Self-Reported Breathlessness on Exertion Is Associated with Poor Outcomes Among Women with Systemic Lupus Erythematosus (SLE)

Patricia P. Katz¹, Sofia Pedro², Robert S. Katz³, Frederick Wolfe⁴ and Kaleb Michaud⁵, ¹Medicine/Rheumatology, University of California, San Francisco, San Francisco, CA, ²National Data Bank for Rheumatic Diseases, Wichita, KS, ³Rush University Medical Center, Chicago, IL, ⁴National Data Bank, Wichita, KS, ⁵University of Nebraska Medical Center, Omaha, NE

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: functional status, patient-reported outcome measures and systemic lupus erythematosus (SLE), Pulmonary Involvement

Session Information

Date: Tuesday, November 15, 2016

Title: Epidemiology and Public Health - ARHP Poster

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Breathlessness is often considered as a predictor of functional outcomes in pulmonary disease, but has not been examined in SLE.

Methods: Data were from the National Data Bank for Rheumatic Diseases (NDB), for which participants complete questionnaires every 6 months. Only women with SLE who completed one of the most recent completed questionnaires were included (n = 278). Breathlessness was assessed with the Medical Research Council questionnaire (Table 1). Outcomes examined were self-reported lupus status (Systemic Lupus Activity Questionnaire, SLAQ¹), assessment of lupus activity (rating from 0 [not active] – 100 [very active]), global assessment of health status (rating from 0 [doing very well] – 10 [doing very poorly]), and self-reported assessments of pain, fatigue, and sleep problems, each rated 0 – 10 with higher ratings reflecting worse symptoms. ANOVAs and multivariate linear regression analyses estimated the relationship of breathlessness on outcomes. Multivariate analyses controlled for age, low education, low income, body mass index (BMI), duration of SLE, self-reported disease damage (Brief Inventory of Lupus Damage, BILD²), Rheumatic Disease Comorbidity Index (RDCI)³, current or former smoking, and self-reported chronic obstructive pulmonary disease (COPD) or asthma.

Results: Mean age was 58 ± 13 years, 22% had education ≤ high school, and 47% had low income. Mean disease duration was 21 ± 12 years, mean BMI was 29 ± 8, and mean score on the RDCI was 2.7 ± 1.8. 5% were current smokers, 41% were former smokers, and 7% had self-reported COPD. In both unadjusted and unadjusted analyses, breathlessness ratings were associated with worse outcomes on each measure (Table 2).

Conclusion: Breathlessness was associated with worse patient-reported outcomes among this group of women with SLE, even after controlling for disease status, smoking, and self-reported COPD. While self-reports of breathlessness are often used to assess pulmonary functioning, these items may also indicate poor cardiorespiratory fitness. ¹ Karlson EW, et al. Lupus 2003; 12:280. ² Yazdany J, et al. Arthritis Care Res 2011; 63:1170 ³England BR, et al. Arthritis Care Res 2015; 6: 865

Table 1. MRC categories and frequencies
	% (n)
Group 0: Only get breathless with strenuous exercise	39.8 (98)
Group 1: Get short of breath when hurrying on a level or up a slight hill	25.6 (63)
Group 2: Walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level	14.2 (35)
Group 3: Have to stop for breath after walking 100 yards or after a few minutes on the level	20.2 (50)
Group 4: Too breathless to leave the house	0.8 (2)
• Groups 3 and 4 were combined for analysis. • Respondents were instructed not to answer items if activity problems were due to other physical problems

Table 2. Association of breathlessness ratings with outcomes
	Group 0	Group 1	Group 2	Group 3/4	p-value*
SLAQ	8.3 ± 6.1	10.4 ± 6.3	13.5 ± 6.8	14.9 ± 7.8	.05
Lupus activity rating	21.1 ± 24.0	28.0 ± 22.9	38.1 ± 29.4	45.1 ± 30.6	.009
Global health status rating	2.5 ± 2.3	3.6 ± 2.3	4.9 ± 2.3	5.7 ± 2.7	<.0001
Pain	2.5 ± 2.6	4.0 ± 2.5	5.2 ± 2.8	5.5 ± 2.7	.005
Fatigue	3.5 ± 2.9	4.4 ± 2.7	6.4 ± 2.7	6.8 ± 2.5	<.0001
Sleep	3.1 ± 2.9	4.1 ± 3.0	5.3 ± 3.4	5.8 ± 3.0	.008
* p-value from multiple linear regression controlling for age, education, income, BMI, smoking (current or former), SLE duration, SLE damage (BILD score), comorbidity index (RDCI), and self-reported COPD (chronic obstructive pulmonary disease, emphysema, or chronic bronchitis) or asthma

Disclosure: P. P. Katz, None; S. Pedro, None; R. S. Katz, None; F. Wolfe, None; K. Michaud, Rheumatology Research Foundation, Pfizer, 2.

To cite this abstract in AMA style:

Katz PP, Pedro S, Katz RS, Wolfe F, Michaud K. Self-Reported Breathlessness on Exertion Is Associated with Poor Outcomes Among Women with Systemic Lupus Erythematosus (SLE) [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/self-reported-breathlessness-on-exertion-is-associated-with-poor-outcomes-among-women-with-systemic-lupus-erythematosus-sle/. Accessed .

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