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

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 (TNF alpha), 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 TNF alpha, interleukin (IL)-1 beta, 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 TNF alpha was significantly higher in lupus patients (p < 0.001). After multivariate adjustment, higher serum TNF alpha (beta = -0.224, p = 0.047) remained significantly associated with lower SF-36, along with smoking (beta = -0.253, p = 0.014) and more severe depressive symptoms (beta = -0.433, p = 0.002). In healthy subjects, serum TNF alpha was associated with depressive symptoms but not with SF-36. Conclusions: Higher serum TNF alpha 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. Lupus (2013) 22, 254-261.