Age-related patterns of organ damage impact on health-related quality of life in SLE

To characterise the age-related impact of organ damage patterns on health-related quality of life (HRQoL) in patients with SLE and to identify specific damage patterns affecting physical and mental health outcomes across different age groups.

In this cross-sectional study, 1149 patients with SLE from the Asia Pacific Lupus Collaboration cohort were stratified by age. HRQoL was assessed using the Short Form-36 questionnaire. Clinical characteristics and organ damage (Systemic Lupus International Collaborating Clinics (SLICC) Damage Index) were evaluated. Multiple linear regression analyses identified factors associated with the Physical (PCS) and Mental Component Summary (MCS) scores.

Significant age-related differences were observed in physical HRQoL, with the age group ≥50 years showing lower PCS scores (median 52.6) than the age groups <20 years (56.9) and 20-50 years (57.5) (p<0.001). In multivariable models, higher SLICC Damage Index (β=-1.39), lower educational attainment (β=-7.02) and prednisolone use (β=-1.85) were independently associated with lower PCS scores. MCS scores were positively associated with male gender (β=4.40) and secondary education (β=2.46), but negatively impacted by higher damage index (β=-0.90) and cyclophosphamide use (β=-5.44). Specific damage patterns, such as avascular necrosis, particularly impaired bodily pain and physical functioning domains.

Age-related differences in SLE predominantly affect physical rather than mental aspects of HRQoL. Cumulative organ damage remains a central modifiable factor associated with poorer outcomes across all ages. These findings emphasise the importance of age-specific management strategies and early damage prevention to optimise long-term HRQoL in patients with SLE.