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Abstract
This paper considers the experiences of people with lupus in comparison with those with diabetes, and discusses the impact of lupus specialist nurses in information-giving and education under the guise of 'just in case' vs. 'just in time'. Now recognized as a difficult condition to diagnose, lupus can lead to significant worry and distress especially during delays to diagnosis and times of high disease activity. Providing appropriate, individualized information to people with lupus is embedded in specialist nursing practice and enables individuals to use the tools of self-management approaches in gaining control over everyday symptoms.
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Affiliation(s)
- S Brown
- Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Bath, UK
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52
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Waldheim E, Elkan AC, Pettersson S, Vollenhoven RV, Bergman S, Frostegård J, Henriksson EW. Health-related quality of life, fatigue and mood in patients with SLE and high levels of pain compared to controls and patients with low levels of pain. Lupus 2013; 22:1118-27. [DOI: 10.1177/0961203313502109] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The objective of this paper is to investigate health-related quality of life (HRQoL), fatigue, anxiety and depression in patients with systemic lupus erythematosus (SLE) and higher levels of pain and to compare them to patients with lower levels of pain and controls. Method Patients were dichotomized into two groups based on SLE-related pain score on the visual analog scale (VAS): low-pain group (76%, n = 64, VAS 0–39 mm) and high-pain group (24%, n = 20, VAS 40–100 mm) . Sex- and age-matched controls were randomly selected from the general population. Participants were asked to complete questionnaires regarding self-reported pain, HRQoL, fatigue, anxiety and depression. Medical assessments also were recorded. Result Fatigue score in the high-pain group (median, 36.5; interquartile range (IQR), 32.5–39.7) was significantly higher ( p < 0.001) compared to the low-pain group (median, 23; IQR, 14.6–34.1), as well as scores for anxiety (median, 9; IQR, 6.5–11.5) and depression (median, 7.5; IQR, 5.5–9) ( p < 0.001). The high-pain group had significantly lower scores compared to the low-pain group in all dimensions in the SF-36 ( p ≤ 0.001–0.007). No statistical differences were detected between the low-pain group and controls in any measurement except for the dimensions physical function, general health, vitality and social function in SF-36. Conclusion Patients with SLE scoring higher degrees of pain were burdened with more fatigue, anxiety and depression and lower levels of HRQoL compared to patients with lower levels of pain who did not differ significantly from the general population in most dimensions. These results elucidate the importance of identifying patients with higher degrees of pain who are probably in need of more extensive multidimensional interventions to decrease symptom burden.
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Affiliation(s)
- E Waldheim
- Unit of Rheumatology, Karolinska University Hospital, Sweden; Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden
| | - A-C Elkan
- Innovation and Development SRQ (Swedish Rheumatology Quality Register) Dept. of Rheumatology, Karolinska University Hospital, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - S Pettersson
- Unit of Rheumatology, Karolinska University Hospital, Sweden; Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden
| | - R van Vollenhoven
- Unit of Rheumatology, Karolinska University Hospital, Sweden; Department of Medicine, Solna, Karolinska Institutet, Sweden
| | - S Bergman
- Research and Development Centre, Spenshult Hospital, Sweden; Department of Rheumatology, Clinical Sciences, Lund University, Sweden
| | - J Frostegård
- Institute of Environmental Medicine, Unit of Immunology and Chronic Disease, Karolinska Institutet, Sweden
| | - E Welin Henriksson
- Unit of Rheumatology, Karolinska University Hospital, Sweden; Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden
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53
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kotb HA, Rady HM, Ghanim DH. Sleep disturbance in female patients with systemic lupus erythematosus and its relation to disease parameters. EGYPTIAN RHEUMATOLOGIST 2013. [DOI: 10.1016/j.ejr.2013.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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54
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Fatigue, health-related quality of life and other patient-reported outcomes in systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2013; 27:363-75. [DOI: 10.1016/j.berh.2013.07.009] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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55
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Direct cost of management and treatment of active systemic lupus erythematosus and its flares in Spain: The LUCIE Study. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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56
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Cervera R, Rúa-Figueroa I, Gil-Aguado A, Sabio J, Pallarés L, Hernández-Pastor L, Iglesias M. Coste económico directo del control y el tratamiento del lupus eritematoso sistémico activo y sus brotes en España: estudio LUCIE. Rev Clin Esp 2013; 213:127-37. [DOI: 10.1016/j.rce.2012.11.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 10/11/2012] [Accepted: 11/20/2012] [Indexed: 11/26/2022]
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57
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Beckerman NL, Sarracco M. Listening to lupus patients and families: fine tuning the assessment. SOCIAL WORK IN HEALTH CARE 2012; 51:597-612. [PMID: 22905976 DOI: 10.1080/00981389.2012.683679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Given the chronicity and uncertainty of lupus, patients and their family members will face physical, financial, social, and emotional challenges that can be overwhelming. This article records the experiences of three different families affected by lupus. Although these patients and families are very different, their perspectives identify common emotional challenges. Understanding these experiences from their perspectives can help facilitate an assessment that is highly attuned to the potential psychosocial impact of lupus on the patient and the family.
