SHORT COMMUNICATION 1145
ActaDV ActaDV
Advances in dermatology and venereology Acta Dermato-Venereologica
Quality of Life in Greek Patients with Autoimmune Bullous Diseases Assessed with ABQOL and TABQOL Indexes
Aikaterini PATSATSI 1, Miltiadis KOKOLIOS 1, Αikaterini KYRIAKOU 1, Foteini LAMPROU 1, Despoina STYLIANIDOU 1, Apostolos TSAPAS 2, Dimitrios G. GOULIS 3, Dedee F. MURRELL 4 and Dimitrios SOTIRIADIS 1
1
2 nd Dermatology Department, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road 56403, N, Efkarpia, Thessaloniki, 2 Clinical Research and Evidence-Based Medicine Unit and 3 Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, and 4 Department of Dermatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia. E-mail: katerinapatsatsi @ gmail. com, apatsats @ auth. gr Accepted Jun 28, 2017; Epub ahead of print Jun 29, 2017
Autoimmune bullous diseases( AIBD) place a significant burden on patients’ quality of life( QoL). Specific QoL instruments( 1, 2), Autoimmune Bullous Diseases Quality of Life( ABQOL)( 1) and Treatment Autoimmune Bullous Diseases Quality of Life( TABQOL)( 2), were introduced to quantify the impact of AIBD and its treatment on patients’ well-being. The aim of this study was to assess QoL in Greek patients with AIBD, using the ABQOL and TABQOL questionnaires.
MATERIALS AND METHODS
Patients with newly diagnosed AIBDs were recruited consecutively. Ethical approval was obtained from the local Institutional Review Board and all patients signed an informed consent form. In patients with AIBD in the pemphigus spectrum, the clinical extent and severity were measured with Pemphigus Disease Area Index( PDAI)( 3) and Autoimmune Bullous Skin Disorder Intensity Score( ABSIS)( 4). Thus, in patients with AIBD in the pemphigoid spectrum, the clinical extent and severity were measured with BPDAI and ABSIS. The questionnaires were handed in at 4 different time points:
• The time point of established diagnosis, at which the patient had the typical clinical picture and no therapy had yet been administered, was defined as baseline( BL).
• Time point 2 was the point at which the patients presented with no new lesions( NL).
• Time points 3 and 4 were defined as 1( M1) and 3 months( M3) after baseline, respectively.
Dermatology Life Quality Index( DLQI) and ABQOL were completed at all 4 time points( BL, NL, M1 and M3) before the patients were reviewed by the physician. TABQOL was handed out and completed at time points 2, 3 and 4( NL, M1, M3), as at baseline patients had not yet been under treatment and this is a treatment-based questionnaire.
Statistical analysis of the data was performed using the software Statistical Package for Social Sciences( SPSS), version 22.0( SPSS, Inc., Chicago, IL, USA). All tests were 2-sided and the significance level was chosen to be α = 0.05. Spearman’ s = r, Friedman’ s = χ 2, Wilcoxon = z were used.
RESULTS
Fifty-three patients were invited into the study; of these, 50 agreed to be included and completed the study. Patients were studied and analysed, after they had been divided into 2 groups based on the disease type( intraepidermal or subepidermal AIBD).
Intraepidermal AIBD( pemphigus spectrum)
At baseline, DLQI was strongly and significantly correlated with both ABSIS( r = 0.677, p = 0.006) and PDAI( r = 0.559, p = 0.03). Thus, ABQOL was significantly correlated with PDAI( r = 0.559, p = 0.03), but not with ABSIS( r = 0.490, p = 0.064). Moreover, ABQOL was significantly correlated with the initial titres of antidesmoglein 1( DSG1)( r = 0.542, p = 0.037), but not with the titres of anti-DSG3( r = 0.405, p = 0.134). ABQOL and DLQI were significantly correlated( r = 0.712, p = 0.003).
A marginal, statistically significant decrease was observed in the median DLQI scores when values at selected consecutive time points were compared( χ 2 = 6.143, p = 0.046). However, ABQOL scores were significantly different between consecutively selected time points
Table I. Descriptive statistics for DLQI, ABQOL and TABQOL during weeks of evaluation based on the disease type
Variables
BL or NL Median( range)
M1 Median( range)
M3 Median( range)
Friedman test; p-value
Wilcoxon signed-rank test # BL or NL – M1 M1 – M3 BL or NL – M3
Intraepidermal disease |
DLQI |
7.0( 2.0 – 28.0) |
5.0( 0.0 – 18.0) |
4.0( 0.0 – 17.0) |
χ 2 = 6.143; p = 0.046 * |
z = – 1.783; p = 0.075 |
z = – 0.882; p = 0.378 |
z = – 2.274; p = 0.023 |
ABQOL |
17.0( 4.0 – 40.0) |
7.0( 1.0 – 33.0) |
9.0( 0.0 – 22.0) |
χ 2 = 15.148; p = 0.001 * |
z = – 2.607; p = 0.009 * |
z = – 0.255; p = 0.799 |
z = – 3.081; p = 0.002 * |
TABQOL |
9.0( 1.0 – 19.0) |
8.0( 2.0 – 27.0) |
10.0( 3.0 – 20.0) |
χ 2 = 4.037; p = 0.133 |
N / A |
N / A |
N / A |
Subepidermal disease |
DLQI |
5.0( 0.0 – 28.0) |
2.0( 0.0 – 21.0) |
2.0( 0.0 – 12.0) |
χ 2 = 26.578; p < 0.001 * |
z = – 2.890; p = 0.004 * |
z = – 1.392; p = 0.164 |
z = – 4.519; p < 0.001 * |
ABQOL |
12.0( 2.0 – 35.0) |
7.0( 0.0 – 26.0) |
4.0( 0.0 – 16.0) |
χ 2 = 31.924; p < 0.001 * |
z = – 3.828; p < 0.001 * |
z = – 1.704; p = 0.088 |
z = – 4.553; p < 0.001 * |
TABQOL |
7.0( 0.0 – 23.0) |
6.0( 1.0 – 29.0) |
6.0( 1.0 – 23.0) |
χ 2 = 1.256; p = 0.534 |
N / A |
N / A |
N / A |
* Statistically significant. # Bonferroni adjustment on the results you get from the Wilcoxon tests because you are making multiple comparisons; new significance level of 0.05 / 3 = 0.017.
BL: baseline; NL: new lesion; M1: one month after baseline; M3: 3 months after baseline; N / A: not applicable; DLQI: Dermatology Life Quality Index; ABQOL: Autoimmune Bullous Diseases Quality of Life; TABQOL: Treatment Autoimmune Bullous Diseases Quality of Life.
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2737 Acta Derm Venereol 2017; 97: 1145 – 1147