To evaluate the impact of systemic lupus erythematosus (SLE) on health-related quality of life (HRQoL) assessed with SF-36 and explore factors associated with HRQoL in SLE patients.
Methods
A random-effect meta-analysis was performed to calculate extracted data. Sensitivity and subgroup analyses were performed to distinguish sources of heterogeneity.
Results
A total of 36 articles were finally included in this meta-analysis, including 6510 patients. The pooled mean scores of SF-36 physical component summary and mental component summary were 46.10 (95% confidence interval (CI): 43.09–49.10) and 50.37 (95% CI: 47.78–52.87), respectively. Spearman's correlation analysis found that mean age, proportion of female participants, and publication decades were negatively associated with some of the SF-36 domains. Sample size and SLEDAI were positively associated with some of the SF-36 domains. Patients with SLE have lower HRQoL in comparison to the general population.
Conclusions
SLE has a significant impact on HRQoL, which proves that the necessity of improving HRQoL in SLE patients cannot be ignored. Measuring HRQoL should be considered as an indispensable part of the overall evaluation of health conditions of SLE patients.
TsokosGC. Systemic lupus erythematosus. N Engl J Med2011; 365: 2110–2121.
2.
MurphyGLisnevskaiaLIsenbergD. Systemic lupus erythematosus and other autoimmune rheumatic diseases: challenges to treatment. Lancet2013; 382: 809–818.
3.
PalaginiLMoscaMTaniCet al.Depression and systemic lupus erythematosus: a systematic review. Lupus2013; 22: 409–416.
4.
UrowitzMBGladmanDDIbañezDet al.Evolution of disease burden over five years in a multicenter inception systemic lupus erythematosus cohort. Arthritis Care Res2012; 64: 132–137.
5.
TolozaSMJollyMAlarcónGS. Quality-of-life measurements in multiethnic patients with systemic lupus erythematosus: cross-cultural issues. Curr Rheumatol Rep2010; 12: 237–249.
6.
AaronsonNKMullerMCohenPDet al.Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol1998; 51: 1055–1068.
7.
WareJEJrSherbourneCD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care1992; 30: 473–483.
8.
StollTGordonCSeifertBet al.Consistency and validity of patient administered assessment of quality of life by the MOS SF-36; its association with disease activity and damage in patients with systemic lupus erythematosus. J Rheumatol1997; 24: 1608–1614.
9.
TalwarASahniSKimEJet al.Dyspnea, depression and health related quality of life in pulmonary arterial hypertension patients. J Exerc Rehabil2015; 11: 259–265.
10.
ChaigneBFinckhAAlpizar-RodriguezDet al.Differential impact of systemic lupus erythematosus and rheumatoid arthritis on health-related quality of life. Qual Life Res2017; 26: 1767–1775.
11.
MusturDVesović-PotićVStanisavljevićDet al.Assessment of functional disability and quality of life in patients with ankylosing spondylitis. Srp Arh Celok Lek2009; 137: 524–528.
12.
GuiducciCGongMXuZet al.TLR recognition of self nucleic acids hampers glucocorticoid activity in lupus. Nature2010; 465: 937–941.
13.
WangJBPanHFYeDQet al.Association of lnc5150 gene polymorphisms with systemic lupus erythematosus. Chin J Dis Control Prev2018; 22: 929–932.
14.
MargiottaDPEBastaFDolciniGet al.The relation between, metabolic syndrome and quality of life in patients with systemic lupus erythematosus. PLoS One2017; 12: e0187645.
15.
SchmedingASchneiderM. Fatigue, health-related quality of life and other patient-reported outcomes in systemic lupus erythematosus. Best Pract Res Clin Rheumatol2013; 27: 363–375.
16.
YangXFanDXiaQet al.The health-related quality of life of ankylosing spondylitis patients assessed by SF-36: a systematic review and meta-analysis. Qual Life Res2016; 25: 2711–2723.
17.
