Irreversible Organ Damage, Specifically Musculoskeletal Damage, Negatively Associated With Quality of Life in SLE

older woman lying in hospital bed
Senior woman lying and sleep on hospital ward bed.
Researchers aimed to study the correlation between irreversible organ damage and quality of life in systemic lupus erythematosus, and to identify the type of organ damage that is negatively correlated with QOL.

Irreversible organ damage, specifically musculoskeletal damage, is negatively correlated with quality of life (QOL) in patients with systemic lupus erythematosus (SLE), according to study results published in Lupus.

SLE is an autoimmune disease that affects physical functioning, general health, social functioning, as well as the emotional and mental health of patients. Patients with SLE often experience hair loss, skin rashes, and organ damage. Optimizing QOL and preventing organ damage in SLE have been considered as the goals of intervention.

To examine the relationship between irreversible organ damage and QOL, the authors of the current study used SLE-specific QOL assessment tools, including LupusPRO and SLE symptom checklist (SSC), and the conventional Short Form (SF)-36v2 QOL tool. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) was used to evaluate end-organ damage and covariates, including age, corticosteroid dose, and disease activity, based on the SLE Disease Activity Index 2000 (SLEDAI-2K) criteria.

A total of 265 patients from the Kyoto University Hospital in Japan were included in the analysis. Total SDI score was found to be correlated with physical and role/social component summary of the SF-36v2, health-related QOL (HRQOL) of LupusPRO, and SCC (P <.001). The SDI items, including atrophy/weakness, deforming erosive arthritis, avascular necrosis, and osteoporosis with fracture/vertebral collapse, were negatively correlated with physical, role/social, and HRQOL. Study authors suggested tapering of corticosteroids to help reduce the negative correlations with osteonecrosis and osteoporosis.

Among SDI systems, musculoskeletal damage was found to have higher negative associations with physical, role/social, and HRQOL (P <.001 for all).

Negative correlations were also seen with neuropsychiatric damage (role/social, P <.001), skin damage (mental, P <.028; HRQOL, P <.001), and alopecia (mental, P <.002; HRQOL, P <.001). However, no negative correlations with QOL were seen with cardiovascular and renal health, which, according to the study authors, was because of the ethnic background of the cohort and the low rates of end-stage renal disease in the study population.

Study limitations included the study design and the small cohort of patients at a single study site; the low total SDI and SLEDAI-2K scores, suggesting that many of these patients had low to moderate disease activity; and lack of generalizability of the findings with disease progression.

“[W]e revealed that musculoskeletal damage has high strong correlations with the [HR] QOL, especially the physical and role/social QOL, suggesting that this type of organ damage should be examined with special care in clinical practice,” the study authors concluded.

Disclosure: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Takase Y, Iwasaki Y, Doi H, et al. Correlation between irreversible organ damage and the quality of life of patients with systemic lupus erythematosus: The Kyoto Lupus Cohort survey. Lupus. Published online June 14, 2021 doi:10.1177/09612033211025614