Background/Purpose: SLE-related organ damage is associated with increased morbidity. The comorbidity burden of SLE can involve various organ systems and may include pain, fatigue, difficulty in performing daily life activities, and reduced physical and emotional well-being, all of which contribute to high rates of disability. We conducted a systematic literature review to assess the association between SLE-related organ damage and health-related quality of life (HRQOL).

Methods: Systematic search of PubMed, EMBASE, Cochrane Library, and Latin American and Caribbean Health Sciences Literature bibliography (Jan 2000–Feb 2017) to identify studies in which the association between organ damage (measured by SLICC/ACR Damage Index [SDI]) and HRQOL was evaluated in adults with SLE.

Results: Of 10,420 articles screened, 20 studies (3 prospective cohort and 17 cross-sectional) were included in the analysis. For HRQOL, the 36-item Short-Form Health Survey (SF-36: Physical and Mental Component Summaries [PCS and MCS]) was used in 15 studies; the Fatigue Severity Scale (FSS) in 2 studies; the EuroQOL 5D in 2 studies; and the LupusQOL, Multidimensional Fatigue Inventory, Quality of Life Questionnaire of the European Foundation for Osteoporosis, and WHO Quality of Life Scale (WHOQOL-BREF) in 1 study each. HRQOL was assessed using the SF-36 in the 3 prospective studies; in 2 of these, SDI was modeled as a binary variable. For patients without baseline organ damage, any damage accrued over 2 years was associated with a 5.5-fold increased risk of reduced HRQOL (SF-36 overall relative risk [RR]: 5.5 [95% CI: 1.1–26.6; p=0.03]). Similar trends were observed for PCS (RR: 2.5 [95% CI: 0.6–10.0; p=0.19] and MCS (RR: 4.6 [95% CI: 0.9–22.8; p=0.06]). Any damage at baseline was associated with 67% reduced odds of achieving minimum clinically important improvement in SF-36 PCS (odds ratio: 0.33 [95% CI: 0.13–0.85; p=0.02]; no association was noted for MCS. When SDI was modeled as a continuous variable, increasing organ damage was associated with reduced SF-36 PCS compared with no damage [regression coefficients: (SDI=0); SDI 1: -2.64, p<0.001; SDI 2: -2.86, p=0.003; SDI 3: -5.94, p<0.001; SDI 4: -6.35, p<0.001; and SDI 5+: -8.11, p<0.001]. In cross-sectional evaluations, increasing organ damage correlated modestly with reduced HRQOL (SF-36 correlation coefficient: -0.12 to -0.30; SF-36 regression coefficient: -0.011 to -4.65; LupusQOL correlation coefficient: -0.31, p<0.01; and WHOQOL-BREF regression coefficient: -0.06, p=0.57). Increasing fatigue was weakly correlated with organ damage (FSS correlation coefficient: 0.04 to 0.15).

Conclusion: In most studies analyzed, organ damage was associated with reduced HRQOL. Heterogeneity in HRQOL instruments and methodology was observed across studies. Improving construct validity of instruments and consistent evaluation will enable a more accurate estimation of the burden of SLE and enhance efforts to improve HRQOL in SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-systematic-review-examining-the-association-between-organ-damage-and-health-related-quality-of-life-in-systemic-lupus-erythematosus/