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Klinkhammer S, Duits AA, Horn J, Slooter AJC, Verwijk E, Van Santen S, Visser-Meily JMA, Van Heugten C. Prevalence and trajectories of neuropsychological post-COVID-19 symptoms in initially hospitalized patients. J Rehabil Med 2024; 56:jrm25315. [PMID: 38470168 PMCID: PMC10949081 DOI: 10.2340/jrm.v56.25315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE To investigate the prevalence and trajectories of post-COVID-19 neuropsychological symptoms. DESIGN Prospective longitudinal multicentre cohort study. SUBJECTS A total of 205 patients initially hospitalized with SARS-CoV-2 (COVID-19). METHODS Validated questionnaires were administered at 9 months (T1) and 15 months (T2) post-hospital discharge to assess fatigue, cognitive complaints, insomnia, anxiety, depression, and post-traumatic stress symptoms. RESULTS Analyses included 184 out of 205 patients. Approximately 50% experienced high cognitive complaints at T1 and T2, while severe fatigue affected 52.5% at T1 and 55.6% at T2. Clinically relevant insomnia scores were observed in 25% of patients at both time-points. Clinically relevant anxiety scores were present in 18.3% at T1 and 16.7% at T2, depression in 15.0% at T1 and 18.9% at T2, and PTSD in 12.4% at T1 and 11.8% at T2. Most symptoms remained stable, with 59.2% of patients experiencing at least 1 persistent symptom. In addition, 31.5% of patients developed delayed-onset symptoms. CONCLUSION Post-COVID-19 cognitive complaints and fatigue are highly prevalent and often persist. A subgroup develops delayed symptoms. Emotional distress is limited. Screening can help identify most patients experiencing long-term problems. Future research should determine risk factors for persistent and delayed onset symptoms.
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Affiliation(s)
- Simona Klinkhammer
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands
| | - Annelien A Duits
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Department of Medical Psychology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janneke Horn
- Department of Intensive Care, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjen J C Slooter
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels Health Campus, Jette, Belgium
| | - Esmée Verwijk
- Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Susanne Van Santen
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht, the Netherlands; Center of Excellence for Rehabilitation Medicine and De Hoogstraat Rehabilitation, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Caroline Van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
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Song S, Graham-Engeland JE, Kim J. Associations Between Psychological Stress and Hand Pain Among Rural and Urban Adults: Findings From the KoGES Community Cohort Study. THE JOURNAL OF PAIN 2024; 25:362-375. [PMID: 37659447 DOI: 10.1016/j.jpain.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
Despite known health disparities in chronic pain conditions between rural and urban adults, few studies have examined whether longitudinal associations between psychological stress and hand pain differ. Utilizing community-based cohort data, this study examined whether rural and urban adults differed in the extent to which psychological distress was associated with hand osteoarthritis (OA) symptoms and later functional limitations related to hand pain. Community-dwelling adults (mean age = 51.97, 52.3% women) in a rural (n = 2,971) and urban area (n = 2,782) provided demographic data at baseline and, at a 4-year follow-up, responded to questionnaires about psychological distress and clinical symptoms of hand OA. Levels of functional limitations in hands were assessed at an 8-year follow-up. Ordinal logistic and linear regression were conducted to examine the effects of psychological distress on hand OA symptoms and functional limitations, and whether associations between psychological distress and these pain outcomes were moderated by residential area. The results showed that psychological distress was associated with a higher risk for hand OA symptoms and functional limitations, even after adjusting for demographic and health covariates. There was significant moderation by residential area, such that the association between psychological distress and hand OA was significant only among rural adults and the association with functional limitations was stronger in rural adults than urban adults. Findings suggest greater vulnerability to hand arthritis and hand-related functional limitations among rural adults and the potential for tailored intervention programs to help resolve health disparities among rural communities. PERSPECTIVE: This study compares the association between psychological distress and hand pain outcomes between rural and urban adults using community-based cohort data and suggests that rural adults are more vulnerable to experiencing negative effects of psychological distress on concurrent hand OA symptoms and longitudinal functional limitations in hands.
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Affiliation(s)
- Sunmi Song
- Rehabilitation Science Program, Department of Health Science, Graduate School, Korea University, Seoul, South Korea; Department of Health and Environmental Science, College of Health Science, Korea University, Seoul, South Korea; Department of Physical Therapy, College of Health Science, Korea University, Seoul, South Korea
| | | | - Junesun Kim
- Rehabilitation Science Program, Department of Health Science, Graduate School, Korea University, Seoul, South Korea; Department of Health and Environmental Science, College of Health Science, Korea University, Seoul, South Korea; Department of Physical Therapy, College of Health Science, Korea University, Seoul, South Korea; BK21FOUR Program: Learning Health Systems, College of Health Science, Korea University, Seoul, South Korea
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Seizer L, Huber E, Schirmer M, Hilbert S, Wiest EM, Schubert C. Personalized therapy in rheumatoid arthritis (PETRA): a protocol for a randomized controlled trial to test the effect of a psychological intervention in rheumatoid arthritis. Trials 2023; 24:743. [PMID: 37986029 PMCID: PMC10659068 DOI: 10.1186/s13063-023-07707-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/22/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects cartilage and bone. Psychological stress can both trigger disease exacerbation and result from disease activity. As standard pharmacological interventions alone have limited success in treating RA, a more comprehensive biopsychosocial approach to treatment has been recommended. In this prospective randomized controlled trial (RCT), a psychotherapeutically guided, group-based intervention program will be conducted with RA patients over a period of 9 months. This program combines a dynamic-interactional model with disorder-specific coping-oriented perspectives to improve patients' social, emotional, and problem-solving competencies as well as stress system functional status. The enrolment of 440 patients, randomly allocated to either an intervention (n = 220) or control group (n = 220), is planned. To evaluate the intervention effect, various indicators of RA disease activity, stress system activity, and psychological condition will be assessed through sets of standardized questionnaires and biochemical analyses of blood and saliva samples. Moreover, healthcare-related costs for each patient will be obtained using routine health insurance data. Outcome variables will be measured in all patients at regular intervals prior to intervention (baseline), during the 9-month intervention (five time points), and during a 9-month follow-up phase (three time points), allowing the comprehensive analysis of within- and between-subject effects, i.e. trajectories of the target variables in the intervention and control groups. In addition, to investigate the intervention effects on real-life stress system functioning in RA, 10 integrative single-case studies (n = 5 from the intervention group, n = 5 from the control group) will be conducted. In each study, once before and after the 9-month intervention, urine samples will be collected, and patients will fill out questionnaires for approximately 1 month at 12-h intervals. Moreover, weekly in-depth interviews will be conducted with patients to determine their previous week's emotionally positive and negative incidents. Using time series analysis, it is then possible to investigate whether and how stress system function in these RA patients has improved from the applied intervention. By using both an investigational macro- and microperspective, this project aims to evaluate a psychological intervention in the routine care of individuals with RA.Trial registration German Clinical Trials Register DRKS00028144. Registered on 1 March 2022.
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Affiliation(s)
- Lennart Seizer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Ellis Huber
- Professional Association of Preventologists, Berlin, Germany
| | - Miriam Schirmer
- Faculty of Human Sciences, University of Regensburg, Regensburg, Germany
| | - Sven Hilbert
- Faculty of Human Sciences, University of Regensburg, Regensburg, Germany
| | - Eva-Maria Wiest
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Schubert
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria.
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4
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Friedberg F, Adamowicz JL, Bruckenthal P, Milazzo M, Ramjan S, Zhang X, Yang J. Uplifts and hassles are related to worsening in chronic fatigue syndrome: a prospective study. J Transl Med 2023; 21:557. [PMID: 37598161 PMCID: PMC10440032 DOI: 10.1186/s12967-023-04412-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/02/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Limited published data suggests that absence of uplifts (minor pleasant events) is associated with clinical worsening in patients with chronic fatigue syndrome (CFS). The current study aimed to assess the relation of illness worsening to the trajectories of social and non-social uplifts and hassles in a six-month prospective study in CFS. METHODS Participants were primarily in their 40s, female, white, and ill for over a decade. All participants (N = 128) met criteria for CFS. The interview-based global impression of change rating was used to classify individual outcomes as improved, unchanged, or worsened at six- month follow-up. Uplifts and hassles, both social and non-social, were assessed with the Combined Hassles and Uplifts Scale (CHUS). The CHUS was administered weekly in online diaries over six months. Linear mixed effect models were utilized to examine linear trends for hassles and uplifts. RESULTS No significant differences were found between the three global outcome groups for age, sex, or illness duration; however, work status was significantly lower for the non-improved groups (p < 0.001). Non-social hassles intensity showed an increasing slope for the worsened group (p = 0.03) and a decreasing slope (p = 0.05) for the improved group. For the worsened group, a downward trend was found for frequency of non-social (p = 0.01) uplifts. CONCLUSION Individuals with worsening as compared to improving illness in CFS show significantly different six-month trajectories for weekly hassles and a deficit in uplifts. This may have clinical implications for behavioral intervention. Trial registration ClinicalTrials.gov ID: NCT02948556.
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Affiliation(s)
- Fred Friedberg
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States.
| | - Jenna L Adamowicz
- Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, United States
| | | | - Maria Milazzo
- School of Nursing, Stony Brook University, Stony Brook, New York, United States
| | - Sameera Ramjan
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Xiaoyue Zhang
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States
| | - Jie Yang
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States
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5
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Friedberg F, Adamowicz JL, Bruckenthal P, Milazzo M, Ramjan S, Zhang X, Yang J. Uplifts and hassles are related to worsening in chronic fatigue syndrome A prospective study. RESEARCH SQUARE 2023:rs.3.rs-2865400. [PMID: 37205559 PMCID: PMC10187416 DOI: 10.21203/rs.3.rs-2865400/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background: Limited published data suggests that absence of uplifts (minor pleasant events) is associated with clinical worsening in patients with chronic fatigue syndrome (CFS). The current study aimed to assess the relation of illness worsening to the trajectories of social and non-social uplifts and hassles in a six-month prospective study in CFS. Methods: Participants were primarily in their 40s, female, white, and ill for over a decade. All participants (N=128) met criteria for CFS. The interview-based global impression of change rating was used to classify individual outcomes as improved, unchanged, or worsened at six- month follow-up. Uplifts and hassles, both social and non-social, were assessed with the Combined Hassles and Uplifts Scale (CHUS). The CHUS was administered weekly in online diaries over six months. Linear mixed effect models were utilized to examine linear trends for hassles and uplifts. Results: No significant differences were found between the three global outcome groups for age, sex, or illness duration; however, work status was significantly lower for the non-improved groups ( p <.001). Non-social hassles intensity showed an increasing slope for the worsened group ( p =.03) and a decreasing slope ( p =0.05) for the improved group. For the worsened group, a downward trend was found for frequency of non-social ( p =0.01) uplifts. Conclusion: Individuals with worsening as compared to improving illness in CFS show significantly different six-month trajectories for weekly hassles and a deficit in uplifts. This may have clinical implications for behavioral intervention. Trial Registration: ClinicalTrials.gov ID: NCT02948556.
