Emory University, Atlanta, Georgia.
Edward Via College of Osteopathic Medicine, Spartanburg, South Carolina.
Arthritis Care Res (Hoboken). 2018 Oct;70(10):1469-1477. doi: 10.1002/acr.23507. Epub 2018 Aug 27.
To use multidomain functional assessment, which is commonly performed in geriatric patients but is novel in patients with systemic lupus erythematosus (SLE), to better understand functional impairment in patients with SLE.
We recruited 60 adult participants (aged 20-39 years [26.7%], 40-59 years [50.0%], and ≥60 years [23.3%]; 80.0% African American and 90.0% female) from an existing cohort of SLE patients. During in-person visits (from October 2016 to April 2017), we evaluated physical performance (range 0-4, with higher scores indicating better performance), cognitive performance (5 fluid cognition domains; adjusted T scores), and self-reported measures including physical functioning (T scores), activities of daily living (ADLs), falls, and life-space mobility.
In the SLE patients, the mean balance score (3.7) and gait speed score (3.4) were high, while the mean lower body strength score was low (1.8). Cognitive performance was average (score of 5.0) for episodic (47.7) and working (48.6) memory and low average for cognitive flexibility (43.7), processing speed (42.6), and attention/inhibitory control (38.8 [>1 SD below average]) when compared with healthy individuals of the same age, sex, race, ethnicity, and education level. Most participants reported the ability to independently perform basic ADLs, but many reported the inability to independently perform instrumental ADLs. Nearly half (45.0%) of participants reported falling in the prior year. Only 40.0% reported unlimited ability to travel without the help of another person. Scores generally did not differ substantially according to age.
Our results suggest a high prevalence of impairment across multiple domains of function in SLE patients of all ages, similar to or exceeding the prevalence observed in much older geriatric populations. Further research into the added value of geriatric assessment in routine care for SLE is warranted.
使用多领域功能评估，这种评估在老年患者中很常见，但在系统性红斑狼疮（SLE）患者中是新颖的，以更好地了解 SLE 患者的功能障碍。
我们从现有的 SLE 患者队列中招募了 60 名成年参与者（年龄 20-39 岁[26.7%]，40-59 岁[50.0%]和≥60 岁[23.3%]；80.0%为非裔美国人，90.0%为女性）。在面对面访问期间（2016 年 10 月至 2017 年 4 月），我们评估了身体表现（范围 0-4，分数越高表示表现越好），认知表现（5 个流体认知域；调整后的 T 分数）和自我报告的测量结果，包括身体功能（T 分数），日常生活活动（ADL），跌倒和生活空间移动。
在 SLE 患者中，平衡评分（3.7）和步态速度评分（3.4）较高，而下半身力量评分较低（1.8）。认知表现平均（5.0 分），与年龄，性别，种族，民族和教育水平相同的健康个体相比，情景（47.7）和工作（48.6）记忆较低，认知灵活性（43.7），处理速度（42.6）和注意力/抑制控制（38.8[低于平均水平 1 SD]）较低。大多数参与者报告说他们能够独立完成基本的 ADL，但许多人报告说他们无法独立完成工具性 ADL。近一半（45.0%）的参与者报告在过去一年中跌倒。只有 40.0%的人报告说无需他人帮助即可无限出行。根据年龄，分数通常没有太大差异。
我们的结果表明，所有年龄段的 SLE 患者的功能障碍在多个领域都普遍存在，与在年龄较大的老年人群中观察到的发生率相似或更高。进一步研究在 SLE 常规护理中使用老年评估的附加值是合理的。
