Work-Related Disability and Function in Systemic Lupus Erythematosus (SLE): Outcomes of an Exploratory Study from Different Canadian Centres

Behdin Nowrouzi-Kia¹, J. Antonio Avina-Zubieta², Mary Fox³, William Shaw⁴, Maggie Ho⁵, Qixuan Li⁵, Catherine Ivory⁶, Paul Fortin⁷, Stephanie Keeling⁸, Jennifer Reynolds⁹, Derek Haaland¹⁰, Janet Pope¹¹, Lily Lim¹², Patti Katz¹³, Murray Urowitz¹⁴, Laura Patricia Whittall Garcia⁵, Dafna Gladman¹⁵ and Zahi Touma¹, ¹University of Toronto, Toronto, ON, Canada, ²Arthritis Research Canada, University of British Columbia, Vancouver, BC, Canada, ³York University, Toronto, ON, Canada, ⁴University of Connecticut, School of Medicine, Farmington, CT, ⁵University Health Network, Toronto, ON, Canada, ⁶The Ottawa Hospital, Ottawa, ON, Canada, ⁷Centre ARThrite - CHU de Québec - Université Laval, Quebec, QC, Canada, ⁸University of Alberta, Edmonton, AB, Canada, ⁹UBC, North Vancouver, BC, Canada, ¹⁰The Waterside Clinic, Oro Medonte, ON, Canada, ¹¹University of Western Ontario, London, ON, Canada, ¹²University of Manitoba, Winnipeg, MB, Canada, ¹³UCSF, San Rafael, CA, ¹⁴Self employed, Toronto, ON, Canada, ¹⁵University of Toronto, Toronto Western Hospital, Toronto, ON, Canada

Meeting: ACR Convergence 2024

Keywords: functional status, Patient reported outcomes, Systemic lupus erythematosus (SLE), work

Session Information

Date: Sunday, November 17, 2024

Title: SLE – Diagnosis, Manifestations, & Outcomes Poster II

Session Type: Poster Session B

Session Time: 10:30AM-12:30PM

Background/Purpose: Systemic lupus erythematosus (SLE) has a significant and long-lasting impact on work outcomes, is a source of long-lasting work disability, and presents challenges with participation in activities of daily living. This study aimed to create a functional profile for patients with SLE. A functional profile is defined as activities of daily living and those related to work functioning (activities of daily living).

Methods: A cross-sectional investigation was carried out across six Canadian facilities, comprising six academic institutions and one community-based facility. Clinical measurements were obtained, including the SLEDAI-2K and ACR/SLICC Damage Index (SDI) and patients’ medications. Patients completed the Work Role Functioning Questionnaire v2.0 (WRFQ), the World Health Organization—Disability (WHO-DAS) Assessment Schedule 2.0 (WHO-DAS), and the Beck Depression Inventory (BDI-II). Descriptive and inferential statistics were computed for the demographic, clinical, and functional outcomes. Univariate and multivariate regression analyses to study the association with WHO-DAS and WRF were performed.

Results: 404 patients were studied; mean age was 47.0±13.71 years and 91.8%% were female ( 64.7% White, 12.4% Black, 6.7% Chinese and 16.2% other races) with a mean SLE duration of 15.7 ±11.8 years (Table 1). The total mean score for the WRFQ was 71.51.8±23.5. The WRFQ subscale mean scores were also reported for work scheduling demands (66.8±28.8), work output demands (71.1±25.6), physical demands (67.3±27.9), mental and social demands (74.4±22.8) and flexibility demands (75.0±24.7) (Figure 1) – comparison to the general working population). The WHO-DAS 2.0 total mean score was 25.1±9.71, representing approximately the 93.8th population percentile, meaning that only about 6.1% of the population scored higher (more disabled) than our sample. In the multivariate analysis, sex (Female), damage (SDI), prednisone dose, fatigue severity score, Work Role Functioning total scores, presence of fibromyalgia, Role Emotinal SF-36, depression and pain were associated with increased disability. Similarly, fatigue severity score, depression, and pain were associated with decreased WRF total scores (Table 2).

Conclusion: This Canadian study confirmed that patients with SLE suffers from high level of disability and functional decline and as measured by WHO-DAS and WRF. Several factors were associated with disability and functional decline including accrued damage, presence of fatigue and fibromyalgia, depression, pain and prednisone dose. Developing the initial functional profile of work disability will facilitate a multidisciplinary approach to enhance the care and management of work disabilities and related functional outcomes.

Figure 1: Comparison of Work Functioning Scores between patients with SLE and the general working population

Notes. SLEDAI_2K =Systemic Lupus Ertyhematosus Disease Actvitiy Index 2000, SLICC/ACR Damage Index = SDI, FSS= Fatigue Severity Score, WRF = Work Role Functioning Total Score, Depression =Beck Depression Inventory, FSS= Fatigue Severity Score, WRF = Work Role Functioning Total Score, Depression = Beck Depression Inventory

Disclosures: B. Nowrouzi-Kia: None; J. Avina-Zubieta: None; M. Fox: None; W. Shaw: None; M. Ho: None; Q. Li: None; C. Ivory: AbbVie/Abbott, 2, 6, AstraZeneca, 6, GlaxoSmithKlein(GSK), 6, Novartis, 6, Pfizer, 6; P. Fortin: AstraZeneca, 2, 6, GlaxoSmithKlein(GSK), 2, 6, Moderna, 2; S. Keeling: AbbVie/Abbott, 6, AstraZeneca, 6, GlaxoSmithKlein(GSK), 6, Janssen, 6, Novartis, 6, Roche, 6, UCB, 6; J. Reynolds: None; D. Haaland: None; J. Pope: None; L. Lim: None; P. Katz: None; M. Urowitz: None; L. Whittall Garcia: None; D. Gladman: AbbVie, 2, 5, Amgen, 2, 5, AstraZeneca, 2, BMS, 2, Celgene, 2, 5, Eli Lilly, 2, 5, Galapagos, 2, 5, Gilead, 2, 5, Janssen, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, UCB, 2, 5; Z. Touma: None.

To cite this abstract in AMA style:

Nowrouzi-Kia B, Avina-Zubieta J, Fox M, Shaw W, Ho M, Li Q, Ivory C, Fortin P, Keeling S, Reynolds J, Haaland D, Pope J, Lim L, Katz P, Urowitz M, Whittall Garcia L, Gladman D, Touma Z. Work-Related Disability and Function in Systemic Lupus Erythematosus (SLE): Outcomes of an Exploratory Study from Different Canadian Centres [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/work-related-disability-and-function-in-systemic-lupus-erythematosus-sle-outcomes-of-an-exploratory-study-from-different-canadian-centres/. Accessed .

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