Factors Contributing to Low Quality of Life Scores in Patients with Systemic Lupus Erythematosus

Objectives The LupusQoL is a validated, disease-specific instrument for assessing health-related quality of life (HRQoL) in patients with systemic lupus erythematosus (SLE). Identifying factors influencing HRQoL is essential for optimizing patient-centered care. This study aimed to determine the clinical, psychosocial, and treatment-related predictors of impaired HRQoL, as measured by the LupusQoL. Methods In this cross-sectional study, consecutive SLE patients fulfilling the 2019 EULAR/ACR classification criteria were recruited with informed consent under institutional ethics approval. Demographics, social determinants of health, and LupusQoL scores were collected via standardized questionnaires. Clinical data, including SLEDAI-2K, ACR Damage Index, healthcare utilization, and medication use, were abstracted from medical records. Low QoL was defined as a score below the 50th percentile. Between-group comparisons were performed using t-tests, chi-square, or Mann-Whitney U tests. Results Among 207 patients (mean age 53.1 ± 14.2 years; 88.4% female), 39 (18.8%) had low HRQoL and 168 (81.2%) had high HRQoL. Across all 8 LupusQoL domains, patients with high HRQoL scored significantly better (all p < 0.001). The greatest differences were observed in the Physical, Planning and Burden domains. The low HRQoL group had higher ACR Damage Index scores (1.89 ± 1.87 vs 1.21 ± 1.75; p = 0.022), while mean SLEDAI-2K scores were similar (2.12 ± 2.66 vs 2.00 ± 2.31; p = 0.777). Depression/anxiety was more prevalent among patients with low HRQoL (48.0% vs 25.2%; χ 2 = 8.6, p = 0.004). Fibromyalgia was more frequent among patients with low HRQoL compared to those with high HRQoL (21% vs 5.5%; χ 2 = 10.2, p = 0.001), indicating a strong association between comorbid fibromyalgia and impaired quality of life. Prednisone use was also associated with lower HRQoL scores (41% vs 26%; χ 2 = 3.8, p = 0.05). No statistically significant differences were observed in age, ethnicity, marital status, income, or primary care access. Conclusion In this SLE cohort depression, anxiety, fibromyalgia, corticosteroid use, and greater cumulative organ damage were the strongest predictors of poor HRQoL, outweighing demographic or disease activity measures. Marked impairments across physical, planning, and burden domains highlight the multifactorial nature of HRQoL in SLE and underscore the need for integrated mental health care, steroid-sparing strategies, and prevention of organ damage to enhance quality of life.