SAT0428 Association between organ damage and health-related quality of life in systemic lupus erythematosus (SLE): a systematic review
Authors: E.R. Hammond, D.H. Lin, I.B. Murimi, H. Nab, H. Kan, O. Onasanya, J.C. Tierce, X. Wang, B. Desta, G.C. Alexander
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Organ damage in SLE is associated with increased morbidity and mortality. The comorbid burden of SLE involves various organ systems and may be associated with pain, fatigue, difficulty with daily activities (including school and work), and emotional well-being, all contributing to high rates of disability. <h3>Objectives</h3> We conducted a systematic literature review evaluating association between SLE-related organ damage and health-related quality of life (HRQOL). <h3>Methods</h3> A systematic literature search (January 2000–February 2017) of PubMed, EMBASE, Cochrane Library, and Latin American and Caribbean Health Sciences Literature was conducted to identify studies evaluating association between organ damage (measured by SLICC/ACR Damage Index [SDI]) and HRQOL for adults with SLE. Instruments examined include the Short Form 36 (SF-36: Physical Component Summary [PCS] and Mental Component Summary [MCS], 15 studies); EuroQol 5 Dimensions Questionnaire (EQ-5D) and Fatigue Severity Scale (FSS, 2 studies each); and the LupusQoL, Multidimensional Fatigue Inventory (MFI), Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO), and WHO Quality of Life Scale (WHOQOL-BREF) (1 study each). <h3>Results</h3> From 10 420 articles screened, 20 studies were included (3 prospective cohort studies, 17 cross-sectional studies). The 3 prospective studies evaluated HRQOL by the SF-36, 2 of which modelled SDI as a binary variable. For patients without damage at baseline, any damage accrual over 2 years was associated with a 5.5-fold increased risk of decreased HRQOL compared with those who did not develop new damage (SF-36 overall relative risk [RR] 5.5 [95% CI: 1.1–26.6; p=0.03]). A similar trend toward increased risk of decreased HRQOL was observed with PCS: RR 2.5 (95% CI: 0.6–10.0; p=0.19); and MCS: RR 4.6 (95% CI: 0.9–22.8; p=0.06). Any damage at baseline was associated with 67% decreased odds of achieving minimum clinically important improvement in SF-36 PCS: odds ratio [OR] 0.33 (95% CI: 0.13–0.85; p=0.02). However, no association was observed for MCS. When SDI was modelled as a continuous variable, increasing damage was associated dose-dependently with decreased SF-36 PCS compared with SDI=0; SDI 1: –2.64, p&lt;0.001; SDI 2: –2.86, p=0.003; SDI 3: –5.94, p&lt;0.001; SDI 4: –6.35, p&lt;0.001; and SDI 5+: –8.11, p&lt;0.001. In cross-sectional evaluations, increasing SDI was modestly correlated with decreased HRQOL: SF-36 correlation coefficient score range: –0.12 to –0.30; SF-36 regression coefficient score range: –0.011 to –4.65; LupusQoL correlation coefficient –0.31, p&lt;0.01; and WHOQOL-BREF regression coefficient –0.06, p=0.57. Increasing fatigue displayed weak correlation with damage: FSS correlation coefficient range: 0.04 to 0.15. <h3>Conclusions</h3> Organ damage was associated with decreased HRQOL in most studies evaluated. This review determined heterogeneity in HRQOL instruments and methodology across studies. Improving construct validity of instruments and consistent evaluation will improve the ability to estimate the burden of SLE and enhance efforts to improve HRQOL in SLE. <h3>Disclosure of Interest</h3> E. Hammond Employee of: AstraZeneca, D. Lin: None declared, I. Murimi: None declared, H. Nab Employee of: AstraZeneca, H. Kan Shareholder of: GlaxoSmithKline, O. Onasanya: None declared, J. Tierce: None declared, X. Wang Employee of: AstraZeneca, B. Desta Employee of: AstraZeneca, G. C. Alexander Consultant for: Chair of the FDA's Peripheral and Central Nervous System Advisory Committee, serves as a paid consultant to IQVIA, serves on the Advisory Board of MesaRx Innovations, and serves as a paid member of OptumRx's National P and T Committee. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies.