Serum tumour necrosis factor-alpha is associated with poor health-related quality of life and depressive symptoms in patients with systemic lupus erythematosus

• Published in: Lupus Vol. 22; no. 3; pp. 254 - 261
• Main Authors: Mak, A, Tang, CS, Ho, RC
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.03.2013; Sage Publications Ltd
• Subjects: Adult; Anxiety; Biomarkers - blood; Chronic illnesses; Cytokines; Cytokines - blood; Depression - etiology; Disease; Female; Health surveys; Hospitals; Humans; Immunoassay; Lupus; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - psychology; Male; Medicine; Mental depression; Middle Aged; Quality of Life; Rheumatology; Tumor Necrosis Factor-alpha - blood; Tumor necrosis factor-TNF; Singapore; systemic lupus erythematosus; health-related quality of life; Proinflammatory cytokines; depression; tumour necrosis factor alpha
• ISSN: 0961-2033; 1477-0962; 1477-0962
• DOI: 10.1177/0961203312471872

Objectives While patients with systemic lupus erythematosus (SLE) have poorer health-related quality of life (HRQoL) and are more depressed than healthy people, the impact of proinflammatory cytokines, particularly tumour necrosis factor-alpha (TNFα), on these unfavourable psychosocial parameters is unclear. We aim to explore potential relationships between lupus-related proinflammatory cytokines, HRQoL and depressive symptoms in patients with SLE. Methods Patients with SLE and age-matched healthy subjects were assessed for HRQoL and depressive and anxiety symptoms by the Short Form Health Survey-36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) respectively. Using multiplex immunoassay, a panel of serum proinflammatory cytokines including TNFα, interleukin (IL)-1β, IL-6, IL-17, IL-23 and IL-33 were determined and compared between both groups. Independent associations between SF-36, serum proinflammatory cytokine levels and HADS scores were studied by regression models. Results In total, 54 patients and 54 healthy controls were studied. Lupus patients had significantly poorer HRQoL (p < 0.001) and were significantly more depressed (p = 0.006) and anxious (p = 0.022) than their healthy counterparts. Amongst the proinflammatory cytokines studied, serum TNFα was significantly higher in lupus patients (p < 0.001). After multivariate adjustment, higher serum TNFα (β = −0.224, p = 0.047) remained significantly associated with lower SF-36, along with smoking (β = −0.253, p = 0.014) and more severe depressive symptoms (β = −0.433, p = 0.002). In healthy subjects, serum TNFα was associated with depressive symptoms but not with SF-36. Conclusions Higher serum TNFα level is independently associated with poorer HRQoL and more severe depressive symptoms in SLE patients. These associations suggest a potential impact of inflammatory response on depressive symptoms and the quality of life in patients with SLE.