Background Various psychological distresses in systemic lupus erythematosus (SLE) may be associated with systemic conditions. However, the influence of psychological distresses to the SLE disease activity still remains unclear.
Objectives We evaluated the levels of depression, anxiety, anger and fatigue in patients with SLE, compared to those of healthy controls. We investigated the association between the psychological distresses and disease activity and damage in patients with SLE.
Methods 105 patients with SLE and 51 healthy controls completed a psychological questionnaire. Psychological distresses were assessed as follows: depression, Center for Epidemiologic Studies Depression Scale (CES-D); anxiety, Hospital Anxiety and Depression Scale (HADS); anger, State Trait Anger Expression Inventory (STAXI); fatigue, the Profile of Mood States fatigue-inertia Scale (POMS-F). Disease activity and damage index were measured by the SLE Disease Activity Index (SLEDAI) and the SLE Collaborating Clinics/American College of Rheumatology (SLICC/ACR), respectively.
Results Patients with SLE showed higher levels of depression (p=0.003), anxiety (p=0.049), anger (p=0.021) and fatigue (p=0.003) than healthy controls. In the patients with SLE, psychological distresses were well correlated with each other (depression and anxiety: γ=0.712, p<0.001; depression and anger: γ=0.573, p<0.001; depression and fatigue: γ=0.703, p<0.001; anxiety and anger: γ=0.513, p<0.001; anxiety and fatigue: γ=0.592, p<0.001; anger and fatigue: γ=0.556, p<0.001, respectively). The group using higher doses of glucocorticoids (prednisolone >7.5 mg/day) had greater symptoms in all of the psychological distresses than the group with lower doses of glucocorticoids (prednisolone ≤7.5 mg/day) (depression, p=0.002; anxiety, p=0.027; anger, p=0.007; fatigue, p =0.016, respectively). However, none of the psychological distresses showed significant differences between higher disease activity and lower disease activity groups, and between higher damage and lower damage groups. In a multiple linear analysis, depression was affected by SLE disease activity (β=0.223, p=0.026) and daily prednisolone doses (β=0.228, p=0.029). However, SLE disease activity was not affected by the psychological distresses.
Conclusions SLE patients had more psychological distresses, such as depression, anxiety, anger and fatigue than healthy controls. Higher levels of disease activity and higher use of glucocorticoids affect on depression, while the results do not support that psychological distress affects disease activity status.
Disclosure of Interest None Declared