Background/Purpose: Idiopathic Inflammatory Myopathies (IIM) are rare, multisystemic and complex diseases that strongly impact the Quality of Life (QoL) of those affected. Patient Reported Outcomes (PROs) are validated tools that assess the overall health status of patients, particularly with regard to emotional and functional domains. The aim of the study was to evaluate the impact of disease clinical features and comorbidities on Health-Related (HR) QoL in a monocentric cohort of IIM patients.

Methods: Consecutive adult patients with a diagnosis of IIM (2017 EULAR/ACR criteria) followed at our Myositis Clinic were enrolled in this cross-sectional study. Demographic and clinical data were collected at enrolment. HRQoL was evaluated by administration of generic PROs: Patient Global Assessment (PGA), Health Assessment Questionnaire (HAQ), Short-Form 36 Items Health Survey (SF36), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-F), Hospital Anxiety and Depression Scale (HADS). Intergroup comparisons were assessed using t-test and Mann-Whitney tests, as appropriate. Multivariate analysis was performed by a linear regression model.

Results: We enrolled 85 patients (67.1% female; mean age 65.7±12.5 years; mean disease duration 7.9±6.5 years) with the following diagnosis: 44 dermatomyositis (51.8%), 36 polymyositis (42.3%), 5 inclusion body myositis (5.9%). Among clinical features, dysphagia and sicca symptoms were found to have the greatest impact on HRQoL: in fact, dysphagia was associated with worse outcomes in all PROs (PGA p< 0.001, HAQ p< 0.001, SF36 p≤0.031, FACIT-F p< 0.001, HADS p=0.023 for anxiety and p=0.002 for depression), while sicca symptoms were found to be associated with worse scores in three of four SF36 domains of both mental and physical health (p≤0.044 and p≤0.027, respectively) and in a greater fatigue assessed by FACIT-F (p=0.006). As expected, HRQoL was significantly impaired by the coexistence of fibromyalgia (FM), which indeed determined worse scores of HAQ (p=0.031) and all SF36 domains (p≤0.021), higher fatigue levels (p=0.006) and higher levels of anxiety and depression evaluated by HADS (p=0.025 and p=0.05, respectively); also osteoporosis (OP) was found to significantly impact on PGA (p=0.027) and physical functioning and general health evaluated by SF-36 (p=0.044 and p=0.029, respectively). At multivariate analysis, among clinical variables, only dysphagia maintained a significant impact on almost all PROs (p≤0.018, except for pain and physical role domains of SF36); among comorbidities, FM had a significant impact on all PROs (p≤0.05), whereas OP had an impact only on the SF36 domains (p≤0.03).

Conclusion: Our data could help rheumatologists to focus their attention on specific clinical domains of IIMs in the perspective of preserving patients’ QoL. In particular, dysphagia and FM were found to be the main determinants of HRQoL in IIM patients, thus suggesting their better control and optimized management could significantly improve patients’ physical and psychological functioning. Moreover, OP prevention might further reduce the disease burden in this group of patients, thus ameliorating their quality of care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/health-related-quality-of-life-in-idiopathic-inflammatory-myopathies-how-to-act-for-improving-the-disease-burden-of-patients/