Original articleInverse correlation of each functional status scale of the SF-36 with degree of disease activity in systemic lupus erythematosus (m-SLAM)
Introduction
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease associated with a significant impairment of the quality of life. The improvement of survival and morbidity in SLE, which can be attributed to advances in therapy and recognition of milder cases, has not been paralleled by improvement in quality of life [1], [2]. Assessment of this disease has traditionally involved recording ongoing disease activity and cumulative damage over time. Therefore, most therapeutic trials focus on amelioration of disease activity and preventing organ damage.
Assessment of the quality of life as an outcome measure in SLE is now recognized as an essential component in the evaluation of SLE, particularly in the outpatient setting, where patients are less acutely ill. In this SLE population, traditional laboratory indicators of disease activity tend to be less helpful in guiding therapeutic modifications. In fact, one may consider functional status as a primary outcome measure, especially when there is no serious specific organ involvement. Of the several health status instruments that have been studied in SLE, the Medical Outcomes Study Short Form 36 (SF-36) is particularly important [3]. The SF-36 is a generic health/functional status instrument designed to measure the impact of disease on the patient’s physical, social, and psychological functions and is an internationally accepted tool for the assessment of health status. Comparisons of the SF-36 scales with the general health and quality of life scales have revealed positive and significant correlations [4]. Studies from different countries have validated its use in SLE [3], [5]. The objective of this study is to further assess this association prospectively by grading disease activity in groups (remission, mild, moderate, and severe) and correlating these with each of the eight functional domains of the SF-36.
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Setting
This study was carried out in the outpatient Rheumatology Section of Ochsner Clinic in New Orleans, a large multispecialty, private clinic that serves the greater New Orleans area and a regional referral center. The study was approved by the Ochsner Medical Foundation Clinical Investigations Committee.
Patients
Patients attending the rheumatology clinic on scheduled appointments, who fulfilled the American College of Rheumatology criteria for the diagnosis of SLE, were offered the opportunity to
Patient demographics (Table 1)
Complete data were available for 209 visits (86.4%) of the 242 clinic visits. The mean age of the participants (45 years) was slightly lower than that of the nonparticipants (50 years) (P < 0.05). Females comprised 94.4% of the study group, which was slightly higher than the percentage of females (84.5%) in the nonparticipating group (P < 0.05). Fifty-two percent of the participants were white, 42% were African-American, and 6% were of other races. There was no difference in the races of the
Discussion
This cross-sectional study of 242 consultations of 71 lupus patients demonstrates a significant negative correlation between the degree of lupus activity, as assessed by the modified SLAM, and patient perceived health status quality of life as measured by the eight subscales of the SF-36. To affect favorably the quality of life in patients with lupus, it is necessary to identify the variables that contribute to poor quality of life. This study showed that slight differences in m-SLAM disease
Conclusion
The significant inverse correlation of the modified SLAM with all domains of the SF-36 in this study provides potentially useful information for evaluating patients with SLE. Therapeutic interventions that are currently directed towards an objective reduction of lupus activity as measured by the m-SLAM would be expected to favorably enhance the quality of life and health perception.
Proof of this hypothesis would require a prospective randomized control trial of the particular treatment. Our
References (9)
- et al.
Consistency and validity of patient administered assessment of quality of life by the MOS SF-36; its association with disease activity and damage in patients with systemic lupus erythematosus
J Rheumatol
(1997) Disease activity, cumulative damage and quality of life in systematic lupus erythematosus: results of a cross-sectional study
Lupus
(1997)- et al.
Health status in systemic lupus erythematosus compared to rheumatoid arthritis and healthy controls
J Rheumatol
(1999) - et al.(1993)