ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 294

Effects of Obesity On Health-Related Quality of Life in Childhood-Onset Systemic Lupus Erythematosus

Rina Mina1, Marisa S. Klein-Gitelman2, Shannen Nelson3, Lori B. Tucker4, B. Anne Eberhard5, Nora G. Singer6, Deborah M. Levy7, Kathleen A. Haines8, Karen Onel9, Marilynn G. Punaro10, Kathleen M. O'Neil11, Michael Henrickson12, Jun Ying13 and Hermine Brunner14, 1Rheumatology, Cincinnati Children's Hospital Medical Center/ University of Cincinnati, Cincinnati, OH, 2Division of Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 3Rheumatology, Cincinnati Children's Hospital, Cincinnati, OH, 4Pediatric Rheum/Rm K4-120, BC Childrens Hospital, Vancouver, BC, Canada, 5Cohen Children's Hospital Medical Center, New Hyde Park, NY, 6Medicine, Division of Rheumatology, MetroHealth Medical Center, Cleveland, OH, 7Rheumatology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada, 8Department of Pediatrics, Joseph M Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack, NJ, 9Pediatric Rheumatology, University of Chicago, Chicago, IL, 10Pediatric Rheumatology, Texas Scottish Rite Hospital, Dallas, TX, 11Pediatric Rheumatology, Riley Hospital for Children, Indianapolis, IN, 12MLC 4010, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 13Medicine-Internal Medicine-General Medicine, University of Cincinnati, Cincinnati, OH, 14Cincinnati Children's Hospital, Cincinnati, OH

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Pediatric Systemic Lupus Erythematosus, Pediatric Vasculitis and Pediatric Myositis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Obesity in adults with Systemic Lupus Erythematosus (SLE) is associated with an added risk of cardiovascular disease, decreased health-related quality of life (HRQOL), and increased disability. While cross-sectional studies report the prevalence of obesity in adult SLE cohorts at 27-29%, there are no studies that address the frequency of obesity in childhood-onset SLE (cSLE) or its impact on patient well-being. Patients with cSLE are more often treated with corticosteroids than adults with SLE, putting them likely at a higher risk for obesity. The purpose of this study is to estimate the frequency of obesity in our cSLE cohort and evaluate the effect of obesity on HRQOL measures in cSLE.

Methods: Obesity was defined as a body mass index ≥ 95th% of the sex-specific CDC 2000 BMI-for-age growth charts. In a prospective cSLE cohort (n=202), we compared the domain and summary scores of the generic and rheumatology modules of the Pediatric Quality of Life Questionnaire Inventory (PedsQL) and Child Health Questionnaire (CHQ) between obese cSLE patients and three comparison groups: 1) non-obese cSLE; 2) non-obese healthy children; and 3) obese controls without cSLE.  Using mixed-effects models that adjusted for important predictors, we evaluated the independent contribution of obesity on HRQOL measures.

Results: Twenty five percent (n=51) of the cSLE patients in the cohort were classified as obese. We found a significant negative impact of obesity on overall HRQOL which persists even after adjustment for corticosteroid use, disease activity, disease damage, gender, and race of the patients (Table 1). Obese cSLE patients had significantly lower physical and school functioning, and more pain compared to all three comparator groups (p-values<0.0001-0.05). There was also poorer emotional functioning in obese cSLE patients compared to their non-obese counterparts and healthy children (p-values <0.0001-0.04). Parents of obese cSLE patient worry more and perceive more physical limitations and limited family activities (p-values <0.0001-0.01).

Conclusion: Our study demonstrates that about 25% of cSLE patients evaluated were obese. Obesity negatively impacts many aspects of HRQOL particularly physical functioning and pain/hurt domains. Given the adverse effects on HRQOL, there appears to be an urgent need to include weight management in the day-to-day management of children with cSLE.

Table 1: Difference in scores of health related quality of life (HRQOL) measures in cSLE according to presence of obesityŦ

Health Related Quality of Life Measures

cSLE

Historical controls without cSLE

 

 

 

 

(A) Obese

(N=51)

(B) Non-obese

 (N=151)

P-value (A vs. B)*

 

 

(C) Non-obese

P-value (A vs. C)**

 

(D) Obese¶¶

(N=63)

P-value  (A vs. D)ŦŦ

 

 

Pediatric Quality of Life Questionnaire

 

 

Generic Module: Parent-report

 

69.2 ± 2.8

81.7 ± 2.3

<0.0001

 

82.7 ± 0.2

<0.0001

 

75.0 ± 1.8

<0.0001

 

 

Physical Functioning

 

66.6 ± 3.9

81.6 ± 3.1

0.0004

 

84.5 ± 0.2

<0.0001

 

76.3 ± 2.2

<0.0001

 

 

Emotional Functioning

 

70.6 ± 3.2

80.4 ± 2.6

0.005

 

81.3 ± 0.2

<0.0001

 

72.6 ± 2.2

0.0001

 

 

Social Functioning

 

77.2 ± 3.2

87.7 ± 2.6

0.003

 

83.7 ± 0.2

<0.0001

 

73.5 ± 2.2

<0.0001

 

 

School Functioning

 

64.3 ± 3.3

77.4 ± 2.7

0.0003

 

78.8 ± 0.2

<0.0001

 

76.6 ± 2.1

<0.0001

 

 

Generic Module: Self-report

 

74.0 ± 2.6

81.4 ± 2.2

0.003

 

87.5 ± 0.1

<0.0001

 

74.0 ± 1.8

NS

 

 

Physical Functioning

 

68.6 ± 3.5

80.9 ± 3.0

0.0003

 

83.8 ± 0.1

<0.0001

 

77.5 ± 2.3

<0.0001

 