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Affiliation(s)
| | | | | | | | | | - Xiaoyue Zhang
- Stony Brook University Renaissance School of Medicine
| | - Jie Yang
- Stony Brook University Renaissance School of Medicine
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6
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Paoletti J, Chen MA, Wu-Chung EL, Brown RL, LeRoy AS, Murdock KW, Heijnen CJ, Fagundes CP. Employment and family income in psychological and immune outcomes during bereavement. Psychoneuroendocrinology 2023; 150:106024. [PMID: 36702040 PMCID: PMC9974808 DOI: 10.1016/j.psyneuen.2023.106024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/25/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
Spousal bereavement is one of the most stressful experiences in adulthood. In a sample of 183 widow(er)s, bereaved about three months prior, we examined the intersection of employment, family income, and health outcomes (proinflammatory marker production, perceived stress, and grief symptoms). Bereaved employees had higher levels of monocyte-stimulated interleukin-6, tumor necrosis factor-α, chemokine ligands 4, and perceived stress than bereaved retirees. We also found an interaction such that family income was positively associated with perceived stress and grief symptoms for employed window(er)s, but not for retirees. These findings align with the reserve capacity model, which states that people at higher levels of socioeconomic status have more psychosocial resources to address psychosocial stressors. Employment likely served as an added psychological and inflammatory burden for all bereaved workers, except those with the highest incomes.
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Affiliation(s)
| | | | | | - Ryan L Brown
- University of California San Francisco, United States
| | | | | | - Cobi J Heijnen
- University of Texas MD Anderson Cancer Center, United States
| | - Christopher P Fagundes
- Rice University, United States; University of Texas MD Anderson Cancer Center, United States; Baylor College of Medicine, United States
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7
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Komalasari R, Mpofu E, Prybutok G, Ingman SR. Subjective Aging Difficulties among Older Adults with Subjective Cognitive Decline. J Appl Gerontol 2023; 42:259-269. [PMID: 36154323 DOI: 10.1177/07334648221129546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In older adults, subjective cognitive decline (SCD) may progress to an early stage of dementia. Yet, its association with subjective daily functional difficulties in aging is less well studied by experiences of mentally unhealthy days (MUDs). Employing a cross-sectional design approach, we analyzed the Behavioral Risk Factor Surveillance System dataset on 7429 older adults with SCD (aged 65 to >80, 45% males, 55% females) to explore SCD in instrumental daily activities of living (SCD-IADLs) and healthcare access mediation by MUDs and moderated mediation by age cohort, controlling gender and education. The bias-corrected percentile bootstrap with 5000 samplings revealed that MUDs partially mediate the relationship between SCD-IADLs and healthcare access, with a 28.2% mediating effect. Age cohort moderated the relationship between healthcare access and MUDs, MUDs and SCD-IADLs. Specifically, the predictive effects from healthcare access to MUDs and MUDs to SCD-IADLs were more profound in the 70-74 age cohort.
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Affiliation(s)
- Renata Komalasari
- Department of Rehabilitation and Health Services, College of Health and Public Service, 3404University of North Texas, Denton, TX, USA
| | - Elias Mpofu
- Department of Rehabilitation and Health Services, College of Health and Public Service, 3404University of North Texas, Denton, TX, USA.,School of Health Sciences, University of Sydney, NSW, Australia.,School of Human and Community Development, University of Witwatersrand, South Africa
| | - Gayle Prybutok
- Department of Rehabilitation and Health Services, College of Health and Public Service, 3404University of North Texas, Denton, TX, USA
| | - Stan R Ingman
- Department of Rehabilitation and Health Services, College of Health and Public Service, 3404University of North Texas, Denton, TX, USA
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Nicola M, Correia H, Ditchburn G, Drummond PD. Defining pain-validation: The importance of validation in reducing the stresses of chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:884335. [PMID: 36313220 PMCID: PMC9614309 DOI: 10.3389/fpain.2022.884335] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
Purpose To validate an individual's feelings or behaviour is to sanction their thoughts or actions as worthy of social acceptance and support. In contrast, rejection of the individual's communicated experience indicates a denial of social acceptance, representing a potential survival threat. Pain-invalidation, though ill-defined, appears to be a fundamental component of psychosocial stress for people with chronic pain. As such, the aim of this paper was to define pain-validation and outline its importance for those with chronic pain. Methods The pain-validation construct was defined using themes inherent in the narratives of those with chronic pain, as identified in a previously published systematic search and thematic analysis, together with examination of additional literature on pain-validation in the clinical context. Results We present a construct definition, proposing that pain-validation must necessarily include: (i) belief that the pain experience is true for the individual, (ii) acceptability of the individual's expressions of pain, and (iii) communication of belief and acceptability to the individual experiencing pain. Further, we outline the importance of pain-validation as a protective factor and means of reducing many of the psychosocial stresses of chronic pain; for example, by indicating social support for pain-coping, buffering negative emotions, and re-enforcing unity and shared identity. Implications The role of pain-validation in the current era of pain management intervention is discussed. Adhering to interventions that involve cognitive and behavioural change is often difficult. Acknowledging and validating the acceptability of the patient's pain experience in the early stages of pain management may, therefore, be a key component of intervention that encourages compliance to the treatment plan and achieving therapeutic goals.
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Lam PH, Chen E, Chiang JJ, Miller GE. Socioeconomic disadvantage, chronic stress, and proinflammatory phenotype: an integrative data analysis across the lifecourse. PNAS NEXUS 2022; 1:pgac219. [PMID: 36329724 PMCID: PMC9615129 DOI: 10.1093/pnasnexus/pgac219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
Socioeconomic disadvantage confers risk for many chronic illnesses, and theories have highlighted chronic psychological stress and alterations to inflammatory processes as key pathways. Specifically, disadvantage can heighten chronic stress, which may promote a proinflammatory phenotype characterized by immune cells mounting exaggerated cytokine responses to challenge and being less sensitive to inhibitory signals. Importantly, lifecourse perspectives emphasize that such immune alterations should be more potent earlier in life during a sensitive period when bodily tissues are highly plastic to environmental inputs. However, examining these propositions is resource intensive, as they require cell-culturing approaches to model functional inflammatory activities, a wide age range, and longitudinal data. Here, we integrated data from five independent studies to create a diverse sample of 1,607 individuals (960 with longitudinal data; 8 to 64 years old; 359 Asian, 205 Black, and 151 Latino/a). Leveraging the resulting lifecourse data, rich interview assessments of disadvantage and stress, and ex vivo assessments of inflammation, we examined two questions: (1) Does chronic stress account for the link between disadvantage and proinflammatory phenotype? (2) Is there a developmental period during which inflammatory responses are more sensitive to disadvantage and chronic stress? Disadvantage was associated with higher chronic stress, which was linked with a proinflammatory phenotype cross-sectionally, longitudinally, and in terms of prospective change across 1.5 to 2 years. Consistent with the sensitive period hypothesis, the magnitude of these indirect associations was strongest in earlier decades and declined across the lifecourse. These findings highlight the importance of taking a lifecourse perspective in examining health disparities.
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Affiliation(s)
- Phoebe H Lam
- Department of Psychology, Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston, IL 60208, USA
| | - Edith Chen
- Department of Psychology, Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston, IL 60208, USA
- Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL 60208, USA
| | - Jessica J Chiang
- Department of Psychology, Georgetown University, 306 N White-Gravenor Hall, 37th and O Streets, NW, Washington DC, 20057, USA
| | - Gregory E Miller
- Department of Psychology, Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston, IL 60208, USA
- Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL 60208, USA
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Polsky LR, Rentscher KE, Carroll JE. Stress-induced biological aging: A review and guide for research priorities. Brain Behav Immun 2022; 104:97-109. [PMID: 35661679 PMCID: PMC10243290 DOI: 10.1016/j.bbi.2022.05.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/27/2022] [Accepted: 05/29/2022] [Indexed: 01/13/2023] Open
Abstract
Exposure to chronic adverse conditions, and the resultant activation of the neurobiological response cascade, has been associated with an increased risk of early onset of age-related disease and, recently, with an older biological age. This body of research has led to the hypothesis that exposure to stressful life experiences, when occurring repeatedly or over a prolonged period, may accelerate the rate at which the body ages. The mechanisms through which chronic psychosocial stress influences distinct biological aging pathways to alter rates of aging likely involve multiple layers in the physiological-molecular network. In this review, we integrate research using animal, human, and in vitro models to begin to delineate the distinct pathways through which chronic psychosocial stress may impact biological aging, as well as the neuroendocrine mediators (i.e., norepinephrine, epinephrine, and glucocorticoids) that may drive these effects. Findings highlight key connections between stress and aging, namely cellular metabolic activity, DNA damage, telomere length, cellular senescence, and inflammatory response patterns. We conclude with a guiding framework and conceptual model that outlines the most promising biological pathways by which chronic adverse conditions could accelerate aging and point to key missing gaps in knowledge where future research could best answer these pressing questions.
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Affiliation(s)
- Lilian R Polsky
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, United States
| | - Kelly E Rentscher
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, United States; Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, United States.
| | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, United States
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A randomized, placebo-controlled, double-blind trial of canakinumab in children and young adults with sickle cell anemia. Blood 2022; 139:2642-2652. [PMID: 35226723 DOI: 10.1182/blood.2021013674] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/07/2022] [Indexed: 11/20/2022] Open
Abstract
Excessive intravascular release of lysed cellular contents from damaged red blood cells (RBCs) in patients with sickle cell anemia (SCA) can activate the inflammasome, a multiprotein oligomer promoting maturation and secretion of pro-inflammatory cytokines, including interleukin 1-beta (IL-1b). We hypothesized that IL-1b blockade by canakinumab in patients with SCA would reduce markers of inflammation and clinical disease activity. In this randomized, double-blind, multi-center phase 2a study, patients aged 8-20 years old with SCA (HbSS or HbSb0thalassemia), history of acute pain episodes and elevated hsCRP >1.0 mg/L at screening were randomized 1:1 to received 6 monthly treatments with 300 mg s.c. canakinumab or placebo. Measured outcomes at baseline and weeks 4, 8, 12, 16, 20 and 24 included electronic patient-reported outcomes, hospitalization rate and adverse events (AEs) and serious AEs (SAEs). All but one of the 49 enrolled patients were receiving stable background hydroxyurea therapy. Although the primary objective (pre-specified reduction of pain) was not met, compared to placebo-arm patients, canakinumab-treated patients had reductions in markers of inflammation, occurrence of SCA-related AE and SAE, and number and duration of hospitalizations, as well as trends for improvement in pain intensity, fatigue and absences from school or work. Post-hoc analysis revealed treatment effects on weight, restricted to pediatric patients. Canakinumab was well tolerated with no treatment-related SAEs and no new safety signal. These findings demonstrate that the inflammation associated with SCA can be reduced by selective IL-1b blockade by canakinumab with potential for therapeutic benefits. This trial was registered at www.clinicaltrials.gov as NCT02961218.
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Reed RG, Mauss IB, Ram N, Segerstrom SC. Daily Stressors, Emotion Dynamics, and Inflammation in the MIDUS Cohort. Int J Behav Med 2021; 29:494-505. [PMID: 34661859 PMCID: PMC9013725 DOI: 10.1007/s12529-021-10035-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The current study (1) examined links between daily stressors and inflammation and (2) tested whether negative emotion dynamics (emotional variability) is one pathway through which stressors are linked to inflammation. METHOD A cross-sectional sample of 986 adults (aged 35-86 years, 57% female) from MIDUS reported daily stressor frequency and severity and negative emotions on 8 consecutive nights. Negative emotion variability (intraindividual standard deviation), controlling for overall mean level (intraindividual mean), was the focus of the current study. Interleukin-6 (IL-6) and C-reactive protein (CRP) were assayed from blood drawn at a clinic visit. Regression models adjusted for demographics, health factors, and the time between assessments. RESULTS More severe daily stressors were associated with higher CRP, but this effect was accounted for by covariates. More frequent daily stressors were associated with lower IL-6 and CRP. In follow-up analyses, significant interactions between stressor severity and frequency suggested that participants with lower stressor severity and higher stressor frequency had the lowest levels of IL-6 and CRP, whereas those with higher stressor severity had the highest levels of IL-6 and CRP, regardless of frequency. Daily stressor frequency and severity were positively associated with negative emotion variability, but variability was not linearly associated with inflammation and did not operate as a mediator. CONCLUSION Among midlife and older adults, daily stressor frequency and severity may interact and synergistically associate with inflammatory markers, potentially due to these adults being advantaged in other ways related to lower inflammation, or in a pattern aligning with hormetic stress, where frequent but manageable stressors may yield physiological benefits, or both. Negative emotion variability does not operate as a mediator. Additional work is needed to reliably measure and test other emotion dynamic metrics that may contribute to inflammation.
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Affiliation(s)
- Rebecca G Reed
- Department of Psychology, University of Pittsburgh, 210 S. Bouquet St., Pittsburgh, PA, 15260, USA.
| | - Iris B Mauss
- Department of Psychology, University of California, Berkeley, USA
| | - Nilam Ram
- Departments of Communication and Psychology, Stanford University, Stanford, USA
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Grekhov RA, Suleimanova GP, Trofimenko AS, Shilova LN. Psychosomatic Features, Compliance and Complementary Therapies in Rheumatoid Arthritis. Curr Rheumatol Rev 2021; 16:215-223. [PMID: 31830886 DOI: 10.2174/1573397115666191212114758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022]
Abstract
This review highlights the issue of psychosomatic conditions in rheumatoid arthritis, paying special attention to new researches and trends in this field. Emerging concepts in all the major parts of the problem are covered consecutively, from the impact of chronic musculoskeletal pain on the emotional state to disease influence over quality of life, socio-psychological, and interpersonal relationships. Chronic pain is closely related to emotional responses and coping ability, with a pronounced positive effect of psychotherapeutic interventions, family and social support on it. Psychosexual disorders, anxiety, depression also commonly coexist with rheumatoid arthritis, leading to further decrease in quality of life, low compliance, and high suicide risk. Influence of psychosomatic conditions on the overall treatment effect is usually underestimated by rheumatologists and general practitioners. Psychosomatic considerations are of great importance for up-to-date management of rheumatoid arthritis, as they strongly influence the quality of life, compliance, and thereby disease outcomes. Two major approaches of psychological rehabilitation exist, both coping with pain through the regulation of emotion and psychotherapeutic intervention, which not only helps patients in coping with the disease, but also aimed at improving the overall adaptation of the patient. It includes techniques of relaxation, cognitive-behavioral therapy, and biofeedback therapy. Current data about the efficacy of the additional correcting therapies for patients with rheumatoid arthritis, both emerging and common ones, are discussed in the review.
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Affiliation(s)
- Rostislav A Grekhov
- Research Institute for Clinical and Experimental Rheumatology, Volgograd, Russian Federation
| | - Galina P Suleimanova
- Research Institute for Clinical and Experimental Rheumatology, Volgograd, Russian Federation
| | - Andrei S Trofimenko
- Research Institute for Clinical and Experimental Rheumatology, Volgograd, Russian Federation
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15
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Pedraz-Petrozzi B, Neumann E, Sammer G. Pro-inflammatory markers and fatigue in patients with depression: A case-control study. Sci Rep 2020; 10:9494. [PMID: 32528052 PMCID: PMC7289841 DOI: 10.1038/s41598-020-66532-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/20/2020] [Indexed: 11/20/2022] Open
Abstract
The aim of this work was to investigate differences between depressed subjects (PG) and non-depressed healthy control participants (HCG) with regard to fatigue dimensions and inflammation. For this purpose, 43 participants in the PG and 51 participants in the HCG were included in the study. IL-6, IL-1β, TNF-α, IFN-γ, and CRP were assessed in venous blood samples. Fatigue and depression were assessed using the FIS-D and BDI-FS questionnaires. Main results showed higher BDI-FS values in PG. Moreover, PG showed mean differences for fatigue dimensions when compared to the HCG. For the pro-inflammatory markers, a moderate group effect was found between PG and HCG which was mainly caused by IL-6. Correlations between TNF-α and BDI-FS, TNF-α and cognitive fatigue, TNF-α and psychosocial fatigue were found within the PG. In the HCG, correlations were found between IL-6, TNF-α and somatic fatigue, as well as IL-6 and cognitive fatigue. Significant correlations were found between the psychological variables in both groups. All results were controlled for the confounding variables gender, age, BMI and multiple comparisons. These results suggest the presence of inflammation in both depression and fatigue. However, each correlates with different pro-inflammatory parameters, suggesting a biological heterogeneity.
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Affiliation(s)
- Bruno Pedraz-Petrozzi
- Cognitive Neurosciences at the Center for Psychiatry and Psychotherapy, Justus-Liebig University, Giessen, Hessen, Germany.
| | - Elena Neumann
- Internal Medicine and Rheumatology, Campus Kerckhoff, Justus-Liebig University, Bad Nauheim, Hessen, Germany
| | - Gebhard Sammer
- Cognitive Neurosciences at the Center for Psychiatry and Psychotherapy, Justus-Liebig University, Giessen, Hessen, Germany
- Faculty of Psychology and Sports Science, Justus-Liebig University, Giessen, Hessen, Germany
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Rodríguez-Muguruza S, Combe B, Guillemin F, Fautrel B, Olive A, Marsal S, Valero O, Rincheval N, Lukas C. Predictors of fatigue and persistent fatigue in early rheumatoid arthritis: a longitudinal observational study, data from the ESPOIR cohort. Scand J Rheumatol 2020; 49:259-266. [DOI: 10.1080/03009742.2020.1726449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- S Rodríguez-Muguruza
- Department of Rheumatology, Joan XXIII University Hospital, Tarragona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - B Combe
- Department of Rheumatology, CHU Montpellier, Montpellier University, Montpellier, France
| | - F Guillemin
- APEMAC Research Unit (EA 4360), Faculty of Medicine, University of Lorraine, Nancy, France
- Department of Clinical Epidemiology INSERM CIC 1433, Nancy University Hospital, Nancy, France
| | - B Fautrel
- Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - A Olive
- Department of Rheumatology, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - S Marsal
- Department of Rheumatology, Vall d’Hebrón University Hospital, Barcelona, Spain
| | - O Valero
- Department of Statistics, Autonomous University of Barcelona, Barcelona, Spain
| | - N Rincheval
- Laboratory of Biostatistics and Epidemiology, University of Montpellier, Montpellier, France
| | - C Lukas
- Department of Rheumatology, CHU Montpellier, Montpellier University, Montpellier, France
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Pratap UP, Hima L, Kannan T, Thyagarajan C, Priyanka HP, Vasantharekha R, Pushparani A, Thyagarajan S. Sex-Based Differences in the Cytokine Production and Intracellular Signaling Pathways in Patients With Rheumatoid Arthritis. Arch Rheumatol 2020; 35:545-557. [PMID: 33758811 PMCID: PMC7945702 DOI: 10.46497/archrheumatol.2020.7481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives
This study aims to investigate lymphoproliferation, cytokine production, and intracellular signaling molecules in peripheral blood mononuclear cells (PBMCs) isolated from healthy individuals and rheumatoid arthritis (RA) patients to understand the extent of the involvement of these pathways in the pathogenesis of RA. Patients and methods
The study included 65 participants (29 males, 36 females; mean age 51.8±10.3 years; range, 37 to 71 years) who were categorized into four groups as healthy males (n=22, mean age 49.8±10.6 years; range, 39 to 65 years), male RA patients (n=7, mean age 51.8±13.9 years; range, 37 to 68 years), healthy females (n=20, mean age 53.7±8.8 years; range, 42 to 67 years), and female RA patients (n=16, mean age 52.9±10.4 years; range, 40 to 71 years). PBMCs were collected from the participants and analyzed for Concanavalin A (Con A)-induced lymphoproliferation using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, cytokine production, and phospho-signal transducer and activator of transcription 3 (p-STAT-3), phospho-extracellular-signal-regulated kinase (p-ERK), phospho-cAMP response element binding (p-CREB), and phospho-protein kinase B expressions using enzyme-linked immunosorbent assay. Short form of the Arthritis Impact Measurement Scales 2 and multidimensional health assessment questionnaire were used to measure the level of disability and the quality of life. Results
In RA patients, production of Con A-induced interleukin (IL)-2 and IL-17 was higher in both sexes while interferon-gamma levels decreased in RA females alone. Expression of p-STAT-3 in PBMCs increased in RA males while it was unaltered in RA females. p-ERK expression was not altered while p-CREB expression was enhanced in RA males and females. Protein-protein interaction analyses demonstrated that these and other key signaling molecules were dysregulated in RA patients. Conclusion Our results suggest that sex-based differences in RA pathogenesis result from differential alterations in signaling pathways to influence the inflammatory process.
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Affiliation(s)
- Uday P Pratap
- Integrative Medicine Laboratory, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Lalgi Hima
- Integrative Medicine Laboratory, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Thangamani Kannan
- Integrative Medicine Laboratory, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Chadrasekaran Thyagarajan
- Integrative Medicine Laboratory, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Hannah P Priyanka
- Integrative Medicine Laboratory, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Ramasamy Vasantharekha
- Integrative Medicine Laboratory, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Anand Pushparani
- Department of Anesthesiology, SRM Medical College and Research Center, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Srinivasan Thyagarajan
- Integrative Medicine Laboratory, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
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Abstract
In 1973, IL-6 was identified as a soluble factor that is secreted by T cells and is important for antibody production by B cells. Since its discovery more than 40 years ago, the IL-6 pathway has emerged as a pivotal pathway involved in immune regulation in health and dysregulation in many diseases. Targeting of the IL-6 pathway has led to innovative therapeutic approaches for various rheumatic diseases, such as rheumatoid arthritis, juvenile idiopathic arthritis, adult-onset Still’s disease, giant cell arteritis and Takayasu arteritis, as well as other conditions such as Castleman disease and cytokine release syndrome. Targeting this pathway has also identified avenues for potential expansion into several other indications, such as uveitis, neuromyelitis optica and, most recently, COVID-19 pneumonia. To mark the tenth anniversary of anti-IL-6 receptor therapy worldwide, we discuss the history of research into IL-6 biology and the development of therapies that target IL-6 signalling, including the successes and challenges and with an emphasis on rheumatic diseases. In this Perspective article, the authors recount the earliest stages of translational research into IL-6 biology and the subsequent development of therapeutic IL-6 pathway inhibitors for the treatment of autoimmune rheumatic diseases and potentially numerous other indications.
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Salomon RE, Tan KR, Vaughan A, Adynski H, Muscatell KA. Minimally-invasive methods for examining biological changes in response to chronic stress: A scoping review. Int J Nurs Stud 2020; 103:103419. [PMID: 31945603 DOI: 10.1016/j.ijnurstu.2019.103419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nurse researchers are increasingly interested in incorporating biological indicators related to chronic stress, or repeated or constant exposure to psychological stressors. Minimally invasive collection methods may improve access to vulnerable populations. OBJECTIVE To map biological indicators measured through minimally invasive methods investigating biological changes in response to chronic stress. DESIGN, DATA SOURCES, AND METHODS The paper seeks to answer two questions: What are the characteristics of the minimally-invasive methods used to measure the biological correlates of chronic stress? What are the limitations regarding the use of the minimally-invasive methods and/or biological indicators identified above? Authors completed a scoping review following guidelines from the Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. A literature search was completed in PubMed, PsycINFO, and Scopus. 2518 articles were screened and 145 studies were included. Data were extracted using a standardized extraction tool, compiled, and coded. RESULTS Studies included minimally-invasive methods to measure the hypothalamic-adrenal-pituitary axis (N = 173), immune and inflammatory markers (N = 118), and adult neurogenesis (N = 6). Cortisol was most frequently measured (N = 136), usually in saliva (N = 86). Studies included a variety of limitations for the methods and indicators, including concerns about timing and accuracy of collection, frequency of sampling, and controlling for acute stressors. CONCLUSIONS Nurse researchers have access to many minimally-invasive methods to measure altered biological processes related to chronic stress. A gap identified by this review is the paucity of minimally-invasive methods for investigating neurogenesis; the measurement of brain derived neurotrophic factor in plasma is a distal proxy and further research is needed to test the response of peripheral levels to psychosocial stress interventions. Additionally, while this scoping review allows nurse researchers to consider possible biological indicators to include in their research, future research is still needed on some of the basic premises of stress research, including agreement on the conceptualization of chronic stress.
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Affiliation(s)
- Rebecca E Salomon
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Kelly R Tan
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Ashley Vaughan
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Harry Adynski
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Keely A Muscatell
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Campus Box #3270, 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Campus Box #7295, 450 West Drive, Chapel Hill, NC 27599-7295, USA.
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Impacts of Fatigue, Stress, and Perceived Health Status on Women With Rheumatic Diseases: A Comparison Study. J Nurs Res 2019; 28:e89. [PMID: 31688342 DOI: 10.1097/jnr.0000000000000354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Rheumatic conditions, which increase in prevalence as populations age, are a growing public health problem that disproportionately affects women. Understanding the influences of rheumatic diseases (RDs) on fatigue, stress, and perceived health status is deemed important to the improvement of physical and mental health for women with RDs. PURPOSE This study was designed to compare the fatigue, stress, and perceived physical and mental health status of women with RDs (RD group) with those of peers who did not have chronic illnesses (comparison group). METHODS A cross-sectional, purposive sample and comparative design was used. Four hundred forty-three women with a mean age of 46.2 years participated in this study. Those with physician-diagnosed RDs (n = 212) were enrolled in the RD group, and those without chronic disease were enrolled in the comparison group (n = 231). Measures used included a demographic datasheet, Fatigue Severity Scale, Perceived Stress Scale, and Short Form-12 Items Health Survey. Analysis of covariance was used to examine the intergroup differences for major variables based on demographic covariates. RESULTS The RD group reported significantly more fatigue and stress than the comparison group. Moreover, the RD group reported significantly poorer perceived physical health status, significantly poorer physical functioning and general health, and greater bodily pain compared with the comparison group. Conversely, the RD group reported significantly better perceived mental health status, significantly lower vitality, and better role emotional status than the comparison group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The findings support the theory that RDs have a negative impact on perceived stress and fatigue in women. Physical function, bodily pain, and general health may be the most significantly affected domains of perceived physical health in women with RDs. Of note, with the exception of the vitality subscale, RDs did not adversely affect the perceived mental health of participants with RD in this study. Healthcare professionals should cooperate with clinical rheumatologists, psychologists, and physiotherapists to provide comprehensive care that includes long-term education to help patients with RD self-manage stress, restore vitality, relieve pain, and increase physical function.
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Next-Generation Sequencing Profiles of the Methylome and Transcriptome in Peripheral Blood Mononuclear Cells of Rheumatoid Arthritis. J Clin Med 2019; 8:jcm8091284. [PMID: 31443559 PMCID: PMC6780767 DOI: 10.3390/jcm8091284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
Using next-generation sequencing to decipher methylome and transcriptome and underlying molecular mechanisms contributing to rheumatoid arthritis (RA) for improving future therapies, we performed methyl-seq and RNA-seq on peripheral blood mononuclear cells (PBMCs) from RA subjects and normal donors. Principal component analysis and hierarchical clustering revealed distinct methylation signatures in RA with methylation aberrations noted across chromosomes. Methylation alterations varied with CpG features and genic characteristics. Typically, CpG islands and CpG shores were hypermethylated and displayed the greatest methylation variance. Promoters were hypermethylated and enhancers/gene bodies were hypomethylated, with methylation variance associated with expression variance. RA genetically associated genes preferentially displayed differential methylation and differential expression or interacted with differentially methylated and differentially expressed genes. These differentially methylated and differentially expressed genes were enriched with several signaling pathways and disease categories. 10 genes (CD86, RAB20, XAF1, FOLR3, LTBR, KCNH8, DOK7, PDGFA, PITPNM2, CELSR1) with concomitantly differential methylation in enhancers/promoters/gene bodies and differential expression in B cells were validated. This integrated analysis of methylome and transcriptome identified novel epigenetic signatures associated with RA and highlighted the interaction between genetics and epigenetics in RA. These findings help our understanding of the pathogenesis of RA and advance epigenetic studies in regards to the disease.
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Corominas H, Alegre C, Narváez J, Fernández-Cid CM, Torrente-Segarra V, Gómez MR, Pan FM, Morlà RM, Martínez FJR, Gómez-Centeno A, Ares LL, Molina RG, González-Albo SP, Dalmau-Carolà J, Pérez-García C, Álvarez CB, Ercole L, Terrancle MÁ. Correlation of fatigue with other disease related and psychosocial factors in patients with rheumatoid arthritis treated with tocilizumab: ACT-AXIS study. Medicine (Baltimore) 2019; 98:e15947. [PMID: 31261500 PMCID: PMC6617279 DOI: 10.1097/md.0000000000015947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To assess the hypothesis if tocilizumab (TCZ) is effective on disease activity, and also its effect in fatigue and other clinical and psychological disease-related factors in patients with rheumatoid arthritis (RA) treated with TCZ.A 24-week, multicenter, prospective, observational study in patients with moderate to severe RA receiving TCZ after failure or intolerance to disease-modifying antirheumatic drugs or tumor necrosis factor-alpha was conducted.Of the 122 patients included, 85 were evaluable for effectiveness (85% female, 51.9 ± 12.5 years, disease duration 8.7 ± 7.4 years). Mean change in C-reactive protein level from baseline to week 12 was -11.2 ± 4.0 (P < .001). Mean Disease Activity Index score (DAS28) decreased from 5.5 ± 1.0 at baseline to 2.7 ± 1.3 (P < .001) at week 24. Mean change in Functional Assessment of Chronic Illness Therapy score was -5.4 ± 11.2 points at week 24. Multiple regression analysis showed that the improvement in DAS28, sleep, and depression explained 56% and 47% of fatigue variance at week 12 and 24, respectively.Tocilizumab is effective in reducing disease activity and results in a clinically significant improvement in fatigue, pain, swollen joint count, morning stiffness, sleepiness, depression, and DAS28; the last 3 were specifically identified as factors explaining fatigue variance with the use of TCZ in RA patients.
