Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
Lupus. 2019 Sep;28(10):1189-1196. doi: 10.1177/0961203319862614. Epub 2019 Jul 15.
The objective of this study was to determine the association between disease activity status and health-related quality of life (HRQoL) in systemic lupus erythematosus (SLE) patients.
SLE patients in an out-patient clinic during the previous 12 months were included in the study. The Systemic Lupus Erythematosus-specific Quality-of-Life questionnaire (SLEQoL) was administered at the last visit. Disease activity status was determined retrospectively during the previous year. The categories of disease activity status were defined as: clinical remission (CR): clinical quiescent disease according to Systemic Lupus Erythematosus Disease Activity Index 2000, prednisolone ≤ 5 mg/day; low disease activity (LDA): SLEDAI-2K (without serological domain) ≤ 2, prednisolone ≤ 7.5 mg/day; and non-optimally controlled status: for those who were not in CR/LDA. Immunosuppressive drugs (maintenance dose) and antimalarials were allowed. Prolonged CR or LDA was defined as those with sustained CR or LDA for at least one year. The association between disease activity status and HRQoL was assessed by using regression analysis adjusting for other covariates.
Of 237 SLE patients, 100 patients (42.2%) achieved prolonged CR, 46 patients (19.4%) achieved prolonged LDA and 91 patients (38.4%) were not in CR/LDA. Non-CR/LDA patients had significantly higher total SLEQoL score and in all domains compared to CR/LDA patients. No significant difference in SLEQoL domain scores was found between CR and LDA groups. Multivariable analysis revealed that non-CR/LDA was positively associated with SLEQoL score compared with CR/LDA (β 20.02, 95% confidence interval (CI) 6.81-33.23, < 0.003). Moreover, non-CR/LDA was at a higher risk of impaired QoL (SLEQoL score > 80) compared with CR (hazard ratio 3.8; 95% CI 1.82-7.95; < 0.001). However, there was no significant difference between CR and LDA in terms of SLEQoL score or impaired QoL. Other factors associated with higher SLEQoL score were damage index (β 9.51, 95% CI 3.52-15.49, = 0.002) and anemia (β 24.99, 95% CI 5.71-44.27, = 0.01).
Prolonged CR and LDA are associated with better HRQoL in SLE patients and have a comparable effect. Prolonged CR or optional LDA may be used as the treatment goal of a treat to target approach in SLE.
本研究旨在确定系统性红斑狼疮（SLE）患者的疾病活动状态与健康相关生活质量（HRQoL）之间的关联。
本研究纳入了过去 12 个月内在门诊就诊的 SLE 患者。在最后一次就诊时使用系统性红斑狼疮生活质量问卷（SLEQoL）进行评估。疾病活动状态在过去一年中进行回顾性评估。疾病活动状态的分类定义为：临床缓解（CR）：根据系统性红斑狼疮疾病活动指数 2000，临床静止性疾病，泼尼松龙≤5mg/天；低疾病活动度（LDA）：SLEDAI-2K（无血清学域）≤2，泼尼松龙≤7.5mg/天；非最佳控制状态：不符合 CR/LDA 的患者。允许使用免疫抑制剂（维持剂量）和抗疟药。延长的 CR 或 LDA 定义为持续 CR 或 LDA 至少一年。通过回归分析调整其他协变量来评估疾病活动状态与 HRQoL 之间的关联。
在 237 例 SLE 患者中，100 例（42.2%）患者达到延长的 CR，46 例（19.4%）患者达到延长的 LDA，91 例（38.4%）患者未达到 CR/LDA。与 CR/LDA 患者相比，非 CR/LDA 患者的总 SLEQoL 评分和所有领域的评分均明显更高。CR 组和 LDA 组在 SLEQoL 各领域的评分无显著差异。多变量分析显示，与 CR/LDA 相比，非 CR/LDA 与 SLEQoL 评分呈正相关（β20.02，95%置信区间（CI）6.81-33.23， < 0.003）。此外，与 CR 相比，非 CR/LDA 患者的生活质量受损（SLEQoL 评分>80）的风险更高（风险比 3.8；95%CI 1.82-7.95； < 0.001）。然而，CR 和 LDA 在 SLEQoL 评分或生活质量受损方面无显著差异。与更高的 SLEQoL 评分相关的其他因素包括损伤指数（β9.51，95%CI 3.52-15.49， = 0.002）和贫血（β24.99，95%CI 5.71-44.27， = 0.01）。
延长的 CR 和 LDA 与 SLE 患者的 HRQoL 更好相关，且具有相似的效果。延长的 CR 或可选的 LDA 可作为 SLE 靶向治疗的治疗目标。
