An exploration of patient-reported symptoms in systemic lupus erythematosus and the relationship to health-related quality of life.
OBJECTIVE
The aim of this study was to explore the most distressing symptoms of systemic lupus erythematosus (SLE) and determine how these relate to health-related quality of life (HRQoL), anxiety/depression, patient demographics, and disease characteristics (duration, activity, organ damage).


METHODS
In a cross-sectional study, patients with SLE (n = 324, age 18-84 years) gave written responses regarding which SLE-related symptoms they experienced as most difficult. Their responses were categorized. Within each category, patients reporting a specific symptom were compared with non-reporters and analysed for patient demographics, disease duration, and results from the following questionnaires: the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale (HADS), the Systemic Lupus Activity Measure (SLAM), the SLE Disease Activity Index (SLEDAI), and the Systemic Lupus International Collaboration Clinics/American College of Rheumatology (SLICC/ACR) damage index.


RESULTS
Twenty-three symptom categories were identified. Fatigue (51%), pain (50%), and musculoskeletal distress (46%) were most frequently reported. Compared with non-reporters, only patients reporting fatigue showed a statistically significant impact on both mental and physical components of HRQoL. Patients with no present symptoms (10%) had higher HRQoL (p < 0.001) and lower levels of depression (p < 0.001), anxiety (p < 0.01), and disease activity (SLAM) (p < 0.001).


CONCLUSIONS
Fatigue, pain, or musculoskeletal distress dominated the reported symptoms in approximately half of the patients. Only patients reporting fatigue scored lower on both mental and physical aspects of HRQoL. Our results emphasize the need for further support and interventions to ease the symptom load and improve HRQoL in patients with SLE. Our findings further indicate that this need is particularly urgent for patients with symptoms of pain or fatigue.
Rheumatology Clinic, Karolinska University Hospital, Solna, Stockholm, Sweden. susanne.pettersson@karolinska.se
S
S
Pettersson
M
M
Lövgren
L E
LE
Eriksson
C
C
Moberg
E
E
Svenungsson
I
I
Gunnarsson
E
E
Welin Henriksson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D059026:Diagnostic Self Evaluation; D005221:Fatigue / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires