Session Information
Date: Sunday, October 21, 2018
Title: Systemic Lupus Erythematosus – Clinical Poster I: Clinical Manifestations and Comorbidity
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Patients with systemic lupus erythematosus (SLE) are commonly affected by cognitive impairment (CI), with a meta-analysis finding a prevalence of 38%. Despite this high prevalence, there is limited data regarding the clinical impact of CI on patients with SLE. We hypothesize that the presence of CI is associated with a significant reduction in Health-Related Quality of Life (HRQoL) scores. Specifically we postulate effects on the domains of mental health, planning, and social functioning given the known effects of CI on these areas of function in other patient populations.
Methods:
This single-center, cross sectional study of English-speaking SLE patients who presented in clinic from Ju 2016 to Apr 2017. Patients completed a comprehensive 2-hour neuropsychological battery, the Medical Outcomes Study Short Form 36 (SF-36) and Lupus Quality of Life (LupusQoL). CI was operationalized on the comprehensive battery as a z-score of ≤-1.5 (as compared to controls) on ≥2 domains and/or z ≤-2.0 on ≥1 domain. Propensity scores were generated to balance covariates. Linear regression models were calculated for SF-36 and LupusQoL domain scores with respect to presence of CI.
Results:
171 participants were included in this study. 64 (37.4%) were found to have CI. Patient demographics are represented in table 1. Unadjusted patient characteristics by presence of CI are represented in Table 2. Linear regression models revealed that patients with CI showed statistically significantly lower scores in SF-36 Physical Component Summary score (PCS), SF-36 Mental Health, SF-36 Physical Functioning, SF-36 Social Functioning and LupusQoL Planning (Table 3).
Conclusion:
Similar to previous studies, in our SLE cohort CI is prevalent, even with a high rate of post-secondary education. Our data demonstrate that CI is associated with significantly lower HRQoL scores. In addition to the expected decrease in Mental Health, Social Functioning, and Planning domains, a decrease in SF-36 PCS was also observed. This unexpected finding may be secondary to how patients interpret the PCS items, namely the effects of health on daily work activities. LupusQoL, a specific HRQoL measure for SLE, did not demonstrate a decrease in Physical Health scores but lower scores in Planning.
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Table 1. Patient demographics at enrolment |
|
|
Characteristic |
N=171 |
|
Gender (F) |
154 (90.1%) |
|
Mean age (years) (Mean ± SD) |
42.7 ± 12.1 |
|
Disease duration (Mean ± SD) |
14.5 ± 10.3 |
|
Ethnicity Asian Black Caucasian Other |
15 (8.8%) 34 (19.9%) 104 (60.8%) 18 (10.5%) |
|
Education level High school not completed Secondary school Post-secondary studies |
9 (5.5%) 32 (19.4%) 124 (75.1%) |
|
Employment status Employed or full time student Retired Homemaker Unemployed |
98 (57.3%) 5 (2.9%) 12 (7.0%) 56 (32.8%) |
|
SLE SLICC damage index (Mean ± SD) |
1.2 ± 1.6 |
|
Treatment Antimalarials* Immunosuppressives* Glucocorticoids* Prednisone dose mg/day (Mean ± SD) Median (IQR |
156 (91.2%) 148 (86.5%) 124 (72.5%) 6.32 ± 7.00 5 (2-8) |
|
Cognitive impairment (z-score of -1.5 in ≥ 2 domains)
|
64 (37.4%) |
|
Cognitive battery domains (z-score of -1.5 or less) Motor speed and dexterity Attention and processing speed Visual-spatial Verbal Fluency Learning and memory Executive function |
38 (22.2%) 46 (26.9%) 51 (30.0%) 6 (3.5%) 77 (45.0%) 12 (7.0%) |
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*Treatment within 1 year |
|
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Table 2. Characteristics by cognitive impairment (un-adjusted differences) |
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|
Characteristic |
Cognitive Impairment1 |
p-Value |
|
|
No (N=107) |
Yes (N=64) |
||
|
Gender (F) |
97 (90.7%) |
57 (89.1%) |
0.73 |
