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Low Disease Activity, Remission Predict Better Quality of Life in SLE
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Low disease activity and remission are predictors of increased health-related quality of life in patients with systemic lupus erythematosus, particularly regarding physical and emotional health, pain and feeling like a burden to others, according to data published in Arthritis Care & Research.
“Health-related quality of life (HRQoL) is not strongly associated with disease activity, probably due to the fact that physician and patients have different perception of disease activity,” Manuel F. Ugarte-Gil, MD, MSc, of the Hospital Guillermo Almenara Irigoyen, in Lima, Peru, told Healio Rheumatology. “This lack of association impacts patients’ adherence to their treatment regimen and probably on their outcome.”
“As remission is difficult to achieve, it has been proposed that low disease activity state (LDAS) can be an alternative outcome for the treatment of SLE, as it has been proven to prevent damage, the occurrence of flares and delay mortality,” he added. “However, the impact of LDAS on HRQoL has not been evaluated longitudinally.”
To analyze the impact of low disease activity state on health-related quality of life in patients with SLE, Ugarte-Gil and colleagues studied 243 participants from the Almenara Lupus Cohort. According to the researchers, the cohort began in January 2012 at the Hospital Guillermo Almenara Irigoyen, in which patients were recruited and followed every 6 months. Evaluations included an interview, a review of medical records, a physical examination and laboratory tests.
Ugarte-Gil and colleagues measured health-related quality of life using the Lupus Quality of Life (LupusQoL) questionnaire. Remission was defined as having a SLEDAI2K score of 0, while a SLEDAI2K score of 4 or less, combined with a daily prednisone dose of no more than 7.5 mg and a maintenance dose of immunosuppressive drugs, represented low disease activity status. The researchers performed generalized estimating equations, using each of the eight LupusQoL components, in the subsequent visit, as well as the activity state in the previous visit, as an outcome.
According to Ugarte-Gil and colleagues, 590 of the follow-up visits, or 61.6%, were characterized as low-disease activity status or remission. Both statuses predicted improved health-related quality of life in terms of physical health (B = 4.17; 95% CI,1.2-7.14), pain (B = 6.47; 95% CI, 3.18-9.76), planning (B = 4.97; 95% CI, 1.43-8.52), burden to others (B = 4.12; 95% CI, 0.24-8.01), emotional health (B = 4.5; 95% CI, 1.56-7.44) and fatigue (B = 3.25; 95% CI, 0.04-6.47).
“This study is the first to report the impact of LDAS/remission on the HRQoL of patients with SLE using longitudinal data from a defined lupus cohort,” Ugarte-Gil said. “This work reinforces the notion that treat-to-treat in SLE is followed by better intermediate outcomes.”
He added, “In the treatment of SLE, if remission is not possible to achieve, LDAS is an acceptable target. Achieving LDAS not only beneficially impacts damage, flares and mortality but also the patients’ HRQoL.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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Amanda Mixon, PA-C
We know the disease burden for patients with systemic lupus can be quite high. This not only includes the possibility of end organ damage, but also how the disease impacts the patient’s quality of life. There are more challenges with our lupus patients, in part, because we do not have as many treatment options as we do with some of the other rheumatologic diseases. I am hopeful this will change in upcoming years.
When we get our lupus patients into remission or low disease activity, this can also directly impact their quality of life in the long term. I think this study highlights the importance of a treat-to-target approach in systemic lupus to work at achieving this.
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