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Affiliation(s)
| | | | - Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona
| | | | | | | | | | - Rosa María Morlà
- Department of Rheumatology, Xarxa Sanitaria i Social de Santa Tecla, Tarragona
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Davis MC, Lemery-Chalfant K, Yeung EW, Luecken LJ, Zautra AJ, Irwin MR. Interleukin-6 and Depressive Mood Symptoms: Mediators of the Association Between Childhood Abuse and Cognitive Performance in Middle-Aged Adults. Ann Behav Med 2019; 53:29-38. [PMID: 29562248 PMCID: PMC6301312 DOI: 10.1093/abm/kay014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Childhood abuse is a risk factor for the development of cognitive deficits in adulthood, a relation that is likely mediated by stress-sensitive psychological and physiological indicators. Purpose To evaluate whether the link between exposure to childhood abuse and cognitive function in middle adulthood is mediated by interleukin-6 (IL-6), metabolic risk, and depressive mood symptoms. Methods Participants were 770 adults aged 40-65 recruited from the community, who completed the following: (i) a questionnaire assessing exposure to abuse prior to age 18, (ii) a phone interview assessing current depressive mood symptoms, and (iii) a home visit that included blood sampling for evaluation of IL-6 and assessment of metabolic risk indices. A follow-up telephone assessment evaluating cognitive function was completed by 555 of the participants. Structural equation modeling was used to test study hypotheses. Results Childhood abuse predicted higher levels of IL-6, depressive mood symptoms, and metabolic risk scores (p < .05). The relation between childhood abuse and poorer cognitive performance was mediated by IL-6 (p = .046) and depressive mood symptoms (p = .023), but not metabolic risk. IL-6 and depressive mood symptoms significantly mediated the relation between childhood abuse and adult cognitive function. Conclusions Exposure to early abuse conveys enduring physiological and psychological effects, which may contribute to cognitive deficits that are evident by middle adulthood. Increased vulnerability for cognitive decline among adults with a history of early trauma and the mediating roles of IL-6 and depressive mood symptoms point to the potential value of interventions that address inflammation or depression, singly or together, to prevent cognitive decline in this at-risk population.
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Affiliation(s)
- Mary C Davis
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | | | | | - Linda J Luecken
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Alex J Zautra
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Sharpley CF, Bitsika V, McMillan ME, Jesulola E, Agnew LL. The association between cortisol:C-reactive protein ratio and depressive fatigue is a function of CRP rather than cortisol. Neuropsychiatr Dis Treat 2019; 15:2467-2475. [PMID: 31695383 PMCID: PMC6717724 DOI: 10.2147/ndt.s213839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Hormonal and inflammatory factors have been suggested as potentially influencing depressive state and depressive symptoms, but rarely compared for their relative contribution to these states and to specific depressive symptoms. This study examined cortisol:C-reactive protein (CRP) ratio, plus cortisol and CRP separately, as correlates of global depression and fatigue-related depression. PATIENTS AND METHODS One hundred and twenty-six community volunteers from rural Australia provided saliva and serum samples, and also completed a depression inventory. RESULTS There was a significant correlation between cortisol:CRP ratio and depression-related fatigue, and this resolved to the effects of CRP rather than cortisol. Most of the variance in this association came from patients who were "depressed", and there were no significant gender associations. CONCLUSION Inflammation, rather than HPA-axis activity, was associated with depression-related fatigue, supporting a model that places inflammation as a contributor to one of the major symptoms and predictors of depression. Individualization of therapy for depression-related fatigue in chronically stressed or physically ill patients might benefit from future research into cytokine therapy.
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Affiliation(s)
- Christopher F Sharpley
- Brain-Behaviour Research Group, University of New England, Armidale, NSW 2351, Australia
| | - Vicki Bitsika
- Brain-Behaviour Research Group, University of New England, Armidale, NSW 2351, Australia
| | - Mary E McMillan
- Brain-Behaviour Research Group, University of New England, Armidale, NSW 2351, Australia
| | - Emmanuel Jesulola
- Emergency Department, Bathurst Base Hospital, Bathurst, NSW 2795, Australia
| | - Linda L Agnew
- Brain-Behaviour Research Group, University of New England, Armidale, NSW 2351, Australia
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Wilbur RE, Griffin JS, Sorensen M, Furberg RD. Establishing Digital Biomarkers for Occupational Health Assessment in Commercial Salmon Fishermen: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2018; 7:e10215. [PMID: 30530453 PMCID: PMC6305878 DOI: 10.2196/10215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 12/04/2022] Open
Abstract
Background Commercial salmon fishing in Alaska is one of the most dangerous occupations in the United States. Between 1992 and 2008, the average annual industry mortality rate was 128 deaths per 100,000 workers, and despite an increase in industry regulations, there has not been a significant decrease in mortality rate since 2000. Unpredictable fishing openings and fierce competition for limited resources result in periods of intense sleep deprivation and physical strain during the short commercial salmon season in Alaska. Objective We hypothesize that the combined effect of sleep deprivation, intense physical workload, and significant short-term chronic stress may be deleterious to health in both the short- and long-term among commercial salmon drift gillnet fishermen in Alaska. The objective of this protocol is to determine the feasibility of the study design to test this hypothesis. Methods The study design uses mixed methods and includes biometric monitoring consisting of heart rate variability, respiration, and movement data collected via a personal, wearable biometric device. Additional methods include observational data on activity, including duration and quality of sleep, weather, catch, and financial gain, as well as the collection of salivary cortisol. As such, the study will provide a holistic assessment of individual stress on multiple simultaneous timescales: immediately and continuously through the personal wearable biometric device, on the minute-hour level through the multiple daily collections of salivary cortisol, and by the hour-day through the use of participant and environment observational data. Results Data collection was initiated in July 2017 and will extend through August 2019. Initial data collection has indicated that the methods outlined in this protocol are feasible and allow for effective collection of qualitative and quantitative data related to the psychological and physiological impact of Alaska commercial salmon fishing. Conclusions We anticipate that the use of a biometric device will be crucial in establishing measures of stress and physical activity within a population and environment uniquely challenged by physical isolation, strong weather patterns, and the potential for significant financial gain by fishermen. The potential exists for individuals engaged long-term in the fishing industry, through repeated and extended exposure to periods of intense sleep deprivation and chronic stress, to be at increased risk of cardiovascular disease. International Registered Report Identifier (IRRID) DERR1-10.2196/10215
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Affiliation(s)
| | - Jacob Spencer Griffin
- Department of Anthropology, University of North Carolina, Chapel Hill, NC, United States
| | - Mark Sorensen
- Department of Anthropology, University of North Carolina, Chapel Hill, NC, United States
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Proudfoot K, Weary D, LeBlanc S, Mamedova L, von Keyserlingk M. Exposure to an unpredictable and competitive social environment affects behavior and health of transition dairy cows. J Dairy Sci 2018; 101:9309-9320. [DOI: 10.3168/jds.2017-14115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/11/2018] [Indexed: 12/17/2022]
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Graham-Engeland JE, Song S, Mathur A, Wagstaff DA, Klein LC, Whetzel C, Ayoub WT. Emotional State Can Affect Inflammatory Responses to Pain Among Rheumatoid Arthritis Patients: Preliminary Findings. Psychol Rep 2018; 122:2026-2049. [PMID: 30189801 DOI: 10.1177/0033294118796655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In a novel pilot study, we investigated how emotional state is related to inflammatory responses to acute pain among women with rheumatoid arthritis. Nine women completed four 5-hour visits that varied only by manipulation of emotion (anger, sadness, happiness, vs. control); in each visit, acute pain was elicited, with blood draws at baseline, 10 minutes, 60 minutes, and 100 minutes post-pain. We examined the effects of within-subjects factors on circulating inflammatory biomarkers interleukin (IL)-6, IL-10, tumor necrosis factor-α, C-reactive protein, and cortisol. There was a main effect of state anger on IL-6, with higher reported anger associated with higher IL-6 across conditions. Further, there were several interactions between state emotion and condition. For example, when individuals reported higher state anger in the sadness condition compared to their own average, they showed higher levels of IL-6 and cortisol. Findings are discussed within a larger literature suggesting that mixed emotional states can contribute to psychological stress and inflammatory responses.
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Affiliation(s)
| | - Sunmi Song
- Health Risk Prevention Team, Korea Health Promotion Institute, Seoul, Republic of Korea
| | - Ambika Mathur
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - David A Wagstaff
- Health and Human Development Consulting Group, The Pennsylvania State University, University Park, PA, USA
| | - Laura Cousino Klein
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Courtney Whetzel
- Office for Research Protections, The Pennsylvania State University, University Park, PA, USA
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Social aggravation: Understanding the complex role of social relationships on stress and health-relevant physiology. Int J Psychophysiol 2018; 131:13-23. [DOI: 10.1016/j.ijpsycho.2018.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022]
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Chetina EV, Markova GA. [Upcoming value of gene expression analysis in rheumatology]. BIOMEDIT︠S︡INSKAI︠A︡ KHIMII︠A︡ 2018; 64:221-232. [PMID: 29964257 DOI: 10.18097/pbmc20186403221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology, which involves disturbance in immune system signaling pathway functions, damage of other tissues, pain and joint destruction. Modern treatment attempts to improve pathophysiological and biochemical mechanisms damaged by the disease. However, due to the RA patient heterogeneity personalized approach to treatment is required; the choice of personalized treatment is complicated by the variability of patient's response to treatment. Gene expression analysis might serve a tool for the disease control and therapy personification for inhibition of inflammation and pain as well as for prevention of joint destruction.
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Affiliation(s)
- E V Chetina
- Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - G A Markova
- Nasonova Research Institute of Rheumatology, Moscow, Russia
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Fenton SAM, Veldhuijzen van Zanten JJCS, Duda JL, Metsios GS, Kitas GD. Sedentary behaviour in rheumatoid arthritis: definition, measurement and implications for health. Rheumatology (Oxford) 2018; 57:213-226. [PMID: 28398519 DOI: 10.1093/rheumatology/kex053] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Indexed: 01/14/2023] Open
Abstract
RA is a chronic autoimmune disease characterized by high grade-inflammation, and associated with elevated cardiovascular risk, rheumatoid-cachexia and functional impairment. Sedentary behaviour (SB) is linked to heightened inflammation, and is highly pervasive in RA, likely as a result of compromised physical function and persistent fatigue. This high sedentarity may exacerbate the inflammatory process in RA, and hold relevance for disease-related outcomes. The aim of this narrative review is to provide an overview of the definition, measurement and health relevance of SB in the context of RA. Contradictions are highlighted with regard to the manner in which SB is operationalized, and the significance of SB for disease outcomes in RA is outlined. The advantages and disadvantages of SB measurement approaches are also discussed. Against this background, we summarize studies that have reported SB and its health correlates in RA, and propose directions for future research.
