The relationship of fatigue with quality of life in patients with systemic lupus erythematosus having low disease activity

Abstract

Background: Patients of systemic lupus erythematosus (SLE) are known to have poor quality of life and high levels of fatigue. However, there is limited data on patients with SLE having low disease activity; thus this study looked at theses aspect in Indian patients with low disease activity. Methods: This was a cross-sectional study that included consecutive SLE patients having low activity disease (systemic lupus erythematosus disease activity index :::4). Past major organ involvement and current medication was noted. Controls were recruited from hospital staff. Subjects were administered SF-36v2, WHOQoL-BREF, FACIT-Fatigue subscale and HAQ-DI. Results expressed as mean ± SD and compared by students t test. Corrected p value (p < 0.05) was considered significant (corrected for multiple comparisons). Results: This study included 60 patients with SLE (F:M = 55:5) with mean SLEDAI being 0.9 ± 1.6, and 28 controls (F:M = 24:4). Both the groups had similar age (30.1 ± 9.3, 27.7 ± 7.7 yrs, p = 0.27). Patients had poorer quality of life compared to controls in all domains of SF- 36v2, with lower physical (45.0 ± 9.9, 55.7 ± 3.7, p < 0.01) and mental component summary scores (46.5 ± 11.0, 54.7 ± 6.4, p < 0.01). WHOQol-BREF scores in all domains were lower in patients. Patients had higher fatigue, i.e., lower scores on FACIT-Fatigue subscale (36.8 ± 13.0, 50.5 ± 2.4, p < 0.01) and worse HAQ-DI (0.4 ± 0.6, 0.0 ± 0.1, p < 0.01). Patients taking prednisolone :::7.5 mg per day (N = 45) had a significantly less fatigue thus a higher FACIT score than compared to those on higher doses (FACIT-fatigue score 39.9 ± 10.6, 27.1 ± 15.4, p = 0.03). Conclusions: Despite having low disease activity, SLE patients had worse quality of life and high fatigue levels. Fatigue may have an important role in the impaired quality of life in these patients.