Assessment of Disease Activity and Health Related Quality of Life in Patients With Systemic Lupus Erythematosus at Kenyatta National Hospital

Abstract

Background Systemic lupus erythematosus (SLE) is an autoimmune disorder characterised by inflammation in different organ systems. Disease activity varies from remissions to exacerbations and progression. Assessment of physical health alone is insufficient to evaluate the impact of the disease. Health-related quality of life (HRQoL) represents the patients’ subjective perception of living with the disease and how it affects their physical, emotional and social functions. The aim of this study was to assess the impact of disease activity on HRQoL in SLE patients Methods This was a cross-sectional descriptive study conducted at Kenyatta National Hospital rheumatology and renal outpatient clinics. Ninety patients were assessed for eligibility, 62 patients fulfilling ≥4 Systemic Lupus International Collaborating Clinics Criteria (SLICC) 2012 for classification of SLE were consecutively recruited. Twenty-seven patients with overlap syndromes (SLE/RA, SLE/polmyositis/dermatomyosistis/undifferentiated rheumatic disease) were excluded. Disease activity was assessed by the clinical Systemic Lupus Erythematosus Disease Activity Index 2000 (cSLEDAI-2K). The HRQoL was evaluated using self-administered LupusQoL with scores ranging from 0 (worst) to 100 (best). History of drugs used was corroborated with patients’ medical records. Continuous variables were summarised as means±SD and categorical variables expressed as percentages. HRQoL was correlated with age, disease duration and disease activity using Pearson’s correlation coefficients. A p value of ≤ 0.05 was considered to be significant. All tests were performed on SPSS version 23. Results The study group comprised 60 female and 2 male patients, mean age 34.7±11.8 years. The median disease duration was 36 months, ranging from 1-324 months. Mean cSLEDAI score was 7±5.2 and median disease activity score was 7. Renal disease occurred in 53.2%. All domains of LupusQoL were impaired. The mean scores (out of 100) of the 8 domains of LupusQoL were: physical health 58.2±28.2, pain 60.2±29.8, planning 65.9±29, intimate relationships 50±38.2, burden to others 50.9±34.7, emotional health 62.3±26.2, body image 51±30 and fatigue 65.4±28.7. SLEDAI scores were inversely correlated with scores of physical

health (p=0.043), pain (p=0.027), burden to others (p=0.004), body image (p=0.007) and general health (p=0.026). The patients with renal disease had significantly lower QoL compared to other patients (p=0.037) and the pain (p=0.009), intimate relationships (p=0.04) and body image (p=0.01) were most affected. Age and disease duration were positively correlated with QoL. Disease duration (p=0.01), was associated with a better QoL in the pain (p=0.01), emotional health (p=0.02) and body image (p=0.007) domains. Conclusion Our study showed a low HRQoL in those with active disease. Young age, a recent diagnosis of lupus and presence of renal disease were associated with a poorer QoL. There was marked variation in the drug prescription and limited use of immunosuppressant drugs.