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Affiliation(s)
- Sally A M Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Jet J C S Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - George S Metsios
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - George D Kitas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
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Boer AC, Ten Brinck RM, Evers AWM, van der Helm-van Mil AHM. Does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis? Arthritis Res Ther 2018; 20:93. [PMID: 29724244 PMCID: PMC5934795 DOI: 10.1186/s13075-018-1587-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/03/2018] [Indexed: 01/24/2023] Open
Abstract
Background Within established rheumatoid arthritis (RA), stress can have pro-inflammatory effects by activating the immune system via the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. It is unknown if stress levels also promote inflammation during RA development. We studied whether the psychological stress response was increased in clinically suspect arthralgia (CSA) and if this associated with inflammation at presentation with arthralgia and with progression to clinical arthritis. Methods In 241 CSA patients, psychological stress was measured by the Mental Health Inventory (MHI-5) and the Perceived Stress Scale (PSS-10) at first presentation and during follow-up. Systemic inflammation was measured by C-reactive protein (CRP) and joint inflammation by 1.5 T-MRI of wrist, MCP, and MTP joints. Results At baseline, 12% (24/197) of CSA patients had a high psychological stress response according to the MHI-5. This was not different for patients presenting with or without an elevated CRP, with or without subclinical MRI-detected inflammation and for patients who did or did not develop arthritis. Similar findings were obtained with the PSS-10. When developing clinical arthritis, the percentage of patients with ‘high psychological stress’ increased to 31% (p = 0.025); during the first year of treatment this decreased to 8% (p = 0.020). ‘High psychological stress’ in non-progressors remained infrequent over time (range 7–13%). Stress was associated with fatigue (p = 0.003) and wellbeing (p < 0.001). Conclusions Psychological stress was not increased in the phase of arthralgia, raised at the time of diagnoses and decreased thereafter. The lack of an association with inflammation in arthralgia and this temporal relationship, argue against psychological stress having a significant contribution to progression from CSA to inflammatory arthritis. Electronic supplementary material The online version of this article (10.1186/s13075-018-1587-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aleid C Boer
- Department of Rheumatology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Robin M Ten Brinck
- Department of Rheumatology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Andrea W M Evers
- Department of Health, Medical and Neuropsychology, Faculty of Social and Behavioural Science, Leiden University and Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Rheumatology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Matura LA, Malone S, Jaime-Lara R, Riegel B. A Systematic Review of Biological Mechanisms of Fatigue in Chronic Illness. Biol Res Nurs 2018. [PMID: 29540066 DOI: 10.1177/1099800418764326] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fatigue, a commonly reported symptom, is defined as an overwhelming, debilitating, and sustained sense of exhaustion that decreases the ability to function and carry out daily activities. To date, cancer researchers have been in the forefront in investigating the possible biological mechanisms of fatigue, identifying inflammation, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, and activation of the autonomic nervous system. The purpose of this systematic review is to describe fatigue and what is known about the biological mechanisms described in cancer in five chronic, noninfectious illnesses: heart failure, multiple sclerosis, chronic kidney disease, rheumatoid arthritis, and chronic obstructive pulmonary disease. We searched PubMed and EMBASE using fatigue as a major Medical subject headings (MeSH) heading with each individual disease added as a search term followed by each biological mechanism. We included only primary research articles published in English between 1996 and 2016 describing studies conducted in adult humans. We identified 26 relevant articles. While there is some evidence that the biological mechanisms causing fatigue in cancer are also associated with fatigue in other chronic illnesses, more research is needed to explore inflammation, the HPA axis, and the autonomic nervous system, and other mechanisms in relation to fatigue in a variety of chronic illnesses.
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Affiliation(s)
- Lea Ann Matura
- 1 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Malone
- 1 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Barbara Riegel
- 1 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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The working alliance and Clinician-assisted Emotional Disclosure for rheumatoid arthritis. J Psychosom Res 2018; 104:9-15. [PMID: 29275791 DOI: 10.1016/j.jpsychores.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/03/2017] [Accepted: 11/05/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The working alliance predicts improvement following general psychotherapy, but how it operates in brief interventions conducted with medically ill patients is unknown. Also, the role of the working alliance may differ in emotion-focused versus educational interventions. METHODS We report secondary analyses of a randomized clinical trial (Keefe et al.) [35], in which patients with rheumatoid arthritis (RA) received four nurse-provided sessions of either a) Clinician-assisted Emotional Disclosure (CAED), which emphasized the disclosure, expression, and processing of emotions related to stressful events; or b) Arthritis Education (AE), which provided basic education about RA. The Working Alliance Inventory was completed by both patient and nurse after each session. Patients were evaluated on multiple health measures at baseline and 1, 3, and 12months post-treatment. RESULTS Analyses compared the alliance between interventions and related the alliance to outcomes within interventions. Patients in CAED reported a lower alliance than patients in AE. Interestingly, in CAED, lower alliance ratings predicted better outcomes (improved functioning, lower pain behaviors, lower inflammation, lower daily stress), whereas in AE, the working alliance was largely not predictive of outcomes. CONCLUSION Having nurses encourage emotional disclosure among patients with RA reduced the patients' working alliance, but a lower alliance nonetheless predicted better patient outcomes, perhaps reflecting successful engagement in an intervention that is emotionally and relationally challenging. The level and predictive validity of the working alliance likely depends on patient, provider, and intervention factors, and further study of the working alliance in psychosocial interventions in the medical context is needed.
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Halpern LR, Shealer ML, Cho R, McMichael EB, Rogers J, Ferguson-Young D, Mouton CP, Tabatabai M, Southerland J, Gangula P. Influence of Intimate Partner Violence (IPV) Exposure on Cardiovascular and Salivary Biosensors: Is There a Relationship? J Natl Med Assoc 2017; 109:252-261. [PMID: 29173932 DOI: 10.1016/j.jnma.2017.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/17/2017] [Accepted: 08/09/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND/PURPOSE Intimate partner violence (IPV) is a global public health epidemic that initiates/exacerbates health consequences affecting a victim's lifespan. IPV can significantly predispose women to a lifetime risk of developing cardiovascular disease (CVD) due to the effects of stress and inflammation. This study investigates the correlation among IPV exposure, in-vivo CVD events, and inflammatory biomarkers as predictor indices(s) for CVD in female dental patients. METHODS Of 37 women enrolled in this study, 19 were African-American (AA) and 18 non-African-American (non-AA) and their ages ranged from 19 to 63 years. IPV-exposure and stress-induced in-vivo CVD events such as Chest Pain (CP) and Heart palpitations were recorded from all enrolled subjects. Cardiovascular events were obtained through surveys by patient self-report. Saliva specimens were obtained from all women and were analyzed for CVD biomarkers using multiplex-ELISA. RESULTS The prevalence of IPV was 51% (19/37) and statistically equivalent for AA and non-AA. The results show differences in experience of 1) CP (p < 0.01) and 2) heart palpitations (p < 0.02) when IPV + participants are compared with IPV- AA and non-AA cohorts. Of 10 CVD biomarkers analyzed, significant correlations between IPV+ and IPV- subjects were observed for biomarkers that include Interleukin-1β/sCD40L; TNFα/sCD40L; Myoglobin/IL-1β; CRP/sCD40L; CRP/IL-6; CRP/TNFα; TNFα/siCAM; CRP/MMP9; TNF-α/Adiponectin (p < 0.01). DISCUSSION/IMPLICATIONS Analysis of in vivo CVD status showed that significant race/health disparities exist in IPV + cohorts, as well as increased expression of inflammatory mediators, specifically CRP, IL-1β, IL-6, MMP9. Women who have experienced IPV may be a target cohort for primary prevention of CVD. The use of salivary biomarkers and our protocol may provide a less invasive method to help increase identification of victims at risk for IPV and CVD and potentially decrease other health injuries associated with IPV exposure.
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Affiliation(s)
- Leslie R Halpern
- Department of Oral and Maxillofacial Surgery, University of Utah, School of Dentistry, 530S Wakara Way, Salt Lake City, UT 84108, USA.
| | - Malcolm L Shealer
- Meharry Medical College School of Dentistry, 1005 DB Todd Jr. Blvd, Nashville, TN 37208, USA
| | - Rian Cho
- Meharry Medical College School of Dentistry, 1005 DB Todd Jr. Blvd, Nashville, TN 37208, USA
| | - Elizabeth B McMichael
- Meharry Medical College School of Dentistry, 1005 DB Todd Jr. Blvd, Nashville, TN 37208, USA
| | - Joseph Rogers
- Meharry Medical College School of Dentistry, 1005 DB Todd Jr. Blvd, Nashville, TN 37208, USA
| | - Daphne Ferguson-Young
- Meharry Medical College School of Dentistry, General Practice Residency, 1005 DB Todd Jr. Blvd., Nashville, TN 37208, USA
| | - Charles P Mouton
- University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
| | - Mohammad Tabatabai
- School of Graduate Studies, Meharry Medical College, 1005 DB Todd Jr. Blvd., Nashville, TN 37208, USA
| | - Janet Southerland
- Department of Oral and Maxillofacial Surgery, Meharry Medical College School of Dentistry, 1005 DB Todd Jr. Blvd., Nashville, TN 37208, USA
| | - Pandu Gangula
- Department of Oral Biology, Meharry Medical College, 1005 DB Todd Jr. Blvd., Nashville, TN 37208, USA
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Tchetina E, Markova G. The clinical utility of gene expression examination in rheumatology. Mediterr J Rheumatol 2017; 28:116-126. [PMID: 32185269 PMCID: PMC7046055 DOI: 10.31138/mjr.28.3.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/24/2017] [Indexed: 01/09/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease with unknown etiology that affects various pathways within the immune system, involves many other tissues and is associated with pain and joint destruction. Current treatments fail to address pathophysiological and biochemical mechanisms involved in joint degeneration and the induction of pain. Moreover, RA patients are extremely heterogeneous and require specific treatments, the choice of which is complicated by the fact that not all patients equally respond to therapy. Gene expression analysis offer tools for patient management and personalization of patient’s care to meet individual needs in controlling inflammation and pain and delaying joint destruction.
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Affiliation(s)
- Elena Tchetina
- Immunology and Molecular Biology Laboratory, Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Galina Markova
- Immunology and Molecular Biology Laboratory, Nasonova Research Institute of Rheumatology, Moscow, Russia
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36
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Williams EM, Hyer JM, Viswanathan R, Faith TD, Egede L, Oates JC, Marshall GD. Cytokine balance and behavioral intervention; findings from the Peer Approaches to Lupus Self-Management (PALS) project. Hum Immunol 2017; 78:574-581. [PMID: 28716698 PMCID: PMC6013837 DOI: 10.1016/j.humimm.2017.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/26/2017] [Accepted: 07/10/2017] [Indexed: 12/22/2022]
Abstract
The Peer Approaches to Lupus Self-Management program sought to address the disparate impact of systemic lupus erythematosus (SLE) on African American women through a peer mentoring intervention with aims of reducing stress, anxiety, and depression. Given the association between psychological health and immune function this study examines the relationship between patient reported outcomes (PROs) in these domains and immunologic indicators of disease activity. Twenty-three African American women with SLE served as mentees in the intervention from whom PRO measures were collected at the outset, midpoint, and end of the 12week pilot study. Blood samples were collected pre- and post-intervention. Plasma was collected from the samples and cryopreserved for subsequent analyses. The strongest correlations were between the Generalized Anxiety Disorder measure and Th1/Th2 cytokine balance. Weaker correlations existed between depression and the Th1/Th2 cytokine balance. Assessment of fresh versus cryopreserved samples revealed that changes in Th1/Th2 cytokine balance within the intervention were generally equivalent, regardless of sample type. The PALS intervention resulted in significant improvements to anxiety and depression levels which were significantly associated with positive changes in Th1/Th2 cytokine balance indicating a possible underlying mechanism of action. The nature of this relationship warrants further study.
