Correlates of formal work disability in an urban university systemic lupus erythematosus practice.

OBJECTIVE: Work disability in systemic lupus erythematosus (SLE) has been sparsely studied. We sought to determine the demographic, disease-specific, and psychological features associated with work disability in patients with SLE at our medical center. METHODS: Ambulatory patients with SLE were enrolled in a cross-sectional study. Data collected by standardized interview, examination, questionnaire, and chart review were compared between formally work-disabled and never-disabled subjects. Multivariate logistic regression with outcome of formal work disability was then performed, using significant variables on univariate analysis. RESULTS: One hundred thirty-two of 143 subjects were working or students at time of SLE diagnosis. After a mean of 9.2 years' disease duration, 42.7% reported formal work disability due to SLE. On univariate analysis, lower education, African American ethnicity, marital status, and high disease activity and damage scores were associated with increased prevalence of work disability. Work type did not affect risk of work disability. Work-disabled subjects had more severe pain, fatigue, depression, and anxiety. On multivariate logistic regression, damage, African American ethnicity, and fatigue were associated with formal work disability, while global pain had a marginal association. CONCLUSION: Formal work disability was highly prevalent in SLE, occurring in 42.7% of subjects. Disease damage, global pain, and fatigue were independently associated with formal work disability status on multivariate logistic regression. Premorbid work types did not strikingly influence rates of work disability.

Whole blood viscosity and arterial thrombotic events in patients with systemic lupus erythematosus.

OBJECTIVE: To determine if whole blood viscosity (WBV), a rheologic variable contributing to risk of myocardial infarction and stroke in the general population, is elevated in patients with systemic lupus erythematosus (SLE), particularly SLE patients with a history of thrombotic or atherothrombotic events. Because the high rates of arterial and venous thrombosis in lupus cannot be explained by traditional risk factors, elevated WBV may be an easily measurable nontraditional risk factor to identify SLE patients at high risk for thrombotic events. METHODS: Sixty SLE patients (30 with a history of a thrombotic event) and 20 matched controls were recruited into the study. The thrombosis group was further subdivided into an arterial thrombosis group (n = 17). WBV values were determined at 9 different shear rates (1, 2, 5, 10, 50, 100, 150, 300, and 1,000 seconds(-1)). WBV was then compared between groups by repeated-measures analysis of variance. RESULTS: SLE patients with a history of arterial events had significantly elevated WBV relative to either controls (P = 0.022) or SLE patients without arterial events (P = 0.014). WBV in the total SLE group did not differ from controls. Differences in WBV were most prominent at lower shear rates (1, 2, 5, 10, 50, and 100 seconds(-1)). Anticoagulation, prednisone dose, and antiphospholipid antibodies did not significantly impact WBV. CONCLUSION: Our study demonstrated that WBV is selectively elevated in patients with SLE with a history of arterial events. Although this association is striking, longitudinal studies are needed to assess the positive predictive value of WBV for atherothrombotic events in SLE.