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Anxiety, being significantly more frequent in systemic lupus erythematosus than other common inflammatory rheumatological conditions, is predicted by higher damage accrual, cumulative glucocorticoid dose and depression
Date Issued
2010
Citation
Mak, A., Tang, S. K., Cheak, A. A., & Ho, R. C. (16-19 Jun 2010). Anxiety, being significantly more frequent in systemic lupus erythematosus than other common inflammatory rheumatological conditions, is predicted by higher damage accrual, cumulative glucocorticoid dose and depression. European League Against Rheumatism (EULAR) Congress 2010, Rome, Italy.
URI
Type
Conference Paper
Abstract
Background: The burden and determinants of anxiety in patients with systemic lupus erythematosus (SLE) compared to those with other inflammatory rheumatological conditions are unclear.
Objectives: We aimed to (1) compare the frequency and level of anxiety between patients with SLE, rheumatoid arthritis (RA) and gout and healthy individuals; and (2) explore independent predictors for anxiety and predict the possibility of anxiety in SLE patients.
Methods: Consecutive adult patients (age≥21) with SLE, RA and gout and healthy controls who were age and sex- matched with the SLE group were evaluated for anxiety using the Hospital Anxiety and Depression Scale (HADS) and quality of life with the Short-Form 12 (SF-12). Sociodemographic and clinical variables were compared between all groups by one-way ANOVA and chi2 tests where appropriate. Predictors for anxiety level were studied by linear regression models involving all groups. A binary regression prediction model was constructed to explore predictors for anxiety (HADS-anxiety≥8) in SLE patients.
Results: 271 subjects (60 lupus, 50 gout, 100 RA, 61 SLE-matched healthy controls) were studied. A number of sociodemographic and clinical characteristics were significantly different between groups, such as age(years) (mean±SD; 40.45±12.9 in SLE, 58.20±14.9 in gout, 53.66±13.6 in RA, 42.75±14.0 in controls; P for trend [Ptrend]<0.001), %female (SLE 88%, gout 10%, RA 75%, controls 87%; Ptrend<0.001), number of regular medications (5.07±3.2 in SLE, 3.17±2.8 in gout, 5.38±2.6 in RA; Ptrend<0.001) and comorbidities (2.11±2.7 in SLE, 4.17±2.0 in gout, 2.84±1.3 in RA; Ptrend<0.001). While SLE patients had a significantly higher mean HADS-anxiety (11.23±7.5 in SLE, 7.68±6.2 in gout, 10.03±6.8 in RA, 6.23±4.9 in controls; Ptrend<0.001) and frequency of anxiety (HADS-anxiety≥8) (SLE 38%, gout 6%, RA 26%, controls 10%, Ptrend<0.001), the frequency of depression was comparable between groups (Ptrend=0.287). Univariate linear regression involving all groups revealed that younger age, female sex, Indian race, higher HADS-depression, lower mental and physical component (PCS-12) of SF-12, SLE and gout were associated with higher anxiety level. After an unbiased multivariate adjustment, SLE remained independently predictive of higher anxiety level (slope[r] =1.482, p=0.029), apart from Indian race (r=2.19, p=0.042), HADS-depression (r=0.484, p<0.001) and lower PCS-12 (r=-0.06, p=0.014). Binary multivariate regression revealed that higher SLICC/SDI score (odds ratio[OR]4.92, p=0.038), higher cumulative glucocorticoid dose (OR 1.14, p=0.017), higher HADS-depression (OR 1.49, p=0.01) and fewer regular medications (OR 0.499, p=0.005) predicted anxiety in SLE patients; with the accuracy, sensitivity, specificity and positive and negative predictive values of 90%, 73.9%, 89.2%, 81.0% and 84.6% respectively.
Conclusion: The frequency and level of anxiety were significantly higher in SLE patients than those with RA and gout and healthy individuals. Greater damage accrual, higher cumulative glucocorticoid dose, more severe depression and fewer regular medications accurately predict anxiety in lupus patients.
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