Purpose To investigate the prevalence and main determinants of cognitive dysfunction, anxiety and depression in a cohort of patients with Systemic Lupus Erythematosus (SLE); to explore the coping strategies and impact of these disorders on quality of life and function.
Methods This observational cross-sectional study recruited patients of the University of Campania ‘Luigi Vanvitelli’, from February 4th to April 4h, 2022, who were diagnosed with SLE according to the Systemic Lupus International Collaborating Clinics (SLICC) Criteria. Demographic and clinical data, disease activity (SLEDAI-2k), damage (SDI) and concomitant therapies were analyzed. The definitions for remission (DORIS) and ‘Lupus Low Disease Activity State’ (LLDAS) were applied. At enrollment, each patient underwent a psychiatric evaluation completing the following questionnaires: Hamilton Depression and Anxiety Rating Scales (HAM-D, HAM-A), Montreal Cognitive Assessment (MoCA) and Coping Orientation to Problems Experienced (COPE) Inventory. Health Assessment Questionnaire-Disability Index (HAQ-DI) was also performed. The Spearman test was used for linear correlation. Multivariate analysis was performed by multiple linear and logistic regression.
Results 61 consecutive patients with SLE were enrolled, the majority female (88%) and Caucasian with a mean age of 46 years. 70% were in remission or in LDA. The prevalence of cognitive dysfunction was 65%, executive function and memory were the most affected domains. We found isolated anxiety in 3% and isolated depression in 50.7% of patients, even if mild. Regarding coping strategies, SLE patients reported higher scores on emotion-focused coping, with respect to the other two coping strategies (p< 0,001). Pearson’s correlation analysis highlighted a relationship between higher levels of cognitive impairment and worse quality of life (r = -0.38, p = 0.002) and between hypocomplementemia and depression (r=-0,25; P=0,04). AntidsDNA antibody positivity was slightly significant (r=0,22; P=0,08). Our analysis also highlighted a positive correlation between emotion-focused and avoidance-focused strategies (0.43;P=0.0005). In the multivariate analysis, higher scores on the HAM-D questionnaire (higher levels of depression) were found to be independently associated with higher HAQ score (OR:1.2; p=0.03). Moreover, patients with active disease tend to be more depressed compared to patients in LDA or in remission (p : 0.04).
Fibromyalgia was independently associated with depression (OR: 3.85 p : 0.03). Depression was found to be significantly linked to patients’ worse quality of life, irrespective of disease activity (OR:1.19; p=0.01). Depression, anxiety and fibromyalgia were not associated with objective cognitive dysfunction.
Conclusion Our study confirms the high prevalence of cognitive dysfunction and depressive symptoms in SLE patients and determine a strong negative impact on function and quality of life.
In the context of a multidisciplinary management, collaboration with clinical psychologists should be considered, to improve both coping strategies, patients’ perception of health status and quality of life.
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