Musculoskeletal manifestations as determinants of quality of life impairment in patients with systemic lupus erythematosus

Abstract

Objective The objective of this study was to identify determinants of health-related quality of life (HRQoL) impairment in patients with systemic lupus erythematosus (SLE). Methods Overall, 101 SLE patients were recruited; 37 healthy subjects and 35 rheumatoid arthritis (RA) patients served as controls. HRQoL was evaluated using three patient reported outcomes (PROs): the Short Form-36 version 2 (SF-36v2) health survey, the fatigue scale version 4 (FACITv4) and the Heath Assessment Questionnaire (HAQ). A large set of demographic and clinical variables, including SLE arthritis subtypes, was evaluated searching for factors independently associated with worse QoL. Multivariate models were applied to identify factors independently associated with outcomes. Bonferroni's corrected p values < 0.05 were considered significant. Results SLE patients showed worse results than healthy controls ( p < 0.01) in all SF-36v2 domains and, with reference to the mental QoL, also than RA patients ( p < 0.01). Jaccoud's deformities, active arthritis, and fibromyalgia were the only factors independently associated with worse results in both physical and mental components summary of the SF-36v2 ( p < 0.01) and FACITv4 fatigue scale ( p < 0.01). Fragility fractures, deformities, and active arthritis negatively affected disability perception measured by the HAQ ( p < 0.01). No statistically significant differences in perceived HRQoL were highlighted between patients with deforming and erosive arthritis. However, they had significantly worse results than patients with non-deforming non-erosive arthritis across all investigated PROs ( p < 0.01). Conclusion In order to limit musculoskeletal manifestations as a source of impaired QoL in SLE patients, therapeutic strategies targeted to successfully manage active arthritis and fibromyalgia and to prevent deforming damage are needed.

Jaccoud’s arthropathy in SLE: findings from a Latin American multiethnic population

“…Its aetiology has not been clarified, but it has been associated with clinical and laboratory manifestations, such as cardiac involvement, sicca syndrome and antiphospholipid antibody positivity 5 6. Likewise, JA negatively affects the quality of life of affected patients 7…”

Musculoskeletal Manifestations of Non-RA Connective Tissue Diseases: Scleroderma, Systemic Lupus Erythematosus, Still's Disease, Dermatomyositis/Polymyositis, Sjögren's Syndrome, and Mixed Connective Tissue Disease

“…27 Musculoskeletal involvement is a frequent onset manifestation (50% of patients) and remains a heavy burden on quality of life. 28,29 Morning stiffness, symmetrical polyarthritis, tenosynovitis, tendon rupture, and myalgia can be observed. Avascular necrosis is common and frequently asymptomatic.…”

The effect of therapies on the quality of life of patients with systemic lupus erythematosus: a meta-analysis of randomized trials

“…Systemic lupus erythematosus (SLE) is a chronic, autoimmune, multisystemic inflammatory disease that can cause skin lesions, inflammation of the joints and membranes that cover the lungs and heart, nephritis, cardiovascular, hematological, gastrointestinal and neuropsychiatric disorders. In this way, the symptoms can appear slowly and progressively or quickly and vary with phases of activity and remission [1], which may impair performance in daily activities, leading to impairment of quality of life (QoL).…”