Patients with neuropsychiatric involvement systemic lupus erythematosus experience poorer health-related quality of life and more fatigue than systemic lupus erythematosus patients with no neuropsychiatric involvement, irrespective of neuropsychiatric activity

Dionysis Nikolopoulos; Nursen Cetrez; Julius Lindblom; Leonardo Palazzo; Yvonne Enman; Ioannis Parodis

doi:10.1093/rheumatology/keae216

Patients with neuropsychiatric involvement systemic lupus erythematosus experience poorer health-related quality of life and more fatigue than systemic lupus erythematosus patients with no neuropsychiatric involvement, irrespective of neuropsychiatric activity

Rheumatology (Oxford). 2024 Apr 5:keae216. doi: 10.1093/rheumatology/keae216. Online ahead of print.

Authors

Dionysis Nikolopoulos^{1

2}, Nursen Cetrez^{1

2}, Julius Lindblom^{1

2}, Leonardo Palazzo^{1

2}, Yvonne Enman^{1

2}, Ioannis Parodis^{1

2

3}

Affiliations

¹ Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
² Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
³ Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

PMID: 38579198
DOI: 10.1093/rheumatology/keae216

Abstract

Objectives: Substantial proportions of patients with systemic lupus erythematosus (SLE) report poor health-related quality of life (HRQoL). Our objective was to investigate the impact of neuropsychiatric involvement (NP) in SLE on patient-reported outcomes.

Methods: We analysed data from four phase III trials (BLISS-52, BLISS-76, BLISS-SC, EMBRACE; N = 2968). The neuropsychiatric SLE (NPSLE) group comprised individuals with NP-British Isles Lupus Assessment group (BILAG) A/B/C/D or score in any descriptor of the NP-SLEDAI-2K at baseline (N = 350), while the non-NPSLE group consisted of patients with NP-BILAG E (N = 2618). HRQoL was assessed with the SF-36, EQ-5D-3L, and FACIT-F. Full health state (FHS) was defined as "no problems" in all EQ-5D dimensions.

Results: NPSLE patients reported lower scores in the SF-36 physical and mental component summary compared with the non-NPSLE population (mean±s.d.: 35.7±9.1 versus 39.6±9.6; p<0.001 and 37.3±12.1 versus 41.4±11.0; p<0.001, respectively). NPSLE patients also exhibited impaired HRQoL in all EQ-5D dimensions compared with non-NPSLE patients (p<0.05 for all). A substantially lower proportion among NPSLE patients experienced FHS in comparison with the non-NPSLE group (3.3% versus 14.5%; p<0.001). NPSLE was associated with severe fatigue (23.8±12.2 versus 31.5±11.6; p<0.001). Notably, our findings revealed no discernible distinctions between active and inactive NPSLE patients with regard to SF-36, EQ-5D, FHS, and FACIT-F scores.

Conclusion: Neuropsychiatric involvement in patients with SLE has a detrimental effect on HRQoL experience and is associated with severe fatigue, regardless of the degree of neuropsychiatric disease activity. Early intervention is warranted in NPSLE patients to enhance long-term HRQoL experience.

Keywords: CNS lupus; patient-reported outcomes; quality of life; systemic lupus erythematosus.