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Affiliation(s)
- Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - J Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - Ramakrishnan Viswanathan
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Clinical Cancer Center Building, 5th Floor, Suite C5400, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA.
| | - Jim C Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas St, Suite 8, Charleston, SC 29425, USA; Rheumatology Section, Medial Service, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
| | - Gailen D Marshall
- Division of Clinical Immunology and Allergy, University of Mississippi Medical Center, 2500 North State Street, N416, Jackson, MS 39216, USA.
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Abstract
PURPOSE OF REVIEW To review current information on the causes, treatments, and consequences of fatigue in rheumatoid arthritis. RECENT FINDINGS Disease activity (inflammation, pain, joint symptoms) is associated with greater fatigue. However, disease activity per se accounts for only a small portion of fatigue, and rheumatoid arthritis medications that reduce disease activity have small effects on fatigue. Instead, factors outside the direct effects of rheumatoid arthritis, such as obesity, physical inactivity, sleep disturbance, and depression, explain the majority of variation in fatigue. Some of these factors may be indirect effects of disease (e.g. pain can lead to sleep disturbance). Rheumatoid arthritis has significant effects on the quality of life of individuals with rheumatoid arthritis. The most effective approaches to reducing rheumatoid arthritis fatigue appear to be behavioral, such as increasing physical activity, or cognitive, such as cognitive behavioral interventions. SUMMARY Fatigue in rheumatoid arthritis appears to be largely because of factors outside the direct effects of the disease, such as behavioral and psychological factors. In spite of the tremendous impact of fatigue on patient health and quality of life, effective treatments remain elusive, but existing data show that behavioral and cognitive approaches may be most effective.
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38
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Family environments and leukocyte transcriptome indicators of a proinflammatory phenotype in children and parents. Dev Psychopathol 2017; 30:235-253. [PMID: 28555535 DOI: 10.1017/s0954579417000591] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
High conflict and low warmth in families may contribute to immune cells developing a tendency to respond to threats with exaggerated inflammation that is insensitive to inhibitory signaling. We tested associations between family environments and expression of genes bearing response elements for transcription factors that regulate inflammation: nuclear factor kappa B (NF-κB) and glucocorticoid receptor. The overall sample (47 families) completed interviews, questionnaires, and 8-week daily diary assessments of conflict and warmth, which were used to create composite family conflict and warmth scores. The diaries assessed upper respiratory infection (URI) symptoms, and URI episodes were clinically verified. Leukocyte RNA was extracted from whole blood samples provided by a subsample of 42 children (8-13 years of age) and 73 parents. In children, higher conflict and lower warmth were related to greater expression of genes bearing response elements for the proinflammatory transcription factor NF-κB, and more severe URI symptoms. In parents, higher conflict and lower warmth were also related to greater NF-κB-associated gene expression. Monocytes and dendritic cells were implicated as primary cellular sources of differential gene expression in the sample. Consistent with existing conceptual frameworks, stressful family environments were related to a proinflammatory phenotype at the level of the circulating leukocyte transcriptome.
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Lee H, Nah SS, Chang SH, Kim HK, Kwon JT, Lee S, Cho IH, Lee SW, Kim YO, Hong SJ, Kim HJ. PER2 is downregulated by the LPS-induced inflammatory response in synoviocytes in rheumatoid arthritis and is implicated in disease susceptibility. Mol Med Rep 2017; 16:422-428. [PMID: 28498398 DOI: 10.3892/mmr.2017.6578] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 03/16/2017] [Indexed: 11/05/2022] Open
Abstract
The clinical symptoms of rheumatoid arthritis (RA) present with circadian variation, with joint stiffness and pain more prominent in the early morning. The mammalian clock genes, which include circadian locomotor output cycles kaput, brain and muscle Arnt-like protein 1, period and cryptochrome, regulate circadian rhythms. In order to identify the association between genetic polymorphisms in the circadian clock gene period 2 (PER2) and RA, the present study genotyped three PER2 single nucleotide polymorphisms (SNPs), rs934945, rs6754875, and rs2304674, using genetic information from 256 RA patients and 499 control subjects. Primary cultured rheumatoid synovial cells were stimulated with 10 µM lipopolysaccharide (LPS). Total protein was then extracted from the synovial cells following 12 and 24 h, and PER2 protein expression was assayed by immunoblotting. The rs2304674 SNP demonstrated a significant association with susceptibility to RA following Bonferroni correction. However, statistical analysis indicated that the SNPs were not associated with any clinical features of patients with RA. Immunoblotting analysis demonstrated that PER2 protein expression was decreased by LPS‑induced inflammation in RA synovial cells; however, this was not observed in normal synovial cells. The results suggest that the PER2 gene may be a risk factor for RA, and expression of the PER2 protein may be affected by inflammation. Therefore, PER2 may contribute to the pathogenesis of RA.
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Affiliation(s)
- Hwayoung Lee
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Chungcheongnam 31151, Republic of Korea
| | - Seong-Su Nah
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Cheonan, Chungcheongnam 31151, Republic of Korea
| | - Sung-Hae Chang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Cheonan, Chungcheongnam 31151, Republic of Korea
| | - Hyung-Ki Kim
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Chungcheongnam 31151, Republic of Korea
| | - Jun-Tack Kwon
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Chungcheongnam 31151, Republic of Korea
| | - Sanghyun Lee
- Department of Integrative Plant Science, Chung‑Ang University, Anseong, Gyeonggi 17546, Republic of Korea
| | - Ik-Hyun Cho
- Department of Convergence Medical Science, Brain Korea 21 Plus Program and Institute of Korean Medicine, College of Oriental Medicine, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Sang Won Lee
- Department of Development of Ginseng and Medical Plants Research Institute, Rural Administration, Eumseong, Chungcheongbuk 27709, Republic of Korea
| | - Young Ock Kim
- Department of Development of Ginseng and Medical Plants Research Institute, Rural Administration, Eumseong, Chungcheongbuk 27709, Republic of Korea
| | - Seung-Jae Hong
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Hak-Jae Kim
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Chungcheongnam 31151, Republic of Korea
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Alvarenga-Filho H, Salles M, Hygino J, Ferreira TB, Sacramento PM, Monteiro C, Vasconcelos CCF, Alvarenga RMP, Bento CA. Fatigue favors in vitro Th1 and Th17-like cell expansion and reduces corticoid sensitivity in MS patients. J Neuroimmunol 2017; 303:81-89. [DOI: 10.1016/j.jneuroim.2016.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 11/29/2016] [Accepted: 12/20/2016] [Indexed: 12/28/2022]
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Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways. Nat Rev Rheumatol 2016; 12:532-42. [PMID: 27411910 DOI: 10.1038/nrrheum.2016.112] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In addition to recurrent pain, fatigue, and increased rates of physical disability, individuals with rheumatoid arthritis (RA) have an increased prevalence of some mental health disorders, particularly those involving affective or mood disturbances. This narrative Review provides an overview of mental health comorbidities in RA, and discusses how these comorbidities interact with disease processes, including dysregulation of inflammatory responses, prolonged difficulties with pain and fatigue, and the development of cognitive and behavioural responses that could exacerbate the physical and psychological difficulties associated with RA. This article describes how the social context of individuals with RA affects both their coping strategies and their psychological responses to the disease, and can also impair responses to treatment through disruption of patient-physician relationships and treatment adherence. Evidence from the literature on chronic pain suggests that the resulting alterations in neural pathways of reward processing could yield new insights into the connections between disease processes in RA and psychological distress. Finally, the role of psychological interventions in the effective and comprehensive treatment of RA is discussed.
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Simons LE, Goubert L, Vervoort T, Borsook D. Circles of engagement: Childhood pain and parent brain. Neurosci Biobehav Rev 2016; 68:537-546. [PMID: 27320958 DOI: 10.1016/j.neubiorev.2016.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/17/2016] [Accepted: 06/16/2016] [Indexed: 12/19/2022]
Abstract
Social interaction can have a profound effect on individual behavior, perhaps most salient in interactions between sick suffering children and their parents. Chronic pain is a difficult condition that can produce considerable changes in children's behaviors that can secondarily have profound effects on their parents. It may create a functionally disabling negative feedback loop. Research supports the notion of alterations in the brain of individuals who observe and empathize with loved ones in acute pain. However, neural activity in relation to empathic responses in the context of chronic pain has not been examined. Ongoing suffering with chronic pain in a child can result in child's brain circuit alterations. Moreover, prolonged suffering jointly experienced by the parent may putatively produce maladaptive changes in their neural networks and consequently in parental behaviors. Here we put forth the conceptual framework for 'Chronic pain contagion' (CPC). We review the underlying processes in CPC and discuss implications for devising and implementing treatments for children in chronic pain and their parents.
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Affiliation(s)
- Laura E Simons
- Center for Pain and the Brain, Boston Childrens Hospital (BCH), Boston, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Boston, USA; Department of Psychiatry, Harvard Medical School, Boston, USA.
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - David Borsook
- Center for Pain and the Brain, Boston Childrens Hospital (BCH), Boston, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Boston, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Bossola M, Tazza L. Postdialysis Fatigue: A Frequent and Debilitating Symptom. Semin Dial 2016; 29:222-7. [DOI: 10.1111/sdi.12468] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Maurizio Bossola
- Hemodialysis Service; Department of Urology and Nephrology; Catholic University; Rome Italy
| | - Luigi Tazza
- Hemodialysis Service; Department of Urology and Nephrology; Catholic University; Rome Italy
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Abstract
OBJECTIVE Psychological distress may contribute to chronic activation of acute-phase inflammation. The current study investigated how financial stressors influence psychosocial functioning and inflammation. This study examined a) the direct relations between financial stress and inflammation; b) whether the relationships between financial stress and inflammation are mediated in part by negative interpersonal events, psychological distress, and psychological well-being; and c) whether social standing in one's community moderates the relations between financial stress and psychological distress, psychological well-being, and markers of inflammation (interleukin-6 [IL-6] and C-reactive protein). METHODS Stressful financial and interpersonal events over the previous year, perceived social status, indices of psychological well-being and distress, and levels of IL-6 and C-reactive protein were assessed in a community sample of 680 middle-aged adults (ages 40-65 years). RESULTS Structural equation modeling analyses revealed significant relations among financial stress, interpersonal stress, and psychological distress and well-being, and complex relationships between these variables and inflammatory markers. Psychological well-being mediated the association between financial stress and IL-6 ([mediation] ab = 0.012, standard error [SE] = 0.006, p = .048). Furthermore, individuals with higher perceived social standing within their communities exhibited a stronger relation between negative financial events and both interpersonal stressors (interaction B = 0.067, SE = 0.017, p < .001) and C-reactive protein (interaction B = 0.051, SE = 0.026, p = .050). CONCLUSIONS Financial stress demonstrates complex relations with inflammation, due partly to psychological well-being and social perceptions. Findings are discussed with regard to the social context of stress and physiological factors pertinent to stress adaptation and inflammation.
