Health-related quality of life in Italian patients with systemic lupus erythematosus. II. Role of clinical, immunological and psychological determinants.

Objective: To investigate the role of clinical, immunological and psychological variables in influencing the health-related quality of life (HRQOL) of Italian patients with systemic lupus erythematosus (SLE).

Methods: The Medical Outcomes Study Short Form-36 was applied in a cohort of 126 SLE patients. At the time of HRQOL testing all patients underwent a clinical and laboratory evaluation, together with the measure of disease activity, severity and damage. In addition, a battery of psychological tests including the Hamilton Anxiety Scale (HAS) and the Hamilton Depression Rating scale (HAM-D) was applied.

Results: The parameters which seemed to greatly influence the impairment of HRQOL were older age, arthralgia-arthritis and higher HAS scores as well as HAM-D. In multivariate analysis (adjusted for age), arthralgia-arthritis and a higher HAM-D score were associated with HRQOL impairment. No relationship between HRQOL and SLE activity, severity or damage were found. However, a relationship between HAS or HAM-D scores and damage or arthralgia-arthritis was noted.

Conclusions: Anxiety, depression and joint pain seem to be the major determinants of HRQOL impairment in SLE patients. Damage seems to influence HRQOL mostly through depression.