Quality of Life in Lupus: A Quiz

May 18, 2018

Which symptoms of SLE have the greatest impact on quality of life? What are the most common comorbid emotional disorders? Answers here.

Which clinical features of systemic lupus erythematosus (SLE) have the greatest impact on quality of life? What are the most common comorbid emotional disorders reported by patients? Answers to these and other questions can be found in the following quiz.

1. What are the two most common symptoms of SLE that affect quality of life?

A. Pain and cognitive dysfunction

B. Fatigue and irritability

C. Pain and fatigue

D. Sexual dysfunction and sleep disorders

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Answer: C. Pain and fatigue

According to a review by Olesińska and Saletra,1 the two symptoms most commonly reported in studies as affecting patient quality of life in SLE are fatigue and pain. Over 90% of patients suffer joint pain, and 50% to 90% report constant fatigue that limits daily life. About 95% of patients also experience sleep disorders; however, sexual dysfunction is often unreported. Functional disabilities are largely attributed to pain and fatigue.2

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2. True or false? Disease activity and organ damage in SLE closely correlate with patient-reported quality of life.

A. True

B. False

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Answer: B. False

A longitudinal study by Kiani and colleagues2 confirmed that although these were important outcomes, disease activity and organ damage did not closely correlate with health-related quality of life scores in patients with SLE.

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3. All of the following diseases/disorders frequently coexist with SLE-which is the most frequent?

A. Hypertension

B. Arthritis

C. Skin lesions

D. Psychiatric disorders

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Answer: A. Hypertension

Increased mortality in SLE is influenced primarily by comorbid cardiovascular disease. The LULA study3 of German patients found a 30% rate of hypertension that increased to 41% after 4 years. Comorbid arthritis was present in 27.5%, skin lesions in 21%, and psychiatric disorders in 25%. In addition, osteoporosis, nephropathy, thrombosis, and hyperlipidemia were commonly found in 27.9%, 21%, 20%, and 17.6% of patients with SLE, respectively.

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4. A wide range of emotional disorders have been reported in two-thirds of patients with SLE. Which are the most frequent?

A. Anger and frustration

B. Depression and anxiety

C. Guilt and fear

D. Depression and anger

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Answer: B. Depression and anxiety

More than 70% of SLE patients report anxiety, and 50% report depression.1 Other symptoms of guilt, fear, anger, and frustration-while all present-are reported less frequently as a main symptom.

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5. Which of the following SLE treatments has the most positive impact on quality of life?

A. Immunosuppressant therapies

B. Hydroxychloroquine

C. Glucocorticoids

D. Cognitive behavioral therapy (CBT)

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Answer: D. Cognitive behavioral therapy (CBT)

While immunosuppressant therapies reduce disease activity and hydroxychloroquine increases survival, neither therapy is associated with improved quality of life. Patients express significant concerns about the long-term adverse effects of glucocorticoids, including osteoporosis, weight gain, and glaucoma.1

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6. Increasing physical activity has been found to improve which of these symptoms that affect quality of life?

A. Depression

B. Fatigue

C. Mood disturbances

D. All of the above

E. A and B only

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Answer: D. All of the above

A study by Bogdanovic and colleagues4 reported “significant differences (P < .001) in values of all areas of quality of life questionnaire Short Form 36 before and after implementation of physical activity. . . . Continuous physical activity, regardless of its type, significantly improved quality of life in SLE patients.”

References:

1. Olesińska M, Saletra A. Quality of life in systemic lupus erythematosus and its measurement. Reumatologia. 2018;56:45-54.

2. Kiani AN, Strand V, Fang H, Jaranilla J, Petri M. Predictors of self-reported health-related quality of life in systemic lupus erythematosus. Rheumatology. 2013;52:1651-1657.

3. Tamayo T, Fischer-Betz R, Beer S, et al. Factors influencing the health related quality of life in patients with systemic lupus erythematosus: long-term results (2001–2005) of patients in the German Lupus Erythematosus Self-Help Organization (LULA Study). Lupus. 2010;19:1606-1613.

4. Bogdanovic G, Stojanovich L, Djokovic A, Stanisavljevic N. Physical activity program is helpful for improving quality of life in patients with systemic lupus erythematosus. Tohuku J Exp Med. 2015;237:193-199.