Quality of Life in Sudanese Systemic Lupus Erythematosus Patients: A Cross-Sectional Study

Ziryab Mahmoud ¹, Mishkat Osman², Fatima Ahmed ³, Sara Mohammed ⁴, Ayman Omer⁵

Abstract

Doi :  10.5281/zenodo.17843636

Background

Systemic lupus Erythematosus (SLE) is a multisystem autoimmune disease predominantly affecting women of childbearing age. Its broad range of clinical manifestations and relapsing-remitting course can severely impact patients’ health-related quality of life (HRQoL). There is limited data on HRQoL in SLE patients in Sudan.

Objectives: To evaluate the quality of life of Sudanese SLE patients attending a rheumatology clinic and assess the influence of disease activity and socio-demographic factors on HRQoL.

Methods: We conducted a descriptive observational cross-sectional study among 81 SLE outpatients at Haj Alsafi Teaching Hospital (Khartoum, Sudan) from 2022–2023. All patients met the American College of Rheumatology classification criteria for SLE. HRQoL was measured using the Short Form-36 (SF-36) questionnaire, yielding Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Disease activity was assessed by the SLE Disease Activity Index (SLEDAI) and a patient-reported Quick SLE Activity Questionnaire (Q-SLAQ). Sociodemographic data were collected via interviews. Data were analyzed using SPSS v26. Descriptive statistics, univariate linear regression, Mann–Whitney U, and Kruskal–Wallis tests were used to examine associations between patient factors and SF-36 domain scores. A p-value < 0.05 was considered statistically significant.

 Results: The cohort was 98.8% female (80/81) with a mean age of 34.8 ± 11.2 years. Overall SF-36 scores were modestly reduced: mean PCS was 49.8 ± 5.3 and MCS 47.6 ± 4.1 (on a 0–100 scale), indicating mild impairment. Most patients (98.8%) fell in the “less disability” range (SF-36 score 81–100). Common symptoms included fatigue (81% of patients) and musculoskeletal pain, and 55.6% of patients had high disease activity by Q-SLAQ. Older age was associated with worse physical functioning and vitality (fatigue) scores (p = 0.005 and p = 0.032, respectively). Higher disease activity was significantly correlated with lower scores in nearly all SF-36 domains (p < 0.05). Patients residing in rural areas reported significantly poorer overall QoL than those in urban areas (p < 0.001). Unemployed patients had more physical role limitations and lower energy/emotional well-being compared to employed patients (p = 0.040 and p = 0.026). Educational level and disease duration showed no significant correlation with HRQoL, although patients with longer disease tended toward lower scores. Notably, patients adherent to treatment had better physical health scores than non-adherent patients.

 Conclusions: Sudanese SLE patients experience impaired HRQoL, particularly in physical health domains. Increased age and active disease are associated with poorer QoL, whereas better outcomes are seen with effective disease control and treatment compliance. Socioeconomic factors such as unemployment, lower education, and rural residence may further compromise quality of life. Interventions aimed at stringent disease control and improved support for SLE patients : including access to medications, education, and psychosocial support : are recommended to enhance HRQoL in this population.