Background Systemic Lupus Erythematosus (SLE) is associated to a huge prevalence and incidence of cardiovascular diseases (CVDs) due to accelerated atherosclerosis. Several evidences demonstrated that metabolic syndrome (MeS) could contribute to CVDs burden in SLE. In general population, MeS components and, according to some reports, MeS itself are associated to worsened Health related Quality of Life (HR-QoL). In SLE patients, a severe decline of HR-QoL has been widely demonstrated.
Objectives In the study, we evaluated the association between MeS, HR-QoL and QoL-related factors, such as depression, fatigue and physical activity.
Methods We conducted a cross-sectional study with retrospective evaluation of disease activity, damage and therapies cumulative dosage. MeS was defined according to International Federation of Diabetes (IFD) criteria. All patients were evaluated to explore MeS IFD criteria and other CVD risk factors (familiar history, lifestyle, smoking). SLE disease activity and damage were evaluated using SELENA-SLEDAI and SDI indices, respectively. Disease flares were retrospectively assessed by SFI index. HR-QoL was quantified by SF-36 instrument. We used Beck Depression Inventory (BDI) to assess depression and Facit-Fatigue to evaluate fatigue. Physical activity was quantified using International Physical Activity Questionnaire (IPAQ) and expressed according to categorical IPAQ total score. Patients also completed Pittsburgh Sleep Quality Index (PSQI) exploring sleep pathology.
Results We enrolled 55 SLE patients (2 male and 53 female). Mean age was 45±12.5. MeS prevalence was 23.6% and obesity (according to IFD definition) was recorded in 36.4% of patients. SLE patients with MeS presented reduced scores in SF-36 summary components MCS and PCS compared to patients without MeS (p 0.002 and p 0.04, respectively). The SF-36 individual components significantly decreased in MeS were the Mental Health, the Physical Rose and the Social Role (p 0.003, p 0.03, p 0.05, respectively). In multiple linear regression the values of MCS was significantly associated only to obesity (p 0.01), while neither MeS it self nor any MeS components were associated to PCS values. BDI score was significantly higher and Facit-Fatigue score was reduced in SLE patients meeting MeS criteria compared to subjects without MeS (p<0.0001, p 0.005, respectively). A greater proportion of SLE patients with MeS presented almost mild depression (p 0.03). We found to be physically inactive, according to IPAQ score, the majority of SLE patients with MeS compared to patients without MeS (p<0.0001). In multiple logistic regression, factors related to MeS were the Number of flares in the previous one year [OR (95% CI) 13.7 (1.7–107.8)], to have a BDI>13 (to have almost mild depression) [OR 0.05 (0.004–0.87)] and to be physically inactive (IPAQ=1) [OR 33.5 (2.3–496.4)].
Conclusions HR-QoL seems to be compromised in SLE patients with MeS, especially in mental components. Moreover, SLE patients with MeS often presented depression, are burdened by more severe fatigue and frequently are physically inactive. The presence of MeS in SLE was associated to the number of flare and, above all, to the physical inactivity, while not having depression seems exert a protective effect on MeS.
Disclosure of Interest None declared