Background Systemic Lupus Erythematosus (SLE) is a chronic multisystemic autoimmune pathology of unknown etiology with a variable course and a predilection for women of reproductive age. Chronic activity and flares of disease activity are correlated with greater damage accrual and mortality. Mortality and health-related quality of life (HR-QoL) are higher in SLE patients when compared to general population. Damage accrual, duration of the disease, disease activity and involvement of specific organ systems, might relate to worse HR-QoL in SLE. A worse perception of health is associated with a higher damage accrual over time.
Methods A retrospective cohort of SLE patients (ACR 1997 or SLICC 2012 classification criteria), followed for at least 1 year, between 2015 and 2017 in a specialized center was analyzed. Activity evaluated by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), damage accrual by SLICC/ACR damage index (SDI) and HR-QoL by EQ-5D were measured. Bivariate analysis through chi squared and U Mann Whitney Multivariate analysis was performed by logistic regression to adjust for significant associations. Statistical analysis for related samples was evaluated with Mc. Nemar test.
Results We analyzed 400 Colombian patients. Baseline median age was 49 years (15 IQR) with median age at diagnosis and disease duration of 37 years (17 IQR) and 9 years (13 IQR) respectively. There were 94% female patients and 17.3% late onset SLE. Most frequent clinical manifestations were hematological (82.8%), mucocutaneous (75.3%) and nephritis (33.8%). Only 4.5% had neurological involvement. The mean SLEDAI were 1.18 and 0.65 at first and second measurement respectively, in the first measurement 97.1% of the patients had a SLEDAI ≤4. The mean SDI was 0.7275 at first measurement and 0.985 at the second measurement. Although SDI was associated to various dimensions of HR-QoL measured by ED-5D, disease activity was not related (See table 1).
Conclusions In SLE Colombian patients with a stablished disease and an altered HR-QoL, low disease activity is not related with HR-QoL when measured by EQ-5d. In the present study, it is highlighted that while disease activity decreases, damage increases. Damage accrual has a relation with HR-QoL in the short term. The impact and correlation must be better defined in a long-term follow-up. The associated effect on HRQOL emphasizes the need for strategies to reduce the risk of cumulative organ damage.
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