Lupus Patients Receiving More Quality Clinical Care Report Better Health Outcomes, Study Finds

People with systemic lupus erythematosus (SLE) who received more quality clinical care report lower disease activity, slower accumulation of disease-related damage, and a higher physical health-related quality of life, a study finds. 

The analysis identified parameters that led to improved self-reported health outcomes, including taking antimalarial medications (such as hydroxychloroquine), blood pressure counseling, and osteoporosis protection. 

The study, “Quality of care predicts outcome in systemic lupus erythematosus: a cross-sectional analysis of a German long-term study (LuLa cohort),” was published in the journal Lupus. 

SLE affects people differently, sometimes requiring them to make frequent visits to healthcare providers due to the disease’s chronic nature. Also, because SLE can affect a variety of organs, patients may need to consult with specialists in different medical fields. 

Rheumatology organizations in the U.S., Great Britain, and Europe have developed recommendations to manage this complex disease, but these recommendations haven’t been properly assessed.

Studies on the impact of the quality of healthcare on SLE outcomes are also insufficient. As such, researchers at the Heinrich-Heine-University Düsseldorf, in Germany, in collaboration with the German Lupus Self-Help Community, evaluated the quality of SLE care in the country to identify gaps in healthcare and find links between healthcare management practices and long-term patient outcomes. 

Participants were taking part in the LuLa Study, a nationwide survey of SLE patients started in 2001, in which patients receive an annual questionnaire on multiple aspects of life with this disease.

In 2013, a total of 580 patients were included in this study after completing and returning their questionnaires. Of these, most were women (93.8%), with a mean age of 54 years, and a mean disease duration of 20 years. 

The primary outcomes were patient-reported disease activity, disease-related damage, and health-related quality of life (HRQoL), as assessed by questionnaires. 

Disease activity was measured using the Systemic Lupus Activity Questionnaire, disease-related damage with the Brief Index of Lupus Damage Questionnaire, and HRQoL with the Short Form 12 Health Survey. 

Twenty-one factors that predict good clinical care in SLE were selected for the analysis, including urine and blood tests in the previous year; taking antimalarials, vitamin D, and calcium; counseling on vaccinations and blood pressure; and treatment for co-existing conditions such as hypertension, osteoporosis, and lipid (fat) metabolism disorder.

These parameters were then statistically compared with the patient-reported disease outcomes after adjusting for age, sex, and disease duration. 

Results showed that at least six of 10 parameters — taking antimalarials, urine and blood testing, blood pressure and vaccination counseling, treatment of osteoporosis, hypertension and lipid metabolism disorder, and taking vitamin D and calcium if prednisolone dose is higher than 7.5 mg per day — were important in the healthcare of people with SLE. 

Receiving more clinical care was significantly associated with both low disease activity and slower disease-related damage. 

Also, while it did not have a significant impact on mental health, receiving more care was linked to a better physical HRQoL score. 

Taking antimalarials and protecting against osteoporosis had the greatest impact on disease damage, while osteoporosis protection and blood-pressure counseling had the highest impact on reducing disease activity.

In addition, blood-pressure counseling was important in improving mental and physical HRQoL.

“Our study illustrates a strong link between quality of care and important SLE outcome parameters including quality of life, disease-related damage and disease activity,” the scientists wrote.

“Improvement of healthcare provided on an individual level could therefore be a good approach to improve the outcome of patients with lupus erythematosus,” they added. “The 10 parameters identified in our analysis should be of particular importance in the care of patients with lupus erythematosus.”