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Affiliation(s)
- N L Beckerman
- Wurzweiler School of Social Work, Yeshiva University, New York, New York 10033, USA.
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58
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Schudrich W, Gross D, Rowshandel J. Lupus and community-based social work. SOCIAL WORK IN HEALTH CARE 2012; 51:627-639. [PMID: 22905978 DOI: 10.1080/00981389.2012.683694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Systemic lupus erythematous (SLE) is a chronic autoimmune disease that disproportionately strikes women of color. SLE patients frequently experience physical, emotional, and social challenges that often result in unmet biopsychosocial needs. Because of the nature of the disease and the needs of patients, agencies serving SLE patients that engage in community-based social work can positively impact their clients' lives. The S.L.E. Lupus Foundation participates in a myriad of community-based social work practices to help address the needs of their clients. These services include helping economically disadvantaged patients access appropriate services within their communities, building awareness about SLE in society, connecting with government officials at all levels, and collaborating with health care organizations to serve those affected by SLE. Specific examples of community-based activities at the S.L.E. Lupus Foundation are described in detail.
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Affiliation(s)
- Wendy Schudrich
- Wurzweiler School of Social Work, Yeshiva University, New York, New York 10033, USA.
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59
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Auerbach C, Beckerman NL. Locus of control and lupus: patients' beliefs, perspectives, and disease activity. SOCIAL WORK IN HEALTH CARE 2012; 51:613-626. [PMID: 22905977 DOI: 10.1080/00981389.2012.683685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patients with lupus often experience a high degree of psychological symptoms such as anxiety, depression, and mood disorders that can influence their beliefs and perceptions of their illness. The purpose of the study was to examine how a patient's self-reported psychosocial needs (depression and anxiety) and beliefs about how much control they have over their health (health locus of control) influences their perception of disease chronicity and acuity. The study findings were based on a survey of 378 patients self-diagnosed with lupus.
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Affiliation(s)
- Charles Auerbach
- Wurzweiler School of Social Work, Yeshiva University, New York, New York 10033, USA.
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60
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Stockton KA, Kandiah DA, Paratz JD, Bennell KL. Fatigue, muscle strength and vitamin D status in women with systemic lupus erythematosus compared with healthy controls. Lupus 2011; 21:271-8. [DOI: 10.1177/0961203311425530] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent studies have demonstrated an inverse relationship between vitamin D levels and fatigue in systemic lupus erythematosus (SLE). The aims of this study were to evaluate proximal muscle strength, fatigue and vitamin D levels in women with SLE compared with healthy controls and to investigate relationships between these factors in a cohort of women with SLE. Forty-five women (24 SLE, 21 healthy controls) participated. Primary outcome measures were the fatigue severity scale (FSS), isometric muscle strength of dominant limbs using hand held dynamometry, two functional tests – the 30-second chair stand test and the 1-kg arm lift test, with vitamin D status measured using 25(OH)D. Overall 25(OH)D levels were 68.4 (22.4) nmol/L with no difference between SLE and control groups. There was a statistically and clinically significant difference in fatigue, 1-kg arm lift, 30-second sit to stand, knee extension, hip flexion, hip abduction, shoulder flexion and grip strength in the SLE group compared with the control group ( p < 0.05). In the SLE group FSS was moderately correlated with both functional measures (1-kg arm lift r = −0.42, 30-second chair stand r = −0.44, p < 0.05). However, no statistically significant correlation between dynamometry measures and fatigue was evident. There was no association between fatigue and 25(OH)D level ( r = −0.12). In summary, women with SLE were weaker and demonstrated reduced physical function and higher fatigue levels than healthy controls. Fatigue was related to physical function but not vitamin D status or maximal isometric strength in vitamin D replete individuals with SLE.
