H, Vernier N, Muller G, Turcu A, Samson M, Bielefeld P, Besancenot JF. [Quality of life measures in SLE: An update]. Rev Med Interne 2017; 39:107-116. [PMID: 28457682 DOI: 10.1016/j.revmed.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 02/28/2017] [Accepted: 03/04/2017] [Indexed: 12/20/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic disease that considerably hampers patient's daily living. Qualitative studies with patients' interviews have been conducted to describe the experiences and perspectives of adults living with SLE. Among existing generic and disease-specific quality of life (QOL) questionnaires, none succeeded to exhaustively measure patient's preoccupations. However, these tools are useful to quantify the burden of the disease. Social precariousness, socioeconomic status and education level are intimately correlated to QOL measures, either generic or disease-specific. Musculoskeletal disease activity is also associated with a lower QOL. Using disease-specific tools may be useful because of a better aptitude to record an improvement in health status. Moreover, using generic and disease-specific questionnaires together may help to identify factors associated with a lower quality of life but not related to SLE from the patient's perspective (such as smoking or obesity). Developing new ways of recording QOL data in the future may help to evaluate the real benefit of using QOL scales in daily practice.
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Affiliation(s)
- H Devilliers
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France.
| | - N Vernier
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - G Muller
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - A Turcu
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - M Samson
- Service de médecine interne et immunologie clinique (médecine interne 1), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon, France
| | - P Bielefeld
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - J-F Besancenot
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
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10
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George A, Wong-Pack A, Peschken CA, Silverman E, Pineau C, Smith CD, Arbillaga H, Zummer M, Bernatsky S, Hudson M, Hitchon C, Fortin PR, Nevskaya T, Pope JE. Influence of Education on Disease Activity and Damage in Systemic Lupus Erythematosus: Data From the 1000 Canadian Faces of Lupus. Arthritis Care Res (Hoboken) 2016; 69:124-132. [PMID: 27110869 DOI: 10.1002/acr.22922] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/14/2016] [Accepted: 04/19/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine whether socioeconomic status assessed by education is associated with disease activity and the risk of organ damage in systemic lupus erythematosus (SLE). METHODS Data from the 1000 Canadian Faces of Lupus, a multicenter database of adult SLE patients, was used to compare education as either low (did not complete high school) or high (completed high school or further) for disease activity and damage. Education was also studied as a continuous variable. The relationships between education and SLE outcomes (any organ damage defined as a Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI] score ≥1, serious organ damage [SDI score ≥3], and end-stage renal disease) were evaluated using logistic regression analyses adjusted for age, sex, race/ethnicity, and disease duration. RESULTS A total of 562 SLE patients met inclusion criteria (mean age 47 years, 91% female, and mean disease duration of 10 years); 81% had high education. The low education group was twice as likely to be work disabled (30%; P < 0.0001); they had higher disease activity and reduced renal function. Linear regression analysis revealed that low education was significantly associated with higher disease activity at enrollment into the 1000 Canadian Faces of Lupus database, after adjustment for age (at entry and at diagnosis), race/ethnicity, and sex (B 1.255 + 0.507 [SE], β = 0.115, P = 0.014). In our adjusted logistic regression models we were unable to demonstrate significant associations between education and SLE damage. Results did not change when varying the education variable. CONCLUSION In this cohort, low education was associated cross-sectionally with higher disease activity and work disability, but not damage.
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Affiliation(s)
| | | | | | - Earl Silverman
- University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Hector Arbillaga
- Lethbridge Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Michel Zummer
- Hopital Maisonneuve Rosemount, Montreal, Quebec, Canada
| | | | - Marie Hudson
- McGill University and Jewish General Hospital, Montreal, Quebec, Canada
| | | | | | | | - Janet E Pope
- St. Joseph's Health Care and University of Western Ontario, London, Ontario, Canada
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11
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Kulczycka L, Sysa-Jedrzejowska A, Robak E. Quality of life and satisfaction with life in SLE patients-the importance of clinical manifestations. Clin Rheumatol 2010; 29:991-7. [PMID: 20532577 PMCID: PMC2908751 DOI: 10.1007/s10067-010-1509-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 04/27/2010] [Accepted: 05/25/2010] [Indexed: 11/28/2022]
Abstract
To assess the correlation between quality of life (QoL) and satisfaction with life (SL) in SLE patients and correlate both with clinical symptoms of the disease. The study was performed in 83 patients. QoL was assessed by Short Form 36, and SL was assessed by the Satisfaction with Life Scale. Clinical manifestations presented at the time of examination were taken into consideration. SLE patients assessed their QoL and SL as rather low. Those with photosensitivity as well as neurological symptoms presented lower QoL in particular domains, while those with renal manifestation of SLE assessed their QoL as higher. Similar observations were made for SL only in relation to neurological symptoms. Moreover, our findings show that although SL is a part of QoL, both these parameters should be distinguished in order to fully assess the state of the patient.
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Affiliation(s)
- Lilianna Kulczycka
- Department of Dermatology and Venereology, Medical University of Lodz, Krzemieniecka Street No 5, 94-017, Lodz, Poland.
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