Health-related quality of life evaluated by Pediatric Quality of Life Inventory 4.0 in pediatric leprosy patients with musculoskeletal manifestations

Neder, Luciana; Weelden, Marlon van; Viola, Gabriela Ribeiro; Lourenço, Daniela Mencaroni; Len, Claudio A.; Silva, Clovis A.

doi:10.1016/j.rbr.2014.12.013

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Revista Brasileira de Reumatologia

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Original articles • Rev. Bras. Reumatol. 55 (5) • Sep-Oct 2015 • https://doi.org/10.1016/j.rbr.2014.12.013 copy

Health-related quality of life evaluated by Pediatric Quality of Life Inventory 4.0 in pediatric leprosy patients with musculoskeletal manifestations

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the health-related quality of life (HRQL) in pediatric leprosy patients.

Methods:

A cross-secal study included 47 leprosy patients and 45 healthy subjects. The HRQL was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), and evaluated physical, emotional, social and school domains. The leprosy patients were classified by Ridley and Jopling classification criteria and assessed according to clinical musculoskeletal manifestations, laboratory and radiographic examinations.

Results:

The median of current age was similar in leprosy patients and controls [12 (6-18) vs. 15 (5-18) years, p = 0.384], likewise the frequencies of female gender (p = 0.835) and middle/lower Brazilian socio-economic classes (p = 1.0). The domain school activities according the child-self report was significantly lower in leprosy patients compared to controls in the age group of 13-18 years [75 (45-100) vs. 90 (45-100), p = 0.021]. The other domains were alike in both groups (p > 0.05). At least one musculoskeletal manifestation (arthralgia, arthritis and/or myalgia) was observed in 15% of leprosy patients and none in controls (p= 0.012). Further comparison between all leprosy patients showed that the median of the physical capacity domain [81.25 (50-100) vs. 98.44 (50-100), p = 0.036] and school activities domain by child-self report [60 (50-85) vs. 80 (45-100), p = 0.042] were significantly lower in patients with musculoskeletal manifestations compared to patients without these manifestations. No differences were evidenced between the other HRQL parameters in both groups, reported by patients and parents (p > 0.05).

Conclusions:

Reduced physical capacity and school activities domains were observed in pediatric leprosy patients with musculoskeletal manifestations.

Keywords:
Leprosy; Children; Hansen's disease; Health-related quality of life; Arthritis

Variables	Leprosy patients (n= 47)
Demographic data
Current age, years	12 (3–18)
Female gender	25/47 (53)
Brazilian socio economic classes
Middle/lower middles class	46 (92)

Ridley and Jopling classification criteria
Borderline–borderline	21 (45)
Indeterminate	0 (0)
Tuberculoid	26 (55)
Lepromatous	0 (0)

World Health Organization (WHO) classification
Multibacillary	21 (45)
Paucibacillary	26 (55)

Clinical manifestation
Hypopigmented or reddish skin lesions with loss of sensation	47 (100)
Erythema nodosum leprosum	0 (0)
Peripheral silent neuropathy	2 (4)
Arthralgia	1 (2)
Myalgia	3 (6)
Arthritis	5 (11)

Laboratory
Autoantibodies
Antinuclear antibodies (ANA)	1 (2)
Rheumatoid factor	2/5 (20)
IgM anticardiolipin (aCL)	7 (15)
IgG aCL	1 (2)

Radiography
Joint radiographies abnormalities	0 (0)

Treatments
Prednisone	8 (17)
Rifampicin, dapsone and clofazimin	21 (45)
Rifampicin and dapsone	26 (55)

Variables	Leprosy (n = 47)	Controls (n = 45)	p
5–7 years	(n = 4)	(n = 6)
Physical (Patients)	100 (81–100)	98.44 (88–100)	0.719
(Parents)	98.44 (90.63–100)	98.44 (90.63–100)	1.0
Emotional (Patients)	65 (60–80)	75 (50–90)	0.515
(Parents)	65 (60–80)	72.50 (60–85)	0.504
Social (Patients)	85 (70–90)	82.50 (80–90)	0.909
(Parents)	95 (80–100)	90 (70–95)	0.321
School (Patients)	95 (80–100)	75 (50–100)	0.128
(Parents)	92.50 (75–95)	67.50 (45–95)	0.130

8–12 years	(n = 20)	(n = 12)
Physical (Patients)	95.94 (63–100)	100 (88–100)	0.504
( Parents)	100 (68.75–100)	100 (90.63–100)	0.982
Emotional (Patients)	70 (55–100)	75 (45–100)	0.708
(Parents)	70 (55–100)	72.50 (65–95)	0.569
Social (Patients)	90 (75–100)	90 (45–100)	0.270
(Parents)	95 (35–100)	100 (45–100)	0.691
School (Patients)	80 (60–95)	85 (40–100)	0.346
(Parents)	80 (50–100)	87.50 (45–100)	0.281

13–18 years	(n = 23)	(n = 27)
Physical (Patients)	93.75 (50–100)	93.75 (50–100)	0.597
(Parents)	100 (50–100)	93.75 (53.13–100)	0.179
Emotional (Patients)	70 (30–95)	75 (40–100)	0.358
(Parents)	75 (35–100)	80 (25–100)	0.769
Social (Patients)	90 (45–100)	95 (75–100)	0.506
(Parents)	100 (75–100)	100 (65–100)	0.631
School (Patients)	75 (45–100)	90 (45–100)	0.021
(Parents)	80 (35–95)	80 (35–100)	0.473

Variables	With musculoskeletal manifestations (n = 7)	Without musculoskeletal manifestations (n = 40)	p
Children
Physical	81.25 (50–100)	98.44 (50–100)	0.036
Emotional	65.00 (30–80)	70 (45–100)	0.270
Social	90.00 (65–100)	90 (45–100)	0.336
School	60.00 (50–85)	80 (45–100)	0.042

Parents
Physical	90.63 (50–100)	100 (68.75–100)	0.143
Emotional	65.00 (35–80)	72.50 (50–100)	0.107
Social	95.00 (80–100)	100 (35–100)	0.735
School	70 (50–95)	82.50 (35–100)	0.094

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[1] *Corresponding author. E-mail: clovisaasilva@gmail.com (C.A. Silva).