MatchamFScottICRaynerLet al.The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: a systematic review and meta-analysis. Semin Arthritis Rheum2014; 44: 123–130.
18.
MoherDLiberatiATetzlaffJet al.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ2009; 339: b2535.
19.
WestR. Does blinding of readers affect results of meta-analyses?. Lancet1997; 350: 892.
20.
VandenbrouckeJPvon ElmEAltmanDGet al.Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg2014; 12: 1500–1524.
21.
HendriksmaMJoostenMHPetersJPet al.Evaluation of the quality of reporting of observational studies in otorhinolaryngology – based on the STROBE statement. PLoS One2017; 12: e0169316.
22.
HarrisRBradburnMDeeksJet al.METAN: Stata module for fixed and random effects meta-analysis. Stat Software Components2010; 8: 3–28.
23.
HigginsJPThompsonSGDeeksJJet al.Measuring inconsistency in meta-analyses. BMJ2003; 327: 557–560.
24.
ClarkePMSimonJCullCAet al.Assessing the impact of visual acuity on quality of life in individuals with type 2 diabetes using the short form-36. Diabetes Care2006; 29: 1506–1511.
25.
KusekJWGreenePWangSRet al.Cross-sectional study of health-related quality of life in African Americans with chronic renal insufficiency: the African American Study of Kidney Disease and Hypertension Trial. Am J Kidney Dis2002; 39: 513–524.
26.
Jenkinson C, Coulter A, Wright L. Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. BMJ 1993; 306: 1437--1440.
27.
SchlenkEAErlenJADunbar-JacobJet al.Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36. Qual Life Res1998; 7: 57–65.
28.
AudureauERicanSCosteJ. Worsening trends and increasing disparities in health-related quality of life: evidence from two French population-based cross-sectional surveys, 1995–2003. Qual Life Res2013; 22: 13–26.
29.
RibuLHanestadBRMoumTet al.A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a nondiabetes group from the general population. Qual Life Res2007; 16: 179–189.
30.
ZhuLWZhangTPanHFet al.BMI, disease activity, and health-related quality-of-life in systemic lupus erythematosus. Clin Rheumatol2010; 29: 1413–1417.
31.
JollyMUtsetTO. Can disease specific measures for systemic lupus erythematosus predict patients health related quality of life?Lupus2004; 13: 924–926.
32.
UrowitzMGladmanDDIbañezDet al.Changes in quality of life in the first 5 years of disease in a multicenter cohort of patients with systemic lupus erythematosus. Arthritis Care Res (Hoboken)2014; 66: 1374–1379.
33.
MokCCHoLYCheungMYet al.Effect of disease activity and damage on quality of life in patients with systemic lupus erythematosus: a 2-year prospective study. Scand J Rheumatol2009; 38: 121–127.
34.
WolfeFMichaudKLiTet al.EQ-5D and SF-36 quality of life measures in systemic lupus erythematosus: comparisons with rheumatoid arthritis, noninflammatory rheumatic disorders, and fibromyalgia. J Rheumatol2010; 37: 296–304.
35.
BruceINMakVCHallettDCet al.Factors associated with fatigue in patients with systemic lupus erythematosus. Ann Rheum Dis1999; 58: 379–381.
36.
Yilmaz-OnerSIlhanBCanMet al.Fatigue in systemic lupus erythematosus: Association with disease activity, quality of life and psychosocial factors. Z Rheumatol2017; 76: 913–919.
37.
García-CarrascoMMendoza-PintoCCardielMHet al.Health related quality of life in Mexican women with systemic lupus erythematosus: a descriptive study using SF-36 and LupusQoL(C). Lupus2012; 21: 1219–1224.
38.
DuarteCAbreuPCoutoMet al.Health-related quality of life in portuguese SLE patients: an outcome measure independent of disease activity and cumulative damage. Acta Reumatol Port2010; 35: 30–35.
39.
