An evaluation of quality of life in ambulatory patients with systemic lupus erythematosus attending rheumatology clinic in Kenyatta National Hospital

Abstract

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that affects all organs of the body. It is becoming increasingly clear that SLE is not as rare in Kenya as was previously thought. Due to its chronicity SLE has been known to affect the quality of life of those affected by it. There is minimal data on SLE in East Africa and especially in Kenya. The quality of life of SLE patients in this country has never been assessed. Objectives: To document the quality of life of patients with SLE in Kenyatta National Hospital using LUPUS QOL questionnaire. We also sought to correlate HRQOL with duration of illness, drugs used and age of the patient. Design: This was a cross sectional study done on patients attending Rheumatology Clinic in Kenyatta National Hospital. Methods: Patients who satisfy the ACR criteria were consecutively recruited. All patients with SLE attending the clinic were included in the study. Consent was obtained from the patients after which their demographic data was obtained. Patients were examined for the presence of malar rash, discoid rash, arthritis/athralgia, photosensitivity, CNS symptoms, serositis and oral ulcers. The patients then filled the LUPUS QOL questionnaire. The information acquired was then analysed using SPSS version 17.0 using student t test and regression analysis. The quality of life was calculated and then correlated with age, duration of illness and drug management. Results: Sixty two patients were analysed (60 females 2 males). Mean age of the population was 37.3 years (range 14-71 years). All patients had some level of education with 61.3% of the population having some form of secondary education. Most patients 54.8% were married. Mean age of diagnosis was 34.5 years with mean duration of illness 1.5 years. Majority (88.7%) had arthritis/ athralgia, oral ulcers (62.9%), malar rash (59.7%), photosensitivity (58.1%), serositis (32.3%), CNS symptoms (27.4%) and discoid rash (17.7%). Patients scored globally low in all domains of LUPUS QOL. Highest domain was planning 63.7 (29.3), emotional health 61.3 (26.5), burden to others 58.9 (31.2), fatigue 57.5 (30.0), pain 56.6 (29.6), physical health 54.0 (23.3), body image 47.1 (24.2) intimate relations 41.1 (38.4).The most common drug in use in our population was prednisone at 74.2%. This was followed by HCQ at 69.4%, NSAIDS 54.8%, azathioprine 37.1%, methotrexate 22.6%, mycofenolate mofetil 8.1%, CCB 11.3%, cyclosporine 3.2%. HRQOL correlated positively with advance in age for the domains. Physical health, burden to others, emotional health and fatigue. There was no correlation between HRQOL and duration of illness or drugs used by the population. Conclusion: The HRQOL of our SLE patients was found to be low in all domains and to correlate with advance in age in the domains of physical health, burden to others, emotional health and fatigue. However there was no correlation with duration of illness or the drugs used by the patients.