In the present study, we analyzed 100 SLE patients (91 females and 9 males), 100 RA patients (10 males and 90 males), and 200 controls (124 females and 76 males). We compared RA and SLE patients with the healthy controls in terms of HRQoL. Also, we assessed HRQoL in the 3 groups regarding age, sex, level of education, and duration of disease.
As expected, the control group had higher scores, compared to SLE and RA patients, respectively. The control group obtained higher scores on physical performance, such as physical function and general health. Also, SLE patients had higher scores in HRQoL in comparison with RA cases. In fact, RA patients obtained the lowest HRQoL scores in the physical dimension among the 3 groups. In other words, these patients suffered from numerous physical problems, as they were unable to work for long periods of time and had more limitations in physical activity. Overall, these patients are unable to perform activities such as running, climbing the stairs, lifting heavy objects, or walking.
Based on the present findings, the control group obtained the highest scores in psychological domains, such as vitality, social functioning, and mental health, compared to SLE and RA patients. RA patients mostly complained of disappointment, nervousness, sadness, fatigue, and lack of energy. Evaluation of social functioning showed no significant difference between the 3 groups regarding aspects such as relationship with family, friends, or community members.
In cases with disease exacerbation, there were more complaints of mental health deterioration, particularly depression. In this regard, Bazilchi et al. reported similar results in 93 RA patients and indicated that depressive moods are significantly associated with dysfunctions, except social functioning (8). Khanna et al. also reported similar results in SLE patients, who obtained the lowest scores in terms of physical and mental performance in the exacerbation period; however, there was no significant difference in social functioning (9).
In the current study, the quality of life decreased with advancing age in the 3 groups. In agreement with the present findings, Doria et al. reported that with increasing age, SLE patients obtained lower scores in the physical and mental dimensions of QoL (10). In addition, Elhone et al. performed a study on QoL in lupus patients during 15 years and concluded that age was negatively associated with QoL, especially the physical dimension (11).
In the present study, no significant association was observed between gender and HRQoL in patients and healthy controls. In this regard, Wallenius et al. demonstrated that work disability in both genders reduced the patients’ QoL. Furthermore, they showed that females with RA had a four-fold increased risk of work disability in comparison with men (12). It should be noted that the majority of women in the present study were unemployed and were financially supported by their husbands or parents; therefore, compared with men, the disease had less impact on their QoL. However, since the number of male participants was substantially low, the results regarding gender differences should be interpreted cautiously.
In the present study, it was found that HRQoL in RA and SLE patients is associated with disease duration. In fact, HRQoL decreased as the disease duration increased. Monjamed et al. reported similar results in RA patients (13). Also, Freire EA et al. showed a significant negative correlation between disease duration and HRQoL in SLE patients. It was determined that general health and social functioning dimensions are associated with disease duration (14).
According to the current study, higher educational level was associated with higher HRQoL scores among all the participants. This finding is in agreement with the data reported by Wallenius and colleagues. These results can in fact illustrate the role of patients’ knowledge about their condition. Also, more educated people have a better socioeconomic status and cultural background (12). However, in a previous study, Shakeri et al. did not find a significant relationship between educational level and HRQoL in SLE patients (15).
The present research had a number of limitations, such as the study design (cross sectional). Also, the participants were fairly homogeneous, as the majority of the participants were female. Overall, evaluation of QoL is of importance for the assessment of treatment outcomes and patients’ complications. The present study has certain advantages for the improvement of HRQoL in patients and can minimize damage during treatment. It seems that complementary studies are required in the future to provide more help for the patients.
4.1. Conclusion
As chronic diseases play an important role in decreasing HRQoL among patients, more attention should be paid to the physical, mental, and social aspects. Improvement of patients’ health literacy, as an empowerment strategy, plays a key role in improving HRQoL. Patients need psychological and social support, which is provided by medical teams, including psychiatrists, psychologists, and social workers. Due to the direct and indirect costs imposed on patients, providing insurance facilities can be very useful, as well.
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