Dados do Trabalho

Título

Factors aggravating quality of life in autoimmune diseases of the Central Nervous System: a comparative study between Neuromyelitis Optic Spectrum Diseases (NMOSD) and Multiple Sclerosis (MS)

Resumo

Introduction: Neuromyelitis optical spectrum diseases (NMOSD) and multiple sclerosis (MS) are autoimmune diseases of the central nervous system (CNS) that establish a chronic inflammatory and demyelinating process. The limitations caused by the active disease, or the sequelae, can negatively impact the quality of life, in addition to causing disorders such as depression and anxiety. Comparing the quality of life between the diseases is a point to be explored, as the comparative studies carried out differ both in terms of the presence of differences between groups of diseases and the severity of the factors. Objective: To compare the quality of life in patients with NMOSD or MS, as well as to determine aggravating factors. Methods: Cross-sectional, single-center study conducted with patients who comply with the 2015 International Consensus criteria for the diagnosis of NMOSD or the 2017 McDonald criteria for the diagnosis of MS. The quality of life was quantified by the EQ-5D Quality of Life Questionnaire. Depression and anxiety were measured by the Hospital Anxiety and Depression Scale (HAD). Fatigue was measured by the Modified Fatigue Impact Scale (MFIS). The degree of disability was expressed by the Expanded Disability Status Scale (EDSS). Results: 229 patients were enrolled, of which 69 (30.1%) were diagnosed with NMOSD and 160 (69.9%) with MS. The mean quality of life by EQ-5D was 0.59 (SD ± 0.23). Forty-three patients (18.8%) were classified as having probable symptoms for anxiety and thirty-four (14.8%) as having probable symptoms for depression. One hundred forty-four patients (62.9%) reported symptoms compatible with fatigue on the MIFS scale. Patients with NMOSD had worse quality of life [0.51 (± 0.23) vs 0.62 (± 0.22); p = 0.001]. We did not detect any difference between anxiety symptoms [7.60 (± 4.60) vs 7.60 (± 4.60); p = 0.978], depressive symptoms [6.7 (± 4.90) vs 6.1 (± 4.10); p = 0.353] and fatigue [43.8 (± 17.3) vs 43.5 (±19.9); p = 0.916]. In multivariate analysis, higher scores on the EDSS, MFIS, older age, and employment status were independently associated with worse quality of life. There was no association between diagnosis of NMOSD and quality of life. Conclusion: NMOSD and MS have similar impacts in quality of life after adjusting for disease severity. However, disease severity is clearly worse in NMOSD when compared MS, secondarily impacting quality of life.

Palavras Chave

Neuromyelitis optic spectrum disorders; Multiple Sclerosis; Quality of life; Depression; Fatigue; Anxiety; Disability.