 

Emotional Functioning

 

75.8 ± 3.1

82.3 ± 2.7

0.040

 

79.3 ± 0.2

<0.0001

 

68.6 ± 2.3

<0.0001

 

 

Social Functioning

 

81.7 ± 2.5

89.0 ± 2.2

0.003

 

85.2 ± 0.2

<0.0001

 

72.1 ± 1.8

<0.0001

 

 

 

School Functioning

 

71.6 ± 3.1

74.6 ± 2.7

NS

 

81.1 ± 0.2

<0.0001

 

75.0 ± 1.8

<0.0001

 

 

 

Rheumatology Module: Parent-report

 

79.5 ± 2.1

85.6 ± 1.7

0.007

 

82.0 ± 1.5

NS

ND

 

 

Pain and Hurt

 

65.2 ± 4.1

77.5 ± 3.3

0.005

 

73.1 ± 1.9

0.053

 

 

Daily Activities

 

92.0 ± 2.4

94.0 ± 1.9

NS

 

88.5 ± 1.4

0.028

 

 

Treatment

 

82.0 ± 2.2

85.9 ± 1.8

NS

 

70.8 ± 1.6

<0.0001

 

 

Worry

 

70.3 ± 3.6

80.0 ± 2.9

0.013

 

89.6 ± 1.2

0.002

 

 

Communication

 

81.1 ± 3.0

84.0 ± 2.5

NS

 

87.9 ± 1.4

0.022

 

 

Rheumatology Module: Self-report

 

81.2 ± 2.1

86.0 ± 1.8

0.005

 

84.4 ± 1.5

<0.0001

ND

 

 

Pain and Hurt

 

65.6 ± 3.9

80.7 ± 3.3

<0.0001

 

77.8 ± 2.0

<0.0001

 

 

Daily Activities

 

92.2 ± 2.0

95.9 ± 1.7

NS

 

95.6 ± 0.9

<0.0001

 

 

Treatment

 

85.7 ± 2.2

89.4 ± 1.9

NS

 

82.1 ± 1.4

<0.0001

 

 

Worry

 

65.6 ± 3.7

69.9 ± 3.2

NS

 

83.6 ± 1.6

<0.0001

 

 

Communication

 

78.7 ± 3.2

80.6 ± 2.8

NS

 

82.9 ± 1.7

<0.0001

 

 

Childhood Health Questionnaire

 

 

Physical Functioning

 

67.4 ± 3.5

76.3 ± 3.1

0.020

 

96.1 ± 0.7

<0.0001

ND

 

Role/Social Limitations–Emotional/Behavioral

 

81.0 ± 3.4

87.1 ± 3.0

NS

 

92.5 ± 0.9

<0.0001

 

Role/Social Limitations–Physical

 

84.7 ± 2.8

91.0 ± 2.5

0.044

 

93.6 ± 0.9

<0.0001

 

Bodily Pain

 

51.9 ± 2.0

47.7 ± 1.8

NS

 

81.7 ± 1.0

<0.0001

 

Behavior

 

67.5 ± 1.6

68.2 ± 1.4

NS

 

75.6 ± 0.8

<0.0001

 

Generic Health Perceptions

 

52.7 ± 1.9

51.1 ± 1.6

NS

 

73.0 ± 0.9

<0.0001

 

Mental Health

 

69.8 ± 1.7

72.9 ± 1.5

NS

 

78.5 ± 0.7

<0.0001

 

Self Esteem

 

50.6 ± 3.8

52.3 ± 3.3

NS

 

79.8 ± 0.9

<0.0001

 

Parent Impact–Emotional

 

56.1 ± 3.0

52.1 ± 2.6

NS

 

80.3 ± 1.0

<0.0001

 

Parent Impact–Time

 

65.1 ± 3.7

57.5 ± 3.2

NS

 

87.8 ± 1.0

<0.0001

 

Family Activities

 

69.7 ± 2.7

78.4 ± 2.4

0.004

 

89.7 ± 0.9

<0.0001

 

Ŧ Values are mean ± standard error of the mean (SEM). For details, please refer to Table 1. NS-not significant; ND-not calculated (no comparison data).

* P-value from adjusted mixed effects models with summary and domain scores of HRQOL measures as dependent variable and presence of obesity (yes/no) as independent variable. Models adjusted for disease activity (SLEDAI scores ≤ 4 or not), daily prednisone dose (<0.2 mg/kg/day or not), race (African American or not), gender, and disease damage (total SLICC-DI scores ≤ 1 or not).

** P-value from 2-sided t-test comparing HRQOL scores from A (obese cSLE) vs.  C (healthy controls).

ŦŦ P-value from 2-sided t-test comparing HRQOL scores from A (obese cSLE) vs.  D (obese non-cSLE).

Historical controls.  For PedsQL-Generic Module: healthy pediatric patients with no chronic illness (N=9565) (1). For PedsQL-Rheumatology Module: healthy pediatric patients and JIA controls (N=141) (1). For CHQ: healthy pediatric controls (N=391).

¶¶ Historical controls.  Obese pediatric patients without rheumatologic disease (N=63) (Varni JW, et.al. Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 Generic Core Scales. Health Qual Life Outcomes. 2007; 5:43).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

Disclosure:

R. Mina,
None;

M. S. Klein-Gitelman,
None;

S. Nelson,
None;

L. B. Tucker,
None;

B. A. Eberhard,
None;

N. G. Singer,
None;

D. M. Levy,
None;

K. A. Haines,
None;

K. Onel,
None;

M. G. Punaro,
None;

K. M. O’Neil,
None;

M. Henrickson,
None;

J. Ying,
None;

H. Brunner,
None.

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