ChaiamnuaySLomaratanaVSumransurpSet al.Health-related quality of life and disease severity of SLE patients in Phramongkutklao Hospital. J Med Assoc Thai2010; 93(Suppl 6): S125–S130.
40.
ChenHHChenDYChenYMet al.Health-related quality of life and utility: comparison of ankylosing spondylitis, rheumatoid arthritis, and systemic lupus erythematosus patients in Taiwan. Clin Rheumatol2017; 36: 133–142.
41.
Yilmaz-OnerSOnerCDogukanFMet al.Health-related quality of life assessed by LupusQoL questionnaire and SF-36 in Turkish patients with systemic lupus erythematosus. Clin Rheumatol2016; 35: 617–622.
42.
RinaldiSDoriaASalaffiFet al.Health-related quality of life in Italian patients with systemic lupus erythematosus. I. Relationship between physical and mental dimension and impact of age. Rheumatology (Oxford)2004; 43: 1574–1579.
43.
MedeirosMMMenezesAPSilveiraVAet al.Health-related quality of life in patients with systemic lupus erythematosus and its relationship with cyclophosphamide pulse therapy. Eur J Intern Med2008; 19: 122–128.
44.
JollyM. How does quality of life of patients with systemic lupus erythematosus compare with that of other common chronic illnesses?J Rheumatol2005; 32: 1706–1708.
45.
RinaldiSGhisiMIaccarinoLet al.Influence of coping skills on health-related quality of life in patients with systemic lupus erythematosus. Arthritis Rheum2006; 55: 427–433.
46.
ZhengYYeDQPanHFet al.Influence of social support on health-related quality of life in patients with systemic lupus erythematosus. Clin Rheumatol2009; 28: 265–269.
47.
KulczyckaLSysa-JedrzejowskaAZalewska-JanowskaAet al.Quality of life and socioeconomic factors in Polish patients with systemic lupus erythematosus. J Eur Acad Dermatol Venereol2008; 22: 1218–1226.
48.
StollTKauerYBüchiSet al.Prediction of depression in systemic lupus erythematosus patients using SF-36 Mental Health scores. Rheumatology (Oxford)2001; 40: 695–698.
49.
FurukawaMKiyoharaCHoriuchiTet al.Quality of life in Japanese female patients with systemic lupus erythematosus: Evaluation using the Short Form 36 Health Survey. Mod Rheumatol2016; 26: 240–247.
50.
BarnadoAWhelessLMeyerAKet al.Quality of life in patients with systemic lupus erythematosus (SLE) compared with related controls within a unique African American population. Lupus2012; 21: 563–569.
51.
JollyMGalicierLAumaîtreOet al.Quality of life in systemic lupus erythematosus: description in a cohort of French patients and association with blood hydroxychloroquine levels. Lupus2016; 25: 735–740.
52.
ZengFXuQLiuDet al.Relatives' quality of life and psychological disturbance: a new concern of SLE management. Clin Rheumatol2018; 37: 67–73.
53.
Abu-ShakraMKerenALivshitzIet al.Sense of coherence and its impact on quality of life of patients with systemic lupus erythematosus. Lupus2006; 15: 32–37.
54.
ColangeloKJPopeJEPeschkenC. The minimally important difference for patient reported outcomes in systemic lupus erythematosus including the HAQ-DI, pain, fatigue, and SF-36. J Rheumatol2009; 36: 2231–2237.
55.
Da CostaDClarkeAEDobkinPLet al.The relationship between health status, social support and satisfaction with medical care among patients with systemic lupus erythematosus. Int J Qual Health Care1999; 11: 201–207.
56.
HuangHCChouCTLinKCet al.The relationships between disability level, health-promoting lifestyle, and quality of life in outpatients with systemic lupus erythematosus. J Nurs Res2007; 15: 21–32.
57.
ThumbooJFongKYNgTPet al.Validation of the MOS SF-36 for quality of life assessment of patients with systemic lupus erythematosus in Singapore. J Rheumatol1999; 26: 97–102.
