Association of the lupus low disease activity state (LLDAS) with health-related quality of life in a multinational prospective study.
Systemic lupus erythematosus (SLE) is associated with significant impairment of health-related quality of life (HR-QoL). Recently, meeting a definition of a lupus low disease activity state (LLDAS), analogous to low disease activity in rheumatoid arthritis, was preliminarily validated as associated with protection from damage accrual. The LLDAS definition has not been previously evaluated for association with patient-reported outcomes. The objective of this study was to determine whether LLDAS is associated with better HR-QoL, and examine predictors of HR-QoL, in a large multiethnic, multinational cohort of patients with SLE.



HR-QoL was measured using the Medical Outcomes Study 36-item short form health survey (SF-36v2) in a prospective study of 1422 patients. Disease status was measured using the SLE disease activity index (SLEDAI-2 K), physician global assessment (PGA) and LLDAS.



Significant differences in SF-36 domain scores were found between patients stratified by ethnic group, education level and damage score, and with the presence of active musculoskeletal or cutaneous manifestations. In multiple linear regression analysis, Asian ethnicity (p < 0.001), a higher level of education (p < 0.001), younger age (p < 0.001) and shorter disease duration (p < 0.01) remained significantly associated with better physical component scores (PCS). Musculoskeletal disease activity (p < 0.001) was negatively associated with PCS, and cutaneous activity (p = 0.04) was negatively associated with mental component scores (MCS). Patients in LLDAS had better PCS (p < 0.001) and MCS (p < 0.001) scores and significantly better scores in multiple individual SF-36 domain scores. Disease damage was associated with worse PCS (p < 0.001), but not MCS scores.



Ethnicity, education, disease damage and specific organ involvement impacts HR-QoL in SLE. Attainment of LLDAS is associated with better HR-QoL.
Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia. vera.golder@monash.edu.
Vera
0000-0001-5691-4344
V
Golder
Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia.
Rangi
R
Kandane-Rathnayake
Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia.
Alberta Yik-Bun
AY
Hoi
The University of Melbourne, Melbourne, Australia.
Molla
M
Huq
Chiang Mai University Hospital, Chiang Mai, Thailand.
Worawit
W
Louthrenoo
People's Hospital Peking University Health Sciences Center, Beijing, China.
Yuan
Y
An
People's Hospital Peking University Health Sciences Center, Beijing, China.
Zhan Guo
ZG
Li
Chang Gung Memorial Hospital, Guishan Township, Taiwan.
Shue Fen
SF
Luo
University of Malaya, Kuala Lumpur, Malaysia.
Sargunan
S
Sockalingam
University of Hong Kong, Pokfulam, Hong Kong.
Chak Sing
CS
Lau
University of Hong Kong, Pokfulam, Hong Kong.
Mo Yin
MY
Mok
National University Hospital, Singapore, Republic of Singapore.
Aisha
A
Lateef
Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia.
Kate
K
Franklyn
Monash Health, Melbourne, Australia.
Susan
S
Morton
University of Santo Tomas Hospital, Manila, Philippines.
Sandra Teresa V
ST
Navarra
University of Santo Tomas Hospital, Manila, Philippines.
Leonid
L
Zamora
Chang Gung Memorial Hospital, Guishan Township, Taiwan.
Yeong-Jian
YJ
Wu
University of Padjadjaran, Bandung, Indonesia.
Laniyati
L
Hamijoyo
Tan Tock Seng Hospital, Singapore, Republic of Singapore.
Madelynn
M
Chan
University of New South Wales, Sydney, Australia.
Sean
S
O'Neill
Royal Adelaide Hospital, Adelaide, Australia.
Fiona
F
Goldblatt
The University of Melbourne, Melbourne, Australia.
Mandana
M
Nikpour
Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia.
Eric Francis
EF
Morand
D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D011788:Quality of Life; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
Health-related quality of life; Low disease activity; Patient-reported outcomes; Systemic lupus erythematosus; Treatment target