Background Although the treatments for systemic lupus erythematosus (SLE) are improving, patients continue to report pain, affected hand function, fatigue resulting in disability in daily life and reduced quality of life. Almost 2/3 of the patients report activity limitations at home or at work. To be able to optimize the rehabilitation efforts for SLE patients, the knowledge about what is related to activity limitations needs to be scrutinized.
Objectives The aim was to identify what measures can explain variations in activity limitations in SLE.
Methods We included 207 patients (90% women) diagnosed with SLE according to the 1982 American College of Rheumatology (ACR) classification criteria (81%) or the Fries (ANA positive + ≥2 typical organ manifestations) criteria (19%). 193/207 individuals (93%) were Caucasian.
Data concerning demographics (age, disease duration), disease variables (blood cell counts, ESR, CRP, C3, C4, C3d, creatine kinase, creatinine, urinalysis, anti-dsDNA antibodies), medication (DMARDs, prednisolone), disease phenotype (ACR criteria), organ damage and disease activity (SLICC/ACR damage index, SLEDAI, modified SLEDAI, physician’s global assessment), and self-reported health (pain intensity, EQ5D, wellbeing) were collected at regular follow-ups. Activity limitations in daily life was measured with the Swedish version of the Health Assessment Questionnaire (HAQ). The study is cross-sectional, based on data from the latest follow up in 2011, including 117 patients with a HAQ score >0.
Potential predictors of HAQ were organized into three groups; demographic, disease variables and self-reported health. The analysis was made in 3 steps. In step one the correlations (Pearson) between the potential predictors with HAQ were examined. In the second step the predictors correlating significantly with HAQ were entered into groupwise linear regression analyses based on the groups demographics, disease variables and self-reported health. In the final step all of the significant predictors from step two were entered into a final linear regression model. Results show how much of the variance in HAQ could be explained by all 3 groups together.
Results Of the 117 patients, 38% were prescribed antimalarials (AM) alone, 34% had other DMARDs ± AM and 71% prednisolone. Mean HAQ score was 0.73 (SD 0.62). HAQ was significantly correlated with age, age at SLE debut, SLICC/ACR damage index, pain intensity, EQ5D and wellbeing. Demographics, disease variables and disability variables could explain 8.3%, 24.2% and 34.7% of the variance in HAQ respectively. In total, 45.6% of the variance in HAQ could be explained.
Conclusions The variation in activity limitations as measured by HAQ was mostly explained by self-reported health measures and the SLICC/ACR damage index, which indicates the importance of an early diagnosis and a highlighting of the patients’ own experience of the disease in a multiprofessional treatment.
Disclosure of Interest None Declared
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