|
Age at CI study enrolment (Mean ± SD) |
42.2 ± 12.2 |
43.4 ± 12.1 |
0.53 |
|
Disease duration at CI study enrolment (Mean ± SD) |
15.3 ± 10.7 |
13.3 ± 9.5 |
0.23 |
|
Ethnicity Asian Black Caucasian Other |
11 (10.3%) 14 (13.1%) 66 (61.7%) 16 (15.0%) |
4 (6.3%) 20 (31.3%) 38 (59.4%) 2 (3.1%) |
0.005* |
|
Education Secondary education in-completed Secondary education Post-secondary education |
3 (2.9%) 20 (19.4%) 80 (77.7%) |
6 (9.7%) 12 (19.4%) 44 (71.0%) |
0.17 |
|
Employment status Employed student Unemployed Homemaker Retired |
62 (57.9%) 34 (31.8%) 8 (7.5%) 3 (2.8%) |
36 (56.3%) 22 (34.4%) 4 (6.3%) 2 (3.1%) |
0.97 |
|
SLE organ damage index before HRQoL test (Mean score ± SD) |
1.1 ± 1.6 |
1.3 ± 1.7 |
0.67 |
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Mean Lupus QoL Domain scores (Mean score ± SD) |
|||
|
Physical health |
57.4 ± 20.9 |
53.4 ± 18.3 |
0.20 |
|
Pain |
57.3 ± 22.7 |
54.2 ± 20.3 |
0.36 |
|
Planning |
62.5 ± 20.8 |
54.1 ± 21.6 |
0.01* |
|
Intimate relationship |
59.5 ± 26.1 |
52.0 ± 29.5 |
0.13 |
|
Burden to others |
50.6 ± 25.3 |
46.6 ± 23.1 |
0.30 |
|
Emotional health |
59.6 ± 19.1 |
56.9 ± 19.2 |
0.38 |
|
Body image |
60.3 ± 20.5 |
60.4 ± 19.8 |
0.98 |
|
Fatigue |
47.0 ± 22.2 |
41.4 ± 22.0 |
0.11 |
|
Mean SF-36 Domain Scores (Mean score ± SD) |
|||
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Bodily Pain |
60.6 ± 27.1 |
51.5 ± 26.3 |
0.03* |
|
General Health |
44.4 ± 24.0 |
41.7 ± 23.6 |
0.46 |
|
Mental Health |
67.4 ± 21.2 |
60.3 ± 22.4 |
0.04* |
|
Physical Functioning |
71.1 ± 28.3 |
59.6 ± 24.5 |
0.008* |
|
Role Emotional |
59.5 ± 43.0 |
58.3 ± 47.1 |
0.86 |
|
Role physical |
54.0 ± 42.5 |
39.8 ± 45.4 |
0.04* |
|
Social Functioning |
71.3 ± 27.8 |
60.5 ± 29.3 |
0.01* |
|
Vitality |
45.2 ± 26.6 |
39.5 ± 22.7 |
0.15 |
|
Physical Score |
41.2 ± 11.6 |
37.0 ± 10.8 |
0.01* |
|
Mental Score |
45.0 ± 11.9 |
43.1 ± 13.1 |
0.32 |
|
p values are from un-paired t-tests, Chi-Square tests and trend tests for more than two categories *p <0.05 1CI is defined by z-score of -1.5 in ≥ 2 domains |
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Table 3. Linear regression model: Estimated reduction of SF-36 and LupusQoL scores based on presence of cognitive impairment1 |
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HRQoL Tool |
Domain |
Estimated Score Reduction |
95% Confidence Interval |
p value |
|
SF-36 |
Physical component score |
-3.7 |
-7.2 to -0.2 |
0.04* |
|
Mental component score |
-2.2 |
-6.1 to 1.7 |
0.26 |
|
|
Bodily pain |
-8.0 |
-16.0 to 0.4 |
0.06 |
|
|
Global health |
-3.0 |
-10.0 to 4.5 |
0.43 |
|
|
Mental health |
-7.4 |
-14.0 to -0.6 |
0.03* |
|
|
Physical functioning |
-9.6 |
-18.0 to -1.4 |
0.02* |
|
|
Role emotional |
0.2 |
-14.0 to 14.1 |
0.98 |
|
|
Role physical |
-13.0 |
-26.0 to 1.0 |
0.07 |
|
|
Social functioning |
-11.0 |
-20.0 to -1.9 |
0.01* |
|
|
Vitality |
-6.4 |
-14.0 to 1.5 |
0.11 |
|
|
Lupus QoL |
Physical health |
-2.9 |
-9.1 to 3.3 |
0.35 |
|
Pain |
-2.4 |
-9.2 to 4.4 |
0.49 |
|
|
Planning |
-7.9 |
-15.0 to -1.3 |
0.01* |
|
|
Intimate |
-7.0 |
-17.0 to 2.8 |
0.16 |
|
|
Burden |
-4.3 |
-12.0 to 3.4 |
0.27 |
|
|
Emotional |
-2.5 |
-8.5 to 3.5 |
0.42 |
|
|
Body image |
-0.3 |
-6.7 to 6.1 |
0.92 |
|
|
Fatigue |
-5.7 |
-13.0 to 1.3 |
0.10 |
|
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1CI is defined by Z-score of -1.5 in two or more domains of the comprehensive cognitive battery *p ≤0.05 |
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To cite this abstract in AMA style:
Dobrowolski C, Engel L, Green R, Ruttan L, Lombardi S, Tartaglia C, Anderson N, Colosimo K, Vitti M, Bonilla D, Wither JE, Fritzler MJ, Beaton D, Touma Z. Cognitive Impairment and Health-Related Quality of Life in a Lupus Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/cognitive-impairment-and-health-related-quality-of-life-in-a-lupus-cohort/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/cognitive-impairment-and-health-related-quality-of-life-in-a-lupus-cohort/