Abstract：
OBJECTIVE: The predictive validity of disease-specific quality of life (QOL) remains unknown in patients with systemic lupus erythematosus (SLE), although disease-specific measures are equally or more responsive to changes than generic QOL. We aimed to examine the predictive validity of the Lupus patient-reported outcome (PRO) for damage accrual.
METHODS: Patients with SLE and ≥2 measurements over time were included in Japanese nationwide multicentre registry (LUNA). The Lupus PRO questionnaire contains both health-related (HR) and non-HR-QOL measures. Damage accrual was evaluated using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). We examined the association between the Lupus-PRO score at baseline and longitudinal SDI scores using mixed-effects models adjusted for prognostic factors.
RESULTS: Among 1295 patients, those with higher HR-QOL of Lupus PRO at baseline demonstrated a significantly lower increase in SDI (-0.005/year, 95% confidence interval [CI]: -0.007 to - 0.004, p < 0.001). According to the categorisation of HR-QOL based on tertile, a similar dose-dependent effect of HR-QOL on longitudinal SDI was identified (second vs first tertile category: -0.101/year, 95% CI: -0.172 to - 0.030; third tertile category: -0.211/year, 95% CI: -0.281 to - 0.142). Non-HR-QOL was not significantly associated with the SDI scores. Among the HR-QOL domains, cognition, procreation, and physical health were significantly associated with the total SDI scores over time. HR-QOL was associated with corticosteroid-dependent and -independent SDI scores.
CONCLUSIONS: A higher HR-QOL of Lupus PRO was associated with a lower increase in SDI scores. Our findings imply the importance of disease-specific HR-QOL measurements in assessing prognosis.
METHODS: Patients with SLE and ≥2 measurements over time were included in Japanese nationwide multicentre registry (LUNA). The Lupus PRO questionnaire contains both health-related (HR) and non-HR-QOL measures. Damage accrual was evaluated using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). We examined the association between the Lupus-PRO score at baseline and longitudinal SDI scores using mixed-effects models adjusted for prognostic factors.
RESULTS: Among 1295 patients, those with higher HR-QOL of Lupus PRO at baseline demonstrated a significantly lower increase in SDI (-0.005/year, 95% confidence interval [CI]: -0.007 to - 0.004, p < 0.001). According to the categorisation of HR-QOL based on tertile, a similar dose-dependent effect of HR-QOL on longitudinal SDI was identified (second vs first tertile category: -0.101/year, 95% CI: -0.172 to - 0.030; third tertile category: -0.211/year, 95% CI: -0.281 to - 0.142). Non-HR-QOL was not significantly associated with the SDI scores. Among the HR-QOL domains, cognition, procreation, and physical health were significantly associated with the total SDI scores over time. HR-QOL was associated with corticosteroid-dependent and -independent SDI scores.
CONCLUSIONS: A higher HR-QOL of Lupus PRO was associated with a lower increase in SDI scores. Our findings imply the importance of disease-specific HR-QOL measurements in assessing prognosis.
摘要：
目的：系统性红斑狼疮（SLE）患者的疾病特异性生活质量（QOL）的预测有效性仍然未知，尽管与一般QOL相比，疾病特异性措施对变化的反应相同或更敏感。我们旨在检查狼疮患者报告的预后（PRO）对损害累积的预测有效性。
方法：SLE患者和随时间推移的≥2次测量被纳入日本全国多中心注册（LUNA）。狼疮PRO问卷包含与健康相关的（HR）和非HR-QOL测量。使用系统性狼疮国际合作诊所/美国风湿病学会损伤指数（SDI）评估损伤累积。我们使用根据预后因素调整的混合效应模型检查了基线Lupus-PRO评分与纵向SDI评分之间的关联。
结果：在1295名患者中，基线时LupusPRO的HR-QOL较高的人表现出SDI的显着较低的增长（-0.005/年，95%置信区间[CI]：-0.007至-0.004，p<0.001)。根据基于三元组的HR-QOL分类，确定了HR-QOL对纵向SDI的类似剂量依赖性影响（第二与第一三重类别：-0.101/年，95%CI：-0.172至-0.030；第三类：-0.211/年，95%CI：-0.281至-0.142）。非HR-QOL与SDI评分无显著相关。在HR-QOL领域中，认知，生育,随着时间的推移,身体健康与SDI总分显著相关.HR-QOL与皮质类固醇依赖性和非依赖性SDI评分相关。
结论：狼疮PRO较高的HR-QOL与SDI评分较低的增加相关。我们的发现暗示了疾病特异性HR-QOL测量在评估预后中的重要性。
方法：SLE患者和随时间推移的≥2次测量被纳入日本全国多中心注册（LUNA）。狼疮PRO问卷包含与健康相关的（HR）和非HR-QOL测量。使用系统性狼疮国际合作诊所/美国风湿病学会损伤指数（SDI）评估损伤累积。我们使用根据预后因素调整的混合效应模型检查了基线Lupus-PRO评分与纵向SDI评分之间的关联。
结果：在1295名患者中，基线时LupusPRO的HR-QOL较高的人表现出SDI的显着较低的增长（-0.005/年，95%置信区间[CI]：-0.007至-0.004，p<0.001)。根据基于三元组的HR-QOL分类，确定了HR-QOL对纵向SDI的类似剂量依赖性影响（第二与第一三重类别：-0.101/年，95%CI：-0.172至-0.030；第三类：-0.211/年，95%CI：-0.281至-0.142）。非HR-QOL与SDI评分无显著相关。在HR-QOL领域中，认知，生育,随着时间的推移,身体健康与SDI总分显著相关.HR-QOL与皮质类固醇依赖性和非依赖性SDI评分相关。
结论：狼疮PRO较高的HR-QOL与SDI评分较低的增加相关。我们的发现暗示了疾病特异性HR-QOL测量在评估预后中的重要性。
