Background Systemic lupus erythematosus (SLE) is an autoimmune disease which predominantly affects females. The disease characteristics in male SLE patients are reported to be distinct and may vary across ethnicities and geographical regions. Objective To determine and compare the clinical phenotype and organ damage between male and female patients with SLE in Malaysia. Methodology This was a cross-sectional study involving SLE patients from Universiti Kebangsaan Malaysia Medical Centre from June 2016 until June 2017. Information on their socio-demographics and disease characteristics were obtained from the clinical records. Disease damage was assessed using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) scores. The disease characteristics, autoantibody profiles and organ damage were compared between male and female patients, and multivariable analysis using male sex as dependent variable was then performed. Results A total of 418 patients were recruited and a total of 59 (14.1%) patients were male. Male patients presented with lower SLE ACR criteria at initial presentation but a significantly higher number of them had renal involvement (lupus nephritis) (78.0% versus 63.8%, p = 0.04). Male patients had less musculoskeletal involvement (45.8% versus 63.0%, p = 0.02) and tended to have lesser mucocutaneous involvement. Immunologic profile revealed that a lower number of male patients had positive anti-Ro antibody (22.7% versus 44.7%, p = 0.04) and they tended to have positive lupus anticoagulant antibody (27.6% versus 14.3%, p = 0.06). Presence of organ damage (SDI score ≥ 1) was significantly higher among males (55.9% versus 39.6%, p = 0.02) with higher renal damage (25.4% versus 9.2%, p = 0.004) and cardiovascular event of ischaemic heart disease or stroke (20.3% versus 7.0%, p = 0.004). They were also inclined to develop damage much earlier as compared to female patients, 3 (interquartile range (IQR) 7.5) versus 5 (IQR 7) years, p = 0.08. The occurrence of disease damage was independently associated with male gender with odds ratio of 1.9 (95% confidence interval 1.1–3.5), p = 0.02. Conclusion Male patients with SLE have more severe disease with renal damage and cardiovascular event.

Aim To determine the prevalence of work disability (WD) among patients with systemic lupus erythematosus (SLE) and its associated factors. Method This was a cross‐sectional study involving SLE patients aged 18‐56 years from Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Employment history was obtained from clinical interviews. WD was defined as unemployment, interruption of employment or premature cessation of employment due to SLE at any time after the diagnosis. SLE disease characteristics, presence of organ damage and Safety of Estrogens in Lupus Erythematosus National Assessment—SLE Disease Activity Index (SLEDAI) flare index were determined from the medical records. Self‐reported quality of life (QoL) was performed using the Medical Outcomes Study Short Form‐36 (SF‐36). Demographic factors, disease characteristics, and QoL were compared between patients with and without WD using statistical analyses. Results A total of 215 patients were recruited and the majority were Malay (60.5%), followed by Chinese (33.5%), Indian (4.5%) and others (n = 4, 1.9%). The prevalence of WD was 43.2% (n = 93) with 22.3% (n = 48) patients were unemployed at the time of study. Over half the patients with WD (n = 51, 54.8%) had onset of disability at <5 years from diagnosis. Patients with WD had significantly lower health‐related QoL. The independent factors associated with WD were SLEDAI score at diagnosis, frequency of flare, Systemic Lupus International Collaborating Clinics score, being married, had lower education and lupus nephritis. Conclusion We found a high rate of WD in patients with SLE and it was significantly associated with SLE‐related factors, in particular higher disease activity, presence of renal involvement and organ damage.

Objectives: This study aims to assess the self-reported work productivity and activity daily living (ADL) impairment among Malaysian patients with systemic lupus erythematosus (SLE) and to examine their associated factors. Patients and methods: This cross-sectional study included 167 SLE patients (21 males, 146 females; mean age 38.2±9.8 years; range, 20 to 60 years) recruited from the outpatient Rheumatology and Nephrology clinics. Face-to-face interviews were conducted to record patients' socio-demographics (age, sex, ethnicity, marital status, and occupation) and SLE disease characteristics (system involvement, age onset, and presence of organ damage). Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K). Short form 36 (SF-36) was used to determine health-related quality of life (HRQoL) while Work Productivity and Activity Impairment (WPAI) questionnaire was used to assess the four domains of absenteeism, presenteeism, overall work productivity, and non-work related ADL impairment. Univariate analyses and multivariable regression analysis examined the association of demographic variables, SLE disease characteristics, and activity with reduced HRQoL and WPAI scores. Results: The majority of the patients were Malays (59.3%), followed by Chinese (34.7%) and Indian (3.6%) patients. More than two-thirds of the patients reported some degree of impairment in their work productivity and ADL due to the disease. The absenteeism rate was 10.4% in the past one week and their indirect costs were 2,875.17 Malaysian ringgits (US $701.22) in the past seven days. Significant predictors of higher work productivity and ADL impairment scores were higher disease activity, more frequent SLE flares, lupus nephritis, and hematological involvement of SLE. Patients with higher work productivity and ADL impairment scores were also strongly associated with poor QoL. No ethnic disparities of work productivity and ADL impairment were found. Conclusion: Systemic lupus erythematosus significantly affected the overall productivity in work and non-work related activity in our Malaysian multi-ethnic cohort and both impairments were significantly associated with poor QoL.

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BackgroundPatients with Systemic Lupus Erythematosus (SLE) are at risk of work disability due to the substantial impact of the disease towards their physical and mental health.ObjectivesTo study the prevalence of work disability (WD) and unemployment rate among SLE patients, and their associations with the quality of life (QOL) in National University of Malaysia Medical Centre (UKMMC)MethodsThis was a cross-sectional study which recruited consecutive SLE patients who attended the Nephrology and Rheumatology clinic at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from March 2017 to July 2017. Information on their current and past employment history were obtained from a customised questionnaire and WD was defined as unemployment or an inability to do paid work due to illness at the time of study or at any time after the diagnosis of SLE being made. The disease characteristics, disease activity and damage were determined from the medical records. The quality of life was measured using SF-36 questionnaires. Statistical analyses were subsequently performed to determine the factors associated with WD. This study was approved by the UKMMC ethics research committee (FF FF-2017–109).ResultsA total of 197 patients were recruited, and their median age was 37 (32 to 47) years with median disease duration of 12 (8 to 17) years. Majority of them were Malays (n=116, 58.9%), followed by Chinese (n=69, 35%), Indians (n=8, 4.1%) and others (n=4, 2.0%). The prevalence of work disability was 35%(n=69) and the onset of WD was 4 (IQR:1 to 9) years after SLE diagnosis. WD was associated with older age, lower education level, more frequent disease flare, longer disease duration, higher SLICC ACR Damage Index, active disease (SLEDAI 2K and BILAG 2004 and had major organ involvement (lupus nephritis, haematological and neuropsychiatric), all p<0.05. Patients who received plasmapheresis, intravenous methylprednisolone, intravenous immunoglobulin, Mycophenolate Mofetil and calcineurin inhibitors were also associated with WD. Patients with work disability also had significantly impaired QOL with lower SF 36 scores. On multivariate logistic regression analysis, the independent predictors of WD were lower education level, being married and involvement of lupus nephritis, haematological and neurolopsychiatric lupus (NPSLE).ConclusionsMore than one third of SLE patients had experienced work disability. Lower education level, being married and major organ involvement were the independent predictors for work disability. A larger prospective study is warranted to further delineate the risk factors.References[1] Garris C, et al. Impact of systemic lupus erythematosus on burden of illness and work productivity in the United States. Lupus2013;22:1077–1086.[2] Mok CC, et al. Risk and predictors of work disability in Chinese patients with SLE. Lupus2008;17:1103–1107.Disclosure of InterestNone declared