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Affiliation(s)
- KA Stockton
- University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - DA Kandiah
- University of Western Australia, Faculty of Medicine, Dentistry and Health Sciences, Perth, Australia
| | - JD Paratz
- University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - KL Bennell
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
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61
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Mazzoni D, Cicognani E. Social support and health in patients with systemic lupus erythematosus: A literature review. Lupus 2011; 20:1117-25. [DOI: 10.1177/0961203311412994] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the last decades, with the improvement of life expectancies for systemic lupus erythematosus (SLE) patients, the relationship between social support and health in this population has received a considerable amount of attention in behavioural medicine and health psychology. This paper is the first to review research studies which specifically investigated perceived social support in relation to SLE patients’ health outcomes (quality of life, disease activity and damage). Starting with a descriptive approach to social support perceived by patients with SLE, the research evidence on the impact of social support on health is presented. These studies demonstrate that the consideration of social support is critical in predicting disease activity, damage and quality of life (both physical and psychological components) although the precise ways in which social support contributes to health are not yet completely understood. Discussing the results, the authors offer some suggestions which could guide further research in this field. Finally, clinical and non-clinical implications of the findings are discussed.
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Affiliation(s)
- D Mazzoni
- Department of Education Sciences, University of Bologna, Italy
| | - E Cicognani
- Department of Education Sciences, University of Bologna, Italy
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62
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Zirkzee EJM, Steup-Beekman GM, Schouffoer AA, Henquet SM, Caljouw MAA, Huizinga TWJ, Vlieland TPMV. Health care usage in Dutch systemic lupus erythematosus patients. Lupus 2011; 20:1147-54. [DOI: 10.1177/0961203311405372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As a first step in the improvement of the organization of care for patients with systemic lupus erythematosus (SLE) we studied their health care usage and its determinants. A questionnaire was sent to 161 outpatients of the rheumatology clinic of a Dutch university hospital. The questionnaire comprised questions on health care usage, quality of life and sociodemographic characteristics. Disease characteristics were extracted from the medical record. Among the 102 responders (63% response rate) the proportions of patients reporting contacts with a rheumatologist because of SLE since onset of the disease and over the past 12 months were 100% and 83%, respectively. These proportions were 93% and 68% for all other medical specialists, 88% and 44% for the general practitioner, 78% and 44% for any health professional, 29% and 9% for care at home, 48% and 17% for hospital admissions and 29% and 2% for day-patient care. Younger age, major organ involvement, the use of immunosuppressants and worse physical functioning were found to be significantly associated with greater health care use. This study demonstrated that health care usage by SLE patients is substantial and involves a variety of health care services. Further research should be directed at patients’ satisfaction and patients’ needs regarding the optimal organization of integrated, multidisciplinary services that are accessible for SLE patients of all ages.
