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Abstract
Objective Optimisation of health-related quality of life (HRQoL) is among goals of treatment in SLE. The Lupus Low Disease Activity State (LLDAS) has received attention as a goal whenever remission cannot be achieved. How SLE activity, organ damage, and LLDAS attainment relate to patient-reported outcomes (PROs) is not fully explored, which formed the scope of this investigation.
Methods We included 327 patients with SLE from a tertiary referral centre. Longitudinal registrations of disease activity using SLEDAI-2K and physician global assessment (PhGA), organ damage using the SLICC/ACR damage index (SDI), pharmacotherapies, HRQoL using EQ-5D-3L, as well as visual analogue scale (VAS) scores for fatigue, pain, and overall SLE-related health state over a median follow-up time of 8.5 years were analysed. Incident cases (N=90) were followed for 4.3 years (median), and 86 patients with moderately/highly active, autoantibody-positive SLE were followed for 5.2 years (median).
Results LLDAS was associated with favourable HRQoL by EQ-5D-3L (0.062; 95% CI 0.038–0.086). Increasing cSLEDAI-2K and PhGA were associated with decreasing EQ-5D-3L values (-0.009; 95% CI 0.005–0.013 and -0.064; 95% CI 0.048–0.080, respectively). Results were similar for incident cases and patients with moderately/highly active, autoantibody-positive disease. Increasing prednisone equivalent dose was associated with decreases in HRQoL on all PROs. Sustained LLDAS enhanced HRQoL by EQ-5D-3L (0.042; 95% CI 0.013–0.071) compared with not being in LLDAS or being in LLDAS for less than 18 consecutive months. Increasing SDI scores were associated with lower EQ-5D-3L values in the full population (-0.037; 95% CI 0.025–0.049), but not in incident cases or patients with moderately/highly active, autoantibody-positive disease. Advancing SDI scores were also associated with higher pain and worse overall SLE-related health state, but not fatigue. In fully adjusted models, low disease activity and being in LLDAS were associated with favourable PROs irrespective of organ damage or any history of antidepressant use.
Conclusion In one of the longest to date observational studies, we demonstrated that low disease activity and being sustainedly in LLDAS were coupled with favourable HRQoL, pain, fatigue, and overall health experience, irrespective of organ damage.
Acknowledgement This work was sponsored by AstraZeneca AB.
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