title: Impaired health-related quality of life in Addison's disease--impact of replacement therapy, comorbidities and socio-economic factors.
abstract: OBJECTIVE
  Patients with Addison's disease (AD) on conventional replacement therapy have impaired health-related quality of life (HRQoL). It is possible that lower hydrocortisone (HC) doses recommended by current guidelines could restore HRQoL. We compared HRQoL in AD patients treated according to current HC recommendations to that of the age- and gender-standardized general population.
  We assessed HRQoL in a cross-sectional setting with the 15D instrument in a Finnish AD cohort (n = 107) and compared the results with those of a large sample of general population (n = 5671). We examined possible predictors of HRQoL in AD. Within the patient group, HRQoL was also assessed by SF-36.
  
  
  RESULTS
  Mean HC dose was 22 mg/d, corresponding to 12 ± 4 mg/m2. HRQoL was impaired in AD compared with the general population (15D score; 0·853 vs 0·918, P < 0·001). Within single 15D dimensions, discomfort and symptoms, vitality and sexual activity were most affected. Stepwise regression analysis demonstrated that Patient's Association membership (P = 0·02), female gender (P < 0·01), presence of other autoimmune or inflammatory comorbidity (P < 0·02), lower education (P < 0·02) and longer disease duration (P < 0·05) independently predicted impaired HRQoL, whereas replacement regimens, autoimmune-related comorbidities, total number of comorbidities or level of healthcare follow-up did not. In AD, HRQoL was impaired also as assessed by SF-36.
  
  
  CONCLUSIONS
  HRQoL is significantly impaired in AD compared with the general population despite use of recommended HC doses. Patient's Association membership was the most significant predictor of impaired HRQoL. This finding should be explored in more detail in the future.
authors.affiliation: Department of Dermatology, Allergology and Venereology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kluger
authors.forename: Niina
authors.initials: N
authors.lastname: Matikainen
authors.forename: Harri
authors.initials: H
authors.lastname: Sintonen
authors.forename: Annamari
authors.initials: A
authors.lastname: Ranki
authors.forename: Risto P
authors.initials: RP
authors.lastname: Roine
authors.forename: Camilla
authors.initials: C
authors.lastname: Schalin-Jäntti
mesh_terms: D000224:Addison Disease / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006854:Hydrocortisone