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Affiliation(s)
- EJM Zirkzee
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - GM Steup-Beekman
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - AA Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - SM Henquet
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - MAA Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - TWJ Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - TPM Vliet Vlieland
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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63
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Beckerman NL, Auerbach C, Blanco I. Psychosocial dimensions of SLE: implications for the health care team. J Multidiscip Healthc 2011; 4:63-72. [PMID: 21594059 PMCID: PMC3093952 DOI: 10.2147/jmdh.s19303] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Indexed: 11/23/2022] Open
Abstract
Background: The purpose of this exploratory study was threefold, ie, to clarify the unique psychosocial challenges facing those living with systemic lupus erythematosus (SLE), to distinguish which sociodemographic variables impact the lives of SLE patients, and generate knowledge regarding the way patients perceive SLE medication regimens. Methods: This was a cross-sectional exploratory study in 378 patients diagnosed with SLE and receiving services from the SLE Lupus Foundation in New York City. In addition to sociodemographic variables, the instrument used consisted of two scales, ie, the Systemic Lupus Erythematosus Needs Questionnaire (SLENQ) and the Multidimensional Health Locus of Control Scale, as well as questions regarding subjective perceptions of side effects from SLE medication. Results: The highest general cause of self-reported depressive and anxious feelings was changes in appearance due to SLE, and limitations in physical abilities due to SLE (primarily from muscle and joint pain). The higher the sense of control over SLE, the less likely respondents were to report feeling depressed and anxious. African-American and Hispanic SLE patients reported a higher level of unmet psychological needs due to SLE than did their other ethnic counterparts. Weight gain and hair loss were the most likely medication side effects and also the most likely causes of SLE-related depression and anxiety. Conclusion: Those living with SLE are at risk for feelings of depression and anxiety. African-American and Hispanic women are at higher risk for these emotional states. Comprehensive assessment across the disciplines should screen this group of patients for depression and anxiety, and be prepared to refer them to patient education and social work counseling as indicated.
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64
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Abstract
This article reports on the findings of a qualitative study based on three focus-groups of individuals (N = 32) living with Systemic Lupus Erythematosus (SLE). The themes that emerged indicated a high vulnerability for self-reported feelings of depression. The four key challenges included: (1) feeling depressed that they are not who they used to be, (2) feelings of depression and anxiety related to coping with the uncertainty of the illness, (3) physical and emotional fatigue of living with a chronic illness, and (4) coping with the financial strain of the illness. These psychosocial challenges should be considered in screening, assessment, and treatment planning for social work service with this population.
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Affiliation(s)
- Nancy L Beckerman
- Wurweiler School of Social Work, Yeshiva University, New York, New York, USA.
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65
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Haija AJ, Schulz SW. The role and effect of complementary and alternative medicine in systemic lupus erythematosus. Rheum Dis Clin North Am 2010; 37:47-62. [PMID: 21220085 DOI: 10.1016/j.rdc.2010.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The use of complementary and alternative medicine (CAM) is common among patients with systemic lupus erythematosus (SLE), especially those with active disease who often have poorer quality of life and significant unmet needs. It is important for the rheumatologist to be aware of these therapies and to ask the patient with SLE about their active use or future interest in CAM. Future studies on the effectiveness of the aforementioned therapies will be crucial to find better ways for the rheumatologist to integrate their use into the care of the patient with SLE.
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Affiliation(s)
- Anan J Haija
- Division of Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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66
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Abstract
Health outcomes and their measures used as end points in systemic lupus erythematosus (SLE) patient care and clinical trials have been varied and are still evolving. Although significant reductions in morbidity and mortality in SLE have been achieved, the medications approved for SLE have remained the same during the past 50 years. Despite the pressing need, aggressive advocacy in the community, and advances in drug development and testing in SLE, no medications have met US Food and Drug Administration guidelines for a new indication claim approval for SLE. This may be attributable to its multisystemic, remitting, and relapsing nature, and difficulty in identifying useful end points and appropriate tools to measure them. Thus, it is pivotal to identify and validate appropriate global, disease-specific, and perhaps organ-specific health outcomes for clinical research. This article reviews recent physician- and patient-generated health outcomes in SLE.
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67
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Manges AR, Tellis PA, Vincent C, Lifeso K, Geneau G, Reid-Smith RJ, Boerlin P. Multi-locus variable number tandem repeat analysis for Escherichia coli causing extraintestinal infections. J Microbiol Methods 2009; 79:211-3. [PMID: 19765619 DOI: 10.1016/j.mimet.2009.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 09/03/2009] [Accepted: 09/07/2009] [Indexed: 11/24/2022]
Abstract
Discriminatory genotyping methods for the analysis of Escherichia coli other than O157:H7 are necessary for public health-related activities. A new multi-locus variable number tandem repeat analysis protocol is presented; this method achieves an index of discrimination of 99.5% and is reproducible and valid when tested on a collection of 836 diverse E. coli.
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Affiliation(s)
- Amee R Manges
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, Québec, Canada
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