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  1. F. Natalucci1,
  2. F. Ceccarelli1,
  3. C. Massari1,
  4. C. Pirone1,
  5. G. Olivieri1,
  6. V. Orefice1,
  7. L. Picciariello1,
  8. C. Ciancarella1,
  9. C. Garufi1,
  10. S. Mancuso1,
  11. S. Truglia1,
  12. F. R. Spinelli1,
  13. C. Alessandri1,
  14. F. Conti1
  1. 1Sapienza University of Rome, Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Rome, Italy


Background Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by a wide spectrum of manifestations, potentially involving every system. This heterogeneity may influence different aspects of patients’ daily life, including physical ability, working and social life, thus impacting the quality of life (QoL). Among all the SLE-related manifestations, cutaneous involvement may lead to insecurity and isolation, negatively resulting in QoL.

Objectives The aim of the present study was to analyse the QoL in a SLE cohort, determining the potential influence of disease activity, chronic damage, comorbidities, and mood disorders.

Methods We enrolled consecutive SLE patients, diagnosed according to 2019 ACR/EULAR criteria. Clinical and laboratory data were collected, and disease activity and chronic damage were assessed by SLEDAI-2k and SDI. As controls, we enrolled patients affected by Discoid Lupus Erythematosus (DLE) and Undifferentiated Connective Tissue Disease (UCTD). The fibromyalgia diagnosis was made according to the 2016 ACR Classification Criteria. Quality of life was evaluated by using the Lupus Quality of Life questionnaire (LupusQoL); furthermore, each patient filled out the Hospital Anxiety and Depression Scale (HADS) questionnaire.

Results We enrolled 237 SLE patients (M/F 18/219; median age 46 years [IQR 19.5], median disease duration 156 months [IQR 180]), 24 CLE patients (M/F 5/19; median age 61.5 years [IQR 29.5], median disease duration 92.1 months, [IQR 128.5]). and 25 UCTD (M/F 1/24; median age 40 years, [IQR 21.25]; median disease duration 66 months [QR 103.9]). In SLE patients the median SLEDAI-2k value was 0 (IQR 2) and the SDI was 0 (IQR 1). Fibromyalgia was diagnosed in 69 SLE patients (29.1%), 5 CLE (20.8%), and 7 UCTD (28%). The comparison among these three groups of patients revealed for SLE and CLE patients a significantly lower mean values in the LupusQoL domain related to Body Image (BI) (73.9±27.7 and 71.3±30.9, respectively) compared to UCTD patients (87.2±19.0) [p=0.01 and p=0.03, respectively]. Focusing on SLE patients, females showed significantly lower mean values compared to males for almost all domains: Pain (P, [p=0.02]), Intimate Relationship (IR; [p=0.001]), Burden to Others (BtO [p=0.029]), Emotional Health (EH; [p=0.012]), Body Image (BI; [p=0.033]) and Fatigue (F; [p=0.002]). As expected, fibromyalgia patients had lower values in all the domains of the LupusQoL when compared to patients without this condition (p<0.001 for all comparisons, except for BI p=0.006). Moreover, as reported in Figure 1, SDI values negatively correlated with all the LupusQoL domains (Figure 1A); conversely, we found a positive correlation between SDI and both HADS domains (Anxiety [r=0.16; p=0.015]; Depression [r=0.21; p=0.0009]). As expected, a strong negative correlation was identified between LupusQoL score in each domain and both Anxiety [(BH r=-0,58, P p=-0.53, Planning p=-0.52, IR p=-0.62, EH= -0.75, BI= -0.52, F=-0.64, BtO r=-0.62); p < 0.0001 for all the analysis] and Depression [(BH r=-0,61, P p=-0.58, Planning p=-0.63, IR p=-0.61, EH= -0.55, BI= -0.60, F=-0.69, BtO r=-0.55]; p < 0.0001 for all the analysis).

Conclusion The presented results confirmed the negative impact of SLE on the quality of life. Among the analyzed variables, female sex and fibromyalgia deeply influenced the outcome. The chronic damage showed to be one of the main determinants of impairment of the QoL in SLE patients and of the development of Anxiety and Depression, measured through the HADS questionnaire. Lastly, Anxiety and Depression may contribute to the worst QoL in SLE, underlying the need for comprehensive evaluation and management of the SLE-associated comorbidities.

Figure 1.

Correlations between HADS and LupusQoL domains


Acknowledgements: NIL.

Disclosure of Interests None Declared.

  • Quality of life
  • Patient reported outcomes
  • Systemic lupus erythematosus

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