Karlson E W, Daltroy L H, Lew R A, Wright E A, Partridge A J, Fossel A H, Roberts W N, Stern S H, Straaton K V, Wacholtz M C, Kavanaugh A F, Grosflam J M, Liang M H
Harvard Medical School, Boston, MA, USA.
Arthritis Rheum. 1997 Jan;40(1):47-56. doi: 10.1002/art.1780400108.
To study the relationship of race, socioeconomic status (SES), clinical factors, and psychosocial factors to outcomes in patients with systemic lupus erythematosus (SLE).
A retrospective cohort was assembled, comprising 200 patients with SLE from 5 centers. This cohort was balanced in terms of race and SES. Patients provided information on socioeconomic factors, access to health care, nutrition, self-efficacy for disease management, health locus of control, social support, compliance, knowledge about SLE, and satisfaction with medical care. Outcome measures included disease activity (measured by the Systemic Lupus Activity Measure), damage (measured by the SLICC/ACR damage index), and health status (measured by the SF-36).
In multivariate models that were controlled for race, SES, center, psychosocial factors, and clinical factors, lower self-efficacy for disease management (P < or = 0.0001), less social support (P < 0.005), and younger age at diagnosis (P < 0.007) were associated with greater disease activity. Older age at diagnosis (P < or = 0.0001), longer duration of SLE (P < or = 0.0001), poor nutrition (P < 0.002), and higher disease activity at diagnosis (P < 0.007) were associated with more damage. Lower self-efficacy for disease management was associated with worse physical function (P < or = 0.0001) and worse mental health status (P < or = 0.0001).
Disease activity and health status were most strongly associated with potentially modifiable psychosocial factors such as self-efficacy for disease management. Cumulative organ damage was most highly associated with clinical factors such as age and duration of disease. None of the outcomes measured were associated with race. These results suggest that education and counseling, coordinated with medical care, might improve outcomes in patients with SLE.
研究种族、社会经济地位（SES）、临床因素和心理社会因素与系统性红斑狼疮（SLE）患者预后的关系。
组建了一个回顾性队列，包括来自5个中心的200例SLE患者。该队列在种族和SES方面保持平衡。患者提供了有关社会经济因素、医疗保健可及性、营养、疾病管理自我效能感、健康控制点、社会支持、依从性、SLE知识以及对医疗保健满意度的信息。结局指标包括疾病活动度（通过系统性狼疮活动度量表测量）、损伤（通过SLICC/ACR损伤指数测量）和健康状况（通过SF-36测量）。
在对种族、SES、中心、心理社会因素和临床因素进行控制的多变量模型中，疾病管理自我效能感较低（P≤0.0001）、社会支持较少（P<0.005）以及诊断时年龄较小（P<0.007）与更高的疾病活动度相关。诊断时年龄较大（P≤0.0001）、SLE病程较长（P≤0.0001）、营养状况较差（P<0.002）以及诊断时疾病活动度较高（P<0.007）与更多的损伤相关。疾病管理自我效能感较低与较差的身体功能（P≤0.0001）和较差的心理健康状况（P≤0.0001）相关。
疾病活动度和健康状况与潜在可改变的心理社会因素如疾病管理自我效能感密切相关。累积器官损伤与年龄和疾病病程等临床因素高度相关。所测量的结局均与种族无关。这些结果表明，与医疗护理相协调的教育和咨询可能会改善SLE患者的预后。
