Quality of life in patients with systemic lupus erythematosus and pulmonary involvement

Abstract

Introduction: The influence of systemic lupus erythematosus (SLE) on the quality of life (QoL) is an important principle in the management of patients with SLE. Purpose and objectives: Evaluation of QoL in patients with SLE and pulmonary involvement. Material and Methods: The study included a group of consecutive patients who meet the SLICC, 2012 criteria of SLE classification. The disease activity was assessed by SLEDAI and SLAM, organ damage - by SLICC Damage Index. Evaluation of lung involvement was performed by St. George Respiratory Questionaire, imaging (Rx, ECHO, HRCT) and functional respiratory tests (spirometry, DLCO). QoL was assessed by the SF-36 questionaire, which includes eight areas summed to Physical Component Summary (PCS) and Mental Component Summary (MCS). The correlation between variables was calculated by Pearson coefficient. Results: The study enrolled 30 patients with mean age 42.3 ± 11.64 yrs, the disease duration 7.29 ± 7.1 yrs, mean age at onset - 34.43 ± 1 1 .4 yrs, female:male ratio 9:1. The average o f SLICC classification criteria was 6.2 ± 1.64. The activity, assessed by SLEDAI was 12.33 ± 8.07 and by SLAM - 13.63 ± 6.41 points, respectively, SLICC DI was 2.13 ± 2.45 points. Thirteen (43.3%) patients had pulmonary implications: 6 with pleurisy, 3 - pulmonary hypertension, 1 - shrinking lung syndrome, 1 - interstitial pneumopathy, 1 - pulmonary embolism and 1 - lupus pneumonitis. The comparative analysis of patients with and without lung disease showed a decrease in the quality of life in both groups. In the group of patients with pulmonary involvement was obtained a lower summary score of physical component (31.6 vs 36.4) and a higher score of mental component (39.0 vs 36.5) compared with patients without lung involvement. Correlation analysis between QoL in patients with lung disease showed a negative, moderate correlation between the PCS and the disease activity SLAM (r = -0.69, p<0.05) and SLEDAI (r = -0.56, p<0.05), while the MCS had a weak negative correlation with SLEDAI (r = -0.33, p<0.05) and did not correlate with SLAM. In patients without lung disease, was identified a weak negative relationship between SLAM and PCS (r = 0.40, p<0.05). Simultaneously, was established an inverse correlation between the PCS and the organ damage index (SLICC DI) in both groups (r = -0.52, p<0.05) and in patients without lung injury also with MCS (r = -0.38, p<0.05). Conclusion: In patients with SLE was found a diminished QoL. In the group with pulmonary involvement was established a reduced physical component score, which correlated inversely with disease activity. In patients without pulmonary involvement, the QoL was reduced also, with an inverse moderate correlation with SLICC DI and a less significant correlation with disease activity.