Health Related Quality of Life in Lupus:  Self-Management- a Modifiable Predictor.

Background/Purpose: Health related quality of life (HRQOL) is significantly effected in patients with Lupus. While mortality in Lupus patients has improved in the past few decades, these patients continue to have significant impairment in their health related quality of life. There are multiple complex factors which can influence health related quality of life in these patients

Methods: A cross sectional study was done in 50 Patients in the Vanderbilt Lupus Center meeting the 1997 ACR classification criteria for SLE. LupusPRO, a disease-specific patient reported outcomes tool, was used to assess HRQOL and non HRQOL. Disease activity was assessed using the SLEDAI-2K. Data on following were collected:  coping (BRIEF-COPE questionnaire), social support (ENRICHD Social Support Instrument (ESSI)), quality of patient-health care provider communication (Patient-Health Care Provider Communication Scale (PHCPCS)), self-management (Perceived Medical Condition Self-Management Scale (PMCSMS)), and patient-reported medication adherence (Medication Adherence Self-report Inventory (MASRI)). Correlational and multivariate linear regression analyses with HRQOL as the dependent variable were conducted. A p-value of <0.05 was considered significant on 2-sided t-test.

Results: Mean (SD) age was 40.3 (12.9) years; 94% of patients were women (Table 1). Mean (SD) HRQOL score was 68.0 (21.5). HRQOL correlated positively with PMCSMS (0.704, p <0.001), BRIEF-COPE (0.643, p<0.001), ESSI (0.299, p 0.041), PHCPCS (0.464, p 0.001), and SLEDAI (-0.320, p 0.027). On multivariate linear analysis regression, PMCSMS (beta- 2.079, 0.001) and BRIEF-COPE (1.969, p 0.036) were independent predictors of HRQOL (Table 2). Domains for coping, social support and satisfaction with care on the LupusPRO correlated with BRIEF-COPE, ESSI and PHCPCS respectively.

Conclusion: Self-management skills and coping mechanism, are both modifiable predictors of HRQOL in our lupus patients. Besides controlling for disease activity, strategies to intervene on self-management and coping need to be integrated into routine care of Lupus patients.