Health-related quality of life and its associated factors in patients with systemic lupus erythematosus attending the Rheumatology Clinic at the National Hospital of Sri Lanka

Background: The aim of this study was to assess the health-related quality of life (HRQoL) and its associated factors in Systemic Lupus Erythematosus (SLE) patients attending the Rheumatology Clinic at the National Hospital of Sri Lanka.
Methods: A cross-sectional study was conducted in patients who were diagnosed with SLE based on 2012 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) criteria. The Short Form 36 health survey questionnaire (SF-36) which scores 0-100 for each of eight domains and summarised as Physical Component Summary (PCS) and Mental Component Summary (MCS), with higher values indicating better functions and an interviewer-administered questionnaire comprising Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2k) 30-day score, Systemic Lupus Erythematosus Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index, and sociodemographic data were used to collect data. A SLEDAI score of less than 6 was considered as “mild disease activity” while a score equal or higher than 6 was considered as “moderate to high disease activity“. SLICC damage index of 0 was considered as “no damage“ and > 0 was considered as “damage present“. Descriptive statistics, Pearson correlation coefficient (r) (r 0.0- 0.3 - No correlation, r 0.3-0.5 weak, r 0.5 - 0.7 moderate, r >0.7 strong), and Student T-Test were used for data analysis.
Results: Sixty participants were recruited from consecutive sampling, predominantly female (98.3%), with a mean age of 36.1 years (SD 12.96) and a mean disease duration of 6.01 years (SD 5.67). Forty-six (76.7%) of them had mild disease activity with a mean SLEDAI score of 5.08 (SD 8.39) and a mean SLICC damage index of 1.4(SD 1.21). Among the eight domains of SF-36 HRQoL of the total study group, the lowest score was in the general health domain with a mean value of 45.36 (SD 22.78), and the highest was in the social wellbeing domain at 74.01 (SD 26.53). The mean Physical Component Summary score (56.59, SD 27.04) was lower than the mean Mental Component Summary score of 65.69 (SD 25.08). Patients with moderate to high disease activity scored significantly lower (p<0.05) in all HRQoL domains and summary components compared to patients with mild disease activity. Physical and mental summary components negatively correlated with age (PCS r= -0.48, MCS r= -0.40) and Erythrocyte Sedimentation Rate (ESR) (PCS r = -0.38, MCS r = -0.39).
Conclusions: The disease had a negative impact on the quality of life of SLE patients with a higher disease activity causing a significant reduction in all aspects of HRQoL. Thus, actively assessing HRQoL, specially in those with above risks and managing accordingly will help to improve the overall outcome of SLE patients.