Comorbidity burden and its impact on physical functioning and activities of daily living in patients with systemic lupus erythematosus
Maria G Tektonidou, Ioannis ArkoumanisAbstract
Objectives
Comorbidities are highly prevalent in Systemic lupus Erythematosus (SLE) and are associated with increased morbidity and mortality. We investigated the association between cumulative comorbidity burden, physical function, and activities of daily living (ADLs) in SLE patients.
Methods
In this cross-sectional study, we assessed comorbidity burden using the Age-Adjusted Charlson Comorbidity Index (ACCI) and Rheumatic Disease Comorbidity Index (RDCI) in 240 consecutive patients with SLE. Grip strength and dexterity were assessed using the Jamar dynamometer and Purdue pegboard test, respectively. ADLs were evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Health Assessment Questionnaire (HAQ). We also assessed domains of the Lupus Quality of Life (LupusQoL) Questionnaire related to physical function and ADLs, including “Physical Health”, “Pain”, “Planning” and “Fatigue”. Associations were examined using multivariate linear regression models adjusted for potential demographic and clinical confounders.
Results
Median (IQR) ACCI and RDCI scores were 2 (1-3) and 0 (0-2), respectively. In multivariate analysis, higher ACCI scores were associated with impaired dexterity (p < 0.001), reduced grip strength (p < 0.05) across all models, and higher DASH scores and poorer scores in the “Physical Health” and “Pain” domains, after adjustment for pain intensity and fibromyalgia (p < 0.05). Higher RDCI scores were associated with impaired dexterity (p < 0.01), poorer scores in the “Physical Health” domain across all models, and higher DASH scores in three models (p < 0.05).
Conclusion
Comorbidity burden is independently associated with poorer physical functioning and ADLs performance in people with SLE.