title: Effect of disease activity and damage on quality of life in patients with systemic lupus erythematosus: a 2-year prospective study.
abstract: OBJECTIVE
  To examine the effect of disease activity and damage on health-related quality of life (HRQoL) in patients with systemic lupus erythematosus (SLE).
  
  
  METHODS
  Consecutive SLE patients and matched controls were recruited for a study of HRQoL using the Medical Outcomes Study Short Form-36 (SF-36). SLE activity and damage was assessed by the Safety of Oestrogens in Lupus Erythematosus National Assessment SLE Disease Activity Index (SELENA-SLEDAI) and the American College of Rheumatology/Systemic Lupus International Collaborating Clinics (ACR/SLICC) Damage Index (SDI), respectively. Patients were prospectively followed for repeat HRQoL assessment at 2 years. The effects of cumulative disease activity and new damage on changes in SF-36 scores were evaluated.
  
  
  RESULTS
  One hundred and fifty-five patients were studied (94% women; age 37.8+/-11.3 years; SLE duration 7.2+/-5.4 years). Fifty (32%) patients had active disease and 75 (48%) had organ damage at baseline. Compared with age- and gender-matched controls, SLE patients had lower SF-36 scores, and the difference remained significant after adjustment for income and education level. SF-36 scores in SLE patients correlated inversely with SDI but not with SELENA-SLEDAI scores. After 2 years, there was a significant drop in the mental component score of the SF-36. Regression analysis revealed that new damage was the only determinant for a reduction in SF-36 scores. Patients with higher cumulative disease activity had a greater drop in bodily pain and general health subscores.
  
  
  CONCLUSIONS
  Impaired HRQoL is more common in SLE patients than controls, regardless of age, sex, education and poverty. Pre-existing organ damage is associated with poorer HRQoL and new damage predicts a further decline in HRQoL. Persistent disease activity is associated with deterioration in certain domains of the SF-36.
authors.affiliation: Department of Medicine, Tuen Mun Hospital, Hong Kong, SAR China. ccmok2005@yahoo.com
authors.forename: C C
authors.initials: CC
authors.lastname: Mok
authors.forename: L Y
authors.initials: LY
authors.lastname: Ho
authors.forename: M Y
authors.initials: MY
authors.lastname: Cheung
authors.forename: K L
authors.initials: KL
authors.lastname: Yu
authors.forename: C H
authors.initials: CH
authors.lastname: To
mesh_terms: D000328:Adult; D005260:Female; D006304:Health Status; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D018434:Sickness Impact Profile