The Multidimensional Burden of Systemic Lupus Erythematosus: Mortality Risk and Quality of Life Measures Early in the Course of the Disease

Purpose Our primary objective was to evaluate mortality risk and predictors among recently diagnosed systemic lupus erythematosus (SLE) patients. Methods Vital status of 265 SLE patients and 355 controls enrolled in the Carolina Lupus Study (median time since diagnosis = 13 months) was determined approximately 5 years after enrollment. We also assessed the utility of an 8-item quality of life instrument, derived from the standard 36 item Medical Outcomes Survey (SF-36), as an additional measure of disease impact. Results Five years after diagnosis, 9.7% of patients compared with 0.3% of controls had died (p<0.0001). Increased mortality risk was seen among older patients (adjusted hazards ratio, HR, 1.03, 95% confidence interval 1.01, 1.06) per one year increment in age, and among men, African-Americans, patients with lupus nephritis and patients with ds-DNA antibodies (adjusted HR approximately 2.0 for each of these factors). In addition, patients who did not provide a blood sample at study enrollment experienced increased mortality risk (age, gender, and race adjusted HR 3.7, 95% CI 1.5, 9.1). Similar results were seen in analyses limited to time from study enrollment. Physical component scores of the quality of life measure were 7.7 points lower (p < 0.0001), and mental component scores were 1.8 points lower (p = 0.07) in patients compared with controls. Conclusion The mortality risk among SLE patients is significant, even early in the disease process and even with currently available treatments. Differences between cases and controls in health-related quality of life using the SF-8 also demonstrate the multidimensional burden of SLE.