Factors associated with health-related quality of life in women with systemic lupus erythematosus and permanent skin damage – a cross-sectional study

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Abstract Background: Skin manifestations occur in up to 85% of systemic lupus erythematosus (SLE) patients and can result in cutaneous atrophy and scarring, which can have a negative influence on health-related quality of life (HRQoL). Our study aims to describe HRQoL in SLE patients with permanent skin damage and explore its association with sociodemographic characteristics, self-esteem, and depression and anxiety symptoms. Methods: Cross-sectional study of women with SLE and permanent skin damage on the face and low systemic disease activity. HRQoL was assessed by the Systemic Lupus Erythematosus Quality of Life (SLEQOL) and Dermatology Life Quality Index (DLQI) questionnaires - higher scores indicating worse HRQoL. The Rosenberg self-esteem scale was used to assess self-esteem, and depression/anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale. Results: Fifty-six consecutive patients were enrolled with a median (interquartile range - IQR) age of 47.0 (37.3 - 55.0) years and disease duration of 15.0 (8.0 - 24.8) years. The median (IQR) of the modified SLEDAI-2k was 2 (0-2) and that of the SLICC-DI was 2 (1-3). 42.8% were married, 71.4% had less than eight years of education, 71.4% were unemployed and 75.0% had a family income between 1 and 3 times the minimum wage. Higher scores in SLEQOL symptoms domain were associated with a low educational level. Higher DLQI and SLEQOL total scores were associated with low self-esteem and symptoms of depression and anxiety. SLEQOL domains, physical functioning and symptoms, were associated with low self-esteem, depression and anxiety symptoms, and the presence of scarring alopecia, whereas the activities domain was associated with low self-esteem and depression and anxiety symptoms. Mood domain was associated with low self-esteem, self-image, depression and anxiety symptoms, and treatment domain with symptoms of depression. Conclusion: We identified low HRQoL in patients with permanent skin damage and low systemic disease activity, whether in the physical, self-image, mood or psychological domains. Associated factors were low educational level, presence of scarring alopecia, presence of anxiety and depression symptoms, and low self-esteem. These results highlight the importance of strategies to minimize the burden of permanent skin damage on the HRQoL of women with SLE. Trial Registration: UTN code U1111-1210-2554.

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