Differences in quality of life determinants according to the
presence of ﬁbromyalgia in middle-aged female patients
with systemic lupus erythematosus: a multicenter,
cross-sectional, single-ethnicity cohort
Kwi Young KANG,
Ji Hyeon JU,
Chan Hong JEON,
Sang Tae CHOI,
Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, and
Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
Objective: The purpose of this study was to identify whether determinants of health-related quality of life
(HRQoL) in middle-aged female patients with systemic lupus erythematosus (SLE) differed according to the
presence or absence of ﬁbromyalgia.
Methods: One hundred and ﬁfty-two patients with SLE and 139 healthy controls (HCs) completed the Medical
Outcomes Study 36-Item Short Form (SF-36) and EuroQol EQ-5D questionnaires about HRQoL. Disease activ-
ity and cumulative disease damage were assessed with standard indices. Sleep quality was assessed using the Kor-
ean version of the Pittsburgh Sleep Quality Index (K-PSQI).
Result: The mean EQ-5D and physical and mental components of SF-36 were lower in SLE patients with
ﬁbromyalgia (n = 41) than in those without ﬁbromyalgia (n = 111) and HCs. The scores in all eight domains
of the SF-36 were lower in SLE patients with ﬁbromyalgia than in patients without ﬁbromyalgia and HCs. Poor
sleep (deﬁned as a K-PSQI > 5) was reported by 85% of SLE patients with ﬁbromyalgia, by 51% of patients
without ﬁbromyalgia, and by 33% of HCs. Multivariate logistic regression analysis showed that lower educa-
tional level, cumulative organ damage severity and poor sleep quality were independent determinants of HRQoL
in SLE patients with ﬁbromyalgia, whereas disease activity, sleep quality and depressive mood were independent
determinants of HRQoL in those without ﬁbromyalgia.
Conclusion: Poor sleep quality is the common independent risk factor for poor HRQoL in both middle-aged
SLE patients with ﬁbromyalgia and without ﬁbromyalgia. Sleep quality improvement may improve HRQoL in
female SLE patients, even in those without ﬁbromyalgia.
Key words: ﬁbromyalgia, quality of life, sleep quality, systemic lupus erythematosus.
Systemic lupus erythematosus (SLE) is a chronic multi-
system autoimmune disorder of unknown etiology.
Although earlier diagnosis and greater treatment
options have improved the survival of SLE patients in
Correspondence: Jun-Ki Min, MD, PhD, Division of Rheumatol-
ogy, Department of Internal Medicine, College of Medicine,
Bucheon St. Mary’s Hospital, The Catholic University of Korea,
327 Sosa-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-717,
Korea. Email: firstname.lastname@example.org
© 2018 Asia Paciﬁc League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd
International Journal of Rheumatic Diseases 2018; 21: 1173–1184