1038 The Journal of Rheumatology 2008; 35:6 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2008. All rights reserved. TheRelationshipBetweenNeuropsychiatric,Clinical, andLaboratoryVariablesandQualityofLifeof ChinesePatientswithSystemicLupusErythematosus LAI-SHANTAM,ADRIANWONG,VINCENTC.T.MOK,YAN-ERZHU,LAI-WAKWOK,TENAK.LI, KONG-CHIUWONG,andEDMUNDK.LI ABSTRACT. Objective. Toinvestigatetheroleofneuropsychiatric(NP),clinical,andlaboratoryvariablesininflu- encing the health related quality of life (HRQOL) of Chinese patients with systemic lupus erythe- matosus (SLE). Methods. TheMedicalOutcomesStudyShortForm-36wasappliedinacohortof291patientswith SLE. At the time of HRQOL testing all patients underwent a clinical and laboratory evaluation together with measures of disease activity and damage. Patients also submitted to a battery of NP tests. Results. Using multivariate analysis, NP involvement-ever was associated with impairment of the generalhealthsubscale.Cerebrovasculardiseaseandmononeuropathywereassociatedwithimpair- ment of the physical function subscale, while the latter was also associated with impairment of the role-emotionalsubscale.Cognitiveimpairmentwasassociatedwithimpairmentofthementalhealth subscale.TheHospitalAnxietyandDepression(HAD)depressionscorewasassociatedwithimpair- mentofallthe8subscales,physical,andmentalsummaryscores.TheHADanxietyscorewasasso- ciatedwithimpairmentofpredominantlymentalfunction.Activearthritis,lowereducationlevel,and serum albumin levels were associated with impairment of predominantly physical function. Advancing age and damage were associated with impairment of both physical and mental function. Low hemoglobin level and female sex were associated with impairment of predominantly mental function. Conclusion. NP involvement and low-grade inflammation as reflected by low serum albumin and hemoglobinconcentrationswereassociatedwithimpairedHRQOLinpatientswithSLE,independ- ent of other sociodemographic and clinical variables. (First Release May 1 2008; J Rheumatol 2008;35:1038–45) Key IndexingTerms: SYSTEMICLUPUSERYTHEMATOSUS CHINESE NEUROPSYCHIATRIC HEALTHRELATEDQUALITYOFLIFE From the Department of Medicine and Therapeutics, The Prince of Wales Hospital,The Chinese University of Hong Kong, Hong Kong, China. L.S. Tam, MD (CUHK), FRCP (Glasg), Associate Professor; A.Wong, PhD, Post-doctoral Fellow;V.C.T. Mok, MD (CUHK), MRCP (UK), Associate Professor;Y.E. Zhu, BM, MPhil Student; L.W. Kwok, MBChB, MRCP (UK), Resident; T.K. Li, BN, Research Co-ordinator; K.C.Wong, MBBS, MRCP, Consultant;E.K.Li,MD,FRCP,FRCPC,FACP,FACR,Professor. Address reprint requests to Dr. L.S.Tam, Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong. E-mail: tamls_813@yahoo.com Accepted for publication January 10, 2008. Systemic lupus erythematosus (SLE) is a chronic multisys- tem disease that primarily affects young women. Longterm survival of Chinese patients with SLE is comparable to that reported for Caucasian patients 1 . With improvement in sur- vival in SLE, attention has focused on the reductions in healthrelatedqualityoflife(HRQOL)inthesepatients.The majorityofstudiesassessingimportantdomainsofHRQOL in SLE have been performed in Western sociocultural con- texts 2 . Studies pertaining to quality of life in Chinese patients with SLE have been limited 3,4 . It is well known that HRQOL is significantly influenced bySLE 5 .Thereasonforthisisuncertain.Studieshaveiden- tified older age 6-10 , shorter disease duration 9 , joint pain/arthritis 6,11 , endstage renal failure 12 , socioeconomic status 7,8 , psychosocial factors 3,7-9,11,13 , fatigue 9,14 , pain 9 , fibromyalgia 10,15 , and knowledge of lupus 1 as factors asso- ciated with impaired HRQOL in patients with SLE. Devins andEdworthyfoundthateducationalattainmentemergedas an independent mediator for the race-related difference in theHRQOLin3ethnicgroups(Whites,Blacks,Asians),but thenumbersofAsiansweresmall 2 .Theassociationbetween disease activity or damage and HRQOL in SLE patients remains controversial 3-16 . Relatively little is known regarding whether neuropsy- chiatric (NP) disease in lupus was associated with a signifi- cant reduction in quality of life 17 . Neurocognitive dysfunc- tionhasbeenshowntobeassociatedwithimpairedphysical functioning, independent of other risk factors 16 . However, the instrument used for diagnosing the condition was not specified 16 . Anxiety and depression 13,15 consistently have www.jrheum.org Downloaded on September 7, 2022 from