Patient Resilience is associated with Better Patient-Reported Physical and Mental/Emotional Quality of Life in Systemic Lupus Erythematosus.

Abstract

OBJECTIVE To examine the association of patient resilience with health-related quality of life (HRQOL) in Systemic Lupus Erythematosus (SLE). METHODS We used data from a prospective cohort study of patients with SLE enrolled across 15 rheumatology clinics across the U.S. who viewed a patient decision-aid for SLE management during a regular clinic visit. We examined the association of high resilience with HRQOL on PROMIS®-29 domains, using multivariable linear mixed-effects model analysis, adjusted for demographics, social determinants of health (SDOH), flare, site, time and comorbid rheumatic diseases. RESULTS Out of 874 SLE patients, 27% had high resilience with CD-RISC2 score of eight. Compared to SLE patients who had low resilience, SLE patients with high resilience were more likely to report: excellent or very good health, 39.9% versus 15.9%; lower SLE activity, 4.32 versus 5.25 on a 0 to 10 scale; higher SLE impact of 7.21 versus 6.04 on a 0 to 10 scale. We noted that high resilience was associated with a positive moderate effect size (>0.5 standard deviation) for physical functioning, social participation, anxiety, emotional distress, fatigue, pain interference, and pain intensity; and a favorable small effect size (0.2-0.49 standard deviation) for sleep disturbance, in unadjusted analyses. In a multivariable-adjusted mixed linear regression analysis, high resilience was associated with all eight HRQOL scale scores. CONCLUSION High patient resilience was independently associated with better HRQOL outcomes in SLE, after adjusting for demographics, SDOH, site, time and comorbid rheumatic diseases. Interventions to promote resilience have the potential improve SLE HRQOL outcomes. (Trial Registration: NCT03735238).