Elefante Elena, Tani Chiara, Stagnaro Chiara, Signorini Viola, Lenzi Beatrice, Zucchi Dina, Trentin Francesca, Carli Linda, Ferro Francesco, Mosca Marta
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Front Med (Lausanne). 2022 Mar 29;9:859840. doi: 10.3389/fmed.2022.859840. eCollection 2022.
To analyze the prevalence of self-reported anxiety and depression in a monocentric cohort of patients with Systemic Lupus Erythematosus (SLE); to study the main determinants and the impact on quality of life (QoL).
A cross-sectional observational study including adult outpatients with SLE. Demographic and clinical data were analyzed: indices of disease activity (SELENA-SLEDAI); damage (SLICC-DI); comorbidities and concomitant therapies. The definitions for remission (DORIS) and "Lupus Low Disease Activity State" (LLDAS) were applied. At enrollment, each patient completed the following questionnaires: SF-36, FACIT-Fatigue, Lupus Impact Tracker (LIT), Systemic Lupus Activity Questionnaire (SLAQ), and the Hospital Anxiety and Depression Scale (HADS) in order to self-assess anxiety and depression symptoms. The Student -test and Chi tests were conducted for univariate analysis. The Spearman test was used for linear correlation between continuous data. Multivariate analysis was performed by multiple linear and logistic regression.
One hundred fifty-four consecutive patients with SLE were enrolled, the majority female and Caucasian with a mean age = 43.3 ± 13.7 years. 79.9% were in LLDAS or remission. 36.4% had a SDI > 1. 13.7% of patients had concomitant fibromyalgia. 37.4% had symptoms indicating anxiety and 25% of depression according to the HADS questionnaire. In the multivariate analysis, patients with active disease were significantly more anxious and depressed ( < 0.01) compared to patients in LLDAS or remission. Fibromyalgia and older age were independently associated with anxiety and depression, respectively ( < 0.05). Active skin involvement was significantly linked to depression ( < 0.05). Higher scores on the HADS questionnaire (higher levels of anxiety and depression) were found to be significantly linked to patients' perception of higher disease activity and worse quality of life, irrespective of disease activity, age and fibromyalgia.
Symptoms of anxiety and depression are frequent in SLE patients, including outpatients with mild/moderate disease. Such symptoms have a significant negative impact on QoL and perception of disease activity, regardless of other factors. Moreover, disease activity, advanced age and fibromyalgia appear to be significantly linked to mood disorders. Assessing symptoms of the anxious-depressive spectrum in patients with SLE could lead to improvement in patients' perception of health status and quality of life.
分析单中心系统性红斑狼疮（SLE）患者队列中自我报告的焦虑和抑郁患病率；研究主要决定因素及其对生活质量（QoL）的影响。
一项横断面观察性研究，纳入成年SLE门诊患者。分析人口统计学和临床数据：疾病活动指数（SELENA-SLEDAI）；损伤（SLICC-DI）；合并症和伴随治疗。应用缓解（DORIS）和“狼疮低疾病活动状态”（LLDAS）的定义。在入组时，每位患者完成以下问卷：SF-36、FACIT-疲劳量表、狼疮影响追踪器（LIT）、系统性狼疮活动问卷（SLAQ）以及医院焦虑抑郁量表（HADS），以自我评估焦虑和抑郁症状。进行Student检验和卡方检验用于单因素分析。Spearman检验用于连续数据之间的线性相关性分析。多因素分析通过多元线性和逻辑回归进行。
连续纳入154例SLE患者，大多数为女性和白种人，平均年龄 = 43.3 ± 13.7岁。79.9%处于LLDAS或缓解状态。36.4%的患者SDI > 1。13.7%的患者合并纤维肌痛。根据HADS问卷，37.4%的患者有焦虑症状，25%有抑郁症状。在多因素分析中，与处于LLDAS或缓解状态的患者相比，疾病活动期患者焦虑和抑郁程度显著更高（< 0.01）。纤维肌痛和高龄分别独立与焦虑和抑郁相关（< 0.05）。皮肤受累活跃与抑郁显著相关（< 0.05）。发现HADS问卷得分较高（焦虑和抑郁水平较高）与患者对更高疾病活动度和更差生活质量的感知显著相关，无论疾病活动度、年龄和纤维肌痛情况如何。
SLE患者中焦虑和抑郁症状很常见，包括轻度/中度疾病的门诊患者。这些症状对生活质量和疾病活动度感知有显著负面影响，与其他因素无关。此外，疾病活动度、高龄和纤维肌痛似乎与情绪障碍显著相关。评估SLE患者的焦虑抑郁谱症状可能会改善患者对健康状况和生活质量的感知。