58.
ShakeriHArmanFHossieniMet al.Depression, Anxiety and Disease-Related Variables and Quality of Life Among Individuals With Systemic Lupus Erythematosus Living in Kermanshah Province, Iran. Iran Red Crescent Med J2015; 17: e31047.
59.
FreireEBruscatoACiconelliR. Quality of life in systemic lupus erythematosus patients in Northeastern Brazil: Is health-related quality of life a predictor of survival for these patients?Acta Reumatol Port2009; 34: 207–11.
60.
WangCMayoNEFortinPR. The relationship between health related quality of life and disease activity and damage in systemic lupus erythematosus. J Rheumatol2001; 28: 525–532.
61.
AppenzellerSClarkeAEPanopalisPet al.The relationship between renal activity and quality of life in systemic lupus erythematosus. J Rheumatol2009; 36: 947–952.
62.
SliemHTawfikGKhalilKAet al.Pattern of systemic lupus erythematosus in Egyptian patients: the impact of disease activity on the quality of life. Pan Afr Med J2010; 6: 14.
63.
AlarcónGSMcGwinGJrUribeAet al.Systemic lupus erythematosus in a multiethnic lupus cohort (LUMINA). XVII. Predictors of self-reported health-related quality of life early in the disease course. Arthritis Rheum2004; 51: 465–474.
64.
DorseyRRAndresenEMMooreTL. Health-related quality of life and support group attendance for patients with systemic lupus erythematosus. J Clin Rheumatol2004; 10: 6–9.
65.
MakATangCSHoRC. Serum tumour necrosis factor-alpha is associated with poor health-related quality of life and depressive symptoms in patients with systemic lupus erythematosus. Lupus2013; 22: 254–261.
66.
BenithaRTiklyM. Functional disability and health-related quality of life in South Africans with rheumatoid arthritis and systemic lupus erythematosus. Clin Rheumatol2007; 26: 24–29.
67.
ChaigneBChizzoliniCPernegerTet al.Impact of disease activity on health-related quality of life in systemic lupus erythematosus – a cross-sectional analysis of the Swiss Systemic Lupus Erythematosus Cohort Study (SSCS). BMC Immunol2017; 18: 17.
68.
MessutiLZoliAGremeseEet al.Joint involvement in SLE: the controversy of RHUPUS. Int Trends Immun2014; 2: 155–161.
69.
LiXLuJHuSet al.The primary health-care system in China. Lancet2017; 390: 2584–2594.
70.
Al SlamahTNichollBIAlslailFYet al.Self-management of type 2 diabetes in gulf cooperation council countries: a systematic review. PLoS One2017; 12: e0189160.
71.
ZuidemaRMRepping-WutsHEversAWet al.What do we know about rheumatoid arthritis patients' support needs for self-management? A scoping review. Int J Nurs Stud2015; 52: 1617–1624.
72.
GaleaSTracyM. Participation rates in epidemiologic studies. Ann Epidemiol2007; 17: 643–653.
73.
LuTPanYKaoSYet al.Gene regulation and DNA damage in the ageing human brain. Nature2004; 429: 883–891.
74.
Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet2015; 386: 743–800.
75.
MatchamFRaynerLSteerSet al.The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology2013; 52: 2136–2148.
76.
MoranPRomaniukHCoffeyCet al.The influence of personality disorder on the future mental health and social adjustment of young adults: a population-based, longitudinal cohort study. Lancet Psychiatry2016; 3: 636–645.
77.
KuehnerC. Why is depression more common among women than among men?. Lancet Psychiatry2017; 4: 146–158.
78.
WareJSnowKMaKet al.SF36 health survey: manual and interpretation guide, Lincoln, RI: Quality Metric, 1993.
79.
BrownNJPlattMPBeattieRM. Women, children, and global public health: beyond the millennium development goals. BMJ2015; 350: h1755.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
