Association of the lupus low disease activity state (LLDAS) with health-related quality of life in a multinational prospective study

Vera Golder, Rangi Kandane-Rathnayake, Alberta Yik-Bun Hoi, Molla Huq, Worawit Louthrenoo, Yuan An, Zhan Guo Li, Shue Fen Luo, Sargunan Sockalingam, Chak Sing Lau, Mo Yin Mok, Aisha Lateef, Kate Franklyn, Susan Morton, Sandra Teresa V Navarra, Leonid Zamora, Yeong-Jian Wu, Laniyati Hamijoyo, Madelynn Chan, Sean O'Neill, Fiona Goldblatt, Mandana Nikpour, Eric Francis Morand, Asia-Pacific Lupus Collaboration, Vera Golder, Rangi Kandane-Rathnayake, Alberta Yik-Bun Hoi, Molla Huq, Worawit Louthrenoo, Yuan An, Zhan Guo Li, Shue Fen Luo, Sargunan Sockalingam, Chak Sing Lau, Mo Yin Mok, Aisha Lateef, Kate Franklyn, Susan Morton, Sandra Teresa V Navarra, Leonid Zamora, Yeong-Jian Wu, Laniyati Hamijoyo, Madelynn Chan, Sean O'Neill, Fiona Goldblatt, Mandana Nikpour, Eric Francis Morand, Asia-Pacific Lupus Collaboration

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: Ethnicity, education, disease damage and specific organ involvement impacts HR-QoL in SLE. Attainment of LLDAS is associated with better HR-QoL.

Keywords: Health-related quality of life; Low disease activity; Patient-reported outcomes; Systemic lupus erythematosus; Treatment target.

Figures

Fig. 1
Fig. 1
Radar charts comparing short form-36 (SF-36) domain median scores between Asian and Caucasian ethnicity (a), primary, secondary and tertiary education levels (b), presence (Systemic Lupus International Collaborating Clinics damage index (SLICC)-damage index (DI) >0) and absence (SLICC-DI = 0) of disease damage (c) and presence and absence of musculoskeletal (MSK) activity - either arthritis or myositis on the systemic lupus erythematosus disease activity index-2 K (SLEDAI-2 K) (d). Each spoke on the radar chart represents an SF-36 domain on a scale of 0–100, with higher scores representing better health-related quality of life. The domains are physical function (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social function (SF), role emotional (RE) and mental health (MH). *p < 0.001; #p < 0.01 using the two-sample Wilcoxon rank-sum (Mann-Whitney) test or Kruskal-Wallis test as appropriate
Fig. 2
Fig. 2
Radar chart comparing short form-36 (SF-36) domain scores between patients in lupus low disease activity state (LLDAS) and those not in LLDAS. Each spoke on the radar chart represents an SF-36 domain on a scale of 0–100, with higher scores representing better health-related quality of life. The domains are: physical function (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social function (SF), role emotional (RE), and mental health (MH). *p < 0.001; #p < 0.01 using the two-sample Wilcoxon rank-sum (Mann-Whitney) test

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