Longitudinal Trajectories and Predictors of Health-Related Quality of Life in Systemic Lupus Erythematosus: A 2-Year Longitudinal Cohort Study

Health-related quality of life (HRQoL) is a critical patient-reported outcome in systemic lupus erythematosus (SLE). We aimed to evaluate longitudinal trajectories of HRQoL and identify associated clinical and demographic determinants.

This longitudinal cohort study included 1005 patients with SLE from the Asia Pacific Lupus Collaboration. HRQoL was assessed using the Short Form-36 (SF-36) at baseline, 12, and 24 months. Disease activity and organ damage were recorded using validated composite indices (SLEDAI-2 K and SLICC damage index). Generalized estimating equations (GEE) analyzed longitudinal trajectories of Physical Component Summary (PCS) and Mental Component Summary (MCS) scores.

Among 915 women (91.0%) with median age 35.2 years, both PCS and MCS scores remained stable over 24 months (PCS: p = 0.822; MCS: p = 0.819). Age ≥ 50 years was associated with lower PCS (β =  − 5.80, p = 3.85 × 10 ⁻⁹) but higher MCS (β = 2.09, p = 0.032). Male sex predicted higher MCS (β = 3.50, p = 2.70 × 10^–5). Higher SLEDAI-2 K was associated with lower PCS and MCS (both p < 0.05). SLICC damage index negatively affected PCS (β =  − 1.87, p < 0.001) and MCS (β =  − 0.75, p = 0.006). Musculoskeletal and cardiovascular damage had the strongest associations with reduced PCS, while no organ-specific damage remained significantly associated with MCS after adjustment.

HRQoL in SLE remained stable over 2 years. Disease activity and cumulative organ damage were the primary determinants. Organ-specific damage differentially influenced physical but not mental health domains, underscoring the need for domain-tailored assessment and management strategies.