Background/Purpose: Substantial proportions of systemic lupus erythematosus (SLE) patients report severe fatigue and adverse Health-related Quality of Life (HRQoL). Particularly neuropsychiatric manifestations have been associated with reduced HRQoL. Our objective was to investigate patient-reported outcomes in patients with neuropsychiatric SLE (NPSLE) in comparison to SLE patients without neuropsychiatric involvement.

Methods: We analysed baseline data from four phase III trials (BLISS-52, BLISS-76, BLISS-SC, EMBRACE; N=2968). The NPSLE group comprised individuals with NP BILAG scores A/B/C/D (N=350). The active NPSLE group was defined as individuals with NP BILAG scores A/B or active neuropsychiatric involvement based on NP SLEDAI-2K domains (n=71). The non-NPSLE group consisted of patients with NP BILAG score E (N=2621). HRQoL was assessed utilising the generic instruments Medical Outcomes Study Questionnaire Short Form 36 (SF-36) health survey, the three-level version of EQ-5D (EQ-5D-3L), and the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue (FACIT-F) scale. Full health state (FHS) was defined as an experience of “no problems” in all five EQ-5D dimensions. Impaired HRQoL by EQ-5D was defined as level 2 or 3 responses in the different dimension.

Results: We observed clinically momentous reduced HRQoL in SLE patients with neuropsychiatric manifestations. NPSLE patients had significantly lower scores of SF-36 physical component summary (PCS) and mental component summary (MCS) compared to the non-NPSLE population [mean (s.d.): 35.7 (9.1) vs. 39.6 (9.6); p< 0.001 and 37.3 (12.1) vs. 41.4 (11.0); p< 0.001, respectively]. NPSLE patients also exhibited impaired HRQoL in all five EQ-5D dimensions compared to non-NPSLE patients (p< 0.05 for all). A substantially lower proportion among NPSLE patients experienced FHS in comparison to the non-NPSLE group (3.3% vs. 14.5%; p< 0.001). Neuropsychiatric involvement in SLE was associated with more severe fatigue as measured by FACIT-F [23.8 (12.2) vs. 31.5 (11.6); p< 0.001]. Similar associations were detected between active NPSLE patients and the non-NPSLE group with regards to SF-36 PCS/MSC domains, FHS, and FACIT-F scores. However, our findings revealed no discernible distinctions between NPSLE and active NPSLE patients, indicating that impaired HRQoL in patients with NPSLE persists regardless of the disease activity state in the neuropsychiatric domain.

Conclusion: Neuropsychiatric involvement in patients with SLE has a detrimental effect on HRQoL experience and is associated with more severe fatigue. Impaired HRQoL scores remain steady in NPSLE patients regardless of the degree of neuropsychiatric activity. Early intervention strategies are warranted in this specific group of SLE patients to enhance long-term patient-reported outcomes.

« Back to ACR Convergence 2023

ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-neuropsychiatric-involvement-on-health-related-quality-of-life-in-patients-with-systemic-lupus-erythematosus/