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Interleukin-6 and tumor necrosis factor-α are associated with quality of life-related symptoms in pulmonary arterial hypertension. Ann Am Thorac Soc 2015; 12:370-5. [PMID: 25615959 DOI: 10.1513/annalsats.201410-463oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Inflammation is associated with symptoms in many chronic illnesses; however, this link has not been established in pulmonary arterial hypertension. OBJECTIVES The objective of this study was to investigate the association between inflammatory markers and quality of life-related symptoms in patients with pulmonary arterial hypertension. We hypothesized that higher circulating IL-6 and tumor necrosis factor-α levels would be associated with worse quality of life-related symptoms. METHODS We performed a secondary analysis using baseline and 3-month assessments of 62 subjects in a clinical trial of aspirin and simvastatin to determine the association between plasma IL-6 and tumor necrosis factor-α levels and the Medical Outcomes Study Short Form-36 subscales (pain, vitality, mental health). MEASUREMENTS AND MAIN RESULTS The mean age was 49.7±13.4 years; 87% were female. Higher IL-6 levels were significantly associated with lower Medical Outcomes Study Short Form-36 subscale scores, indicating worse bodily pain, vitality, and mental health (all P<0.01). Higher tumor necrosis factor-α levels were significantly associated with increased bodily pain, but better mental health scores. CONCLUSIONS IL-6 and tumor necrosis factor-α levels are associated with certain quality of life domains in patients with pulmonary arterial hypertension. Clinical trial registered with www.clinicaltrials.gov (NCT00384865).
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Matcham F, Ali S, Hotopf M, Chalder T. Psychological correlates of fatigue in rheumatoid arthritis: A systematic review. Clin Psychol Rev 2015; 39:16-29. [DOI: 10.1016/j.cpr.2015.03.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 12/13/2022]
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Song S, Graham-Engeland JE, Corwin EJ, Ceballos RM, Taylor SE, Seeman T, Klein LC. The role of multiple negative social relationships in inflammatory cytokine responses to a laboratory stressor. PeerJ 2015; 3:e959. [PMID: 26056615 PMCID: PMC4458128 DOI: 10.7717/peerj.959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/24/2015] [Indexed: 11/20/2022] Open
Abstract
The present study examined the unique impact of perceived negativity in multiple social relationships on endocrine and inflammatory responses to a laboratory stressor. Via hierarchical cluster analysis, those who reported negative social exchanges across relationships with a romantic partner, family, and their closest friend had higher mean IL-6 across time and a greater increase in TNF-α from 15 min to 75 min post stress. Those who reported negative social exchanges across relationships with roommates, family, and their closest friend showed greater IL-6 responses to stress. Differences in mean IL-6 were accounted for by either depressed mood or hostility, whereas differences in the cytokine stress responses remained significant after controlling for those factors. Overall, this research provides preliminary evidence to suggest that having multiple negative relationships may exacerbate acute inflammatory responses to a laboratory stressor independent of hostility and depressed mood.
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Affiliation(s)
- Sunmi Song
- Social Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health , USA
| | | | | | - Rachel M Ceballos
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center , USA
| | - Shelley E Taylor
- Department of Psychology, University of California , Los Angeles , USA
| | - Teresa Seeman
- Division of Geriatrics, David Geffen School of Medicine, University of California , Los Angeles , USA
| | - Laura Cousino Klein
- Department of Biobehavioral Health and Penn State Institute of the Neuroscience, The Pennsylvania State University , USA
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Sin NL, Graham-Engeland JE, Ong AD, Almeida DM. Affective reactivity to daily stressors is associated with elevated inflammation. Health Psychol 2015; 34:1154-65. [PMID: 26030309 DOI: 10.1037/hea0000240] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Inflammation increases the risk of chronic diseases, but the links between emotional responses to daily events and inflammation are unknown. We examined individual differences in affective reactivity to daily stressors (i.e., changes in positive and negative affect in response to stressors) as predictors of inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP). METHODS A cross-sectional sample of 872 adults from the National Study of Daily Experiences (substudy of Midlife in the United States II) reported daily stressors and affect during telephone interviews for 8 days. Blood samples were obtained at a separate clinic visit and assayed for inflammatory markers. Multilevel models estimated trait affective reactivity slopes for each participant, which were inputted into regression models to predict inflammation. RESULTS People who experienced greater decreases in positive affect on days when stressors occurred (i.e., positive affect reactivity) had elevated log IL-6, independent of demographic, physical, psychological, and behavioral factors (B = 1.12, SE = 0.45, p = .01). Heightened negative affect reactivity was associated with higher log CRP among women (p = .03) but not men (p = .57); health behaviors accounted for this association in women. CONCLUSIONS Adults who fail to maintain positive affect when faced with minor stressors in everyday life appear to have elevated levels of IL-6, a marker of inflammation. Women who experience increased negative affect when faced with minor stressors may be at particular risk of elevated inflammation. These findings add to growing evidence regarding the health implications of affective reactivity to daily stressors.
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van Steenbergen HW, Tsonaka R, Huizinga TWJ, Boonen A, van der Helm-van Mil AHM. Fatigue in rheumatoid arthritis; a persistent problem: a large longitudinal study. RMD Open 2015; 1:e000041. [PMID: 26509063 PMCID: PMC4612698 DOI: 10.1136/rmdopen-2014-000041] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/29/2022] Open
Abstract
Objective Fatigue is prevalent and disabling in rheumatoid arthritis (RA). Surprisingly, the long-term course of fatigue is studied seldom and it is unclear to what extent it is influenced by inflammation. This study aimed to determine the course of fatigue during 8 years follow-up, its association with the severity of inflammation and the effect of improved treatment strategies. Methods 626 patients with RA included in the Leiden Early Arthritis Clinic cohort were studied during 8 years. Fatigue severity, measured on a 0–100 mm scale, and other clinical variables were assessed yearly. Patients included in 1993–1995, 1996–1998 and 1999–2007 were treated with delayed treatment with disease-modifying antirheumatic drugs (DMARDs), early treatment with mild DMARDs and early treatment with methotrexate respectively. After multiple imputation, the serial measurements were analysed using linear quantile mixed models. Results Median fatigue severity at baseline was 45 mm and remained, despite treatment, rather stable thereafter. Female gender (effect size=4.4 mm), younger age (0.2 mm less fatigue/year), higher swollen and tender joint counts (0.3 mm and 1.0 mm more fatigue/swollen or tender joint) and C reactive protein-levels (0.1 mm more fatigue per mg/L) were independently and significantly (p<0.05) associated with fatigue severity over 8 years. Although improved treatment strategies associated with less severe radiographic progression, there was no effect on fatigue severity (p=0.96). Conclusions This largest longitudinal study on fatigue so far demonstrated that the association between inflammation and fatigue is statistically significant but effect sizes are small, suggesting that non-inflammatory pathways mediate fatigue as well. Improved treatment strategies did not result in less severe fatigue. Therefore, fatigue in RA remains an ‘unmet need’.
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Affiliation(s)
| | - Roula Tsonaka
- Department of Medical Statistics , Leiden University Medical Center , Leiden , The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Annelies Boonen
- Department of Rheumatology , University Hospital Maastricht , Maastricht , The Netherlands
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Bossola M, Di Stasio E, Giungi S, Rosa F, Tazza L. Fatigue is associated with serum interleukin-6 levels and symptoms of depression in patients on chronic hemodialysis. J Pain Symptom Manage 2015; 49:578-85. [PMID: 25135658 DOI: 10.1016/j.jpainsymman.2014.07.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/12/2014] [Accepted: 07/23/2014] [Indexed: 12/13/2022]
Abstract
CONTEXT Little is known about activated immune-inflammatory pathways and interleukin-6 (IL-6) in the development of fatigue and/or depression in patients with end-stage renal disease on chronic hemodialysis (HD). OBJECTIVES To evaluate the possible correlation between fatigue and serum levels of IL-6 in patients on chronic HD. METHODS One hundred HD patients were assessed for the presence of fatigue using the SF-36 Vitality subscale and were administered the Beck Depression Inventory (BDI), the Hamilton Anxiety Rating Scale (HARS), the Mini-Mental State Examination (MMSE), the activities of daily living (ADL), and the instrumental activities of daily living (IADL). We also calculated the time of recovery after hemodialysis (TIRD) and the number/severity of comorbidities using the Charlson Comorbidity Index (CCI). Laboratory parameters were measured as well as serum IL-6. RESULTS Forty-three patients constituted the fatigued group and 57 the nonfatigued group. Age, CCI, BDI, HARS, and TIRD were significantly higher in fatigued patients than in the nonfatigued patients. Conversely, the scores of ADL, IADL, and MMSE were significantly lower in fatigued than in nonfatigued patients. Serum IL-6 levels (pg/mL) were higher in the fatigued group (5.1 ± 3.4) than in the nonfatigued group (1.6 ± 1.5; P < 0.001); serum albumin and creatinine levels were significantly lower. Twenty-six patients (26%) had no symptoms of depression (BDI score <10), and 74 patients (74%) had symptoms of depression (BDI score >9). Patients with a BDI score >9 were older; had a higher CCI; a lower MMSE; a higher TIRD; lower serum albumin, creatinine, and urea levels; and higher serum IL-6 levels. The correlation analyses showed that the score of the SF-36 Vitality subscale was associated with age, dialytic age, TIRD, ADL, IADL, CCI, BDI, HARS, MMSE, serum urea, creatinine, albumin, and IL-6 levels. On multivariate general linear model analyses, with fatigue as the dependent variable and gender as a second factor, BDI and serum IL-6 levels were independently associated with the score of the SF-36 Vitality subscale. A canonical correlation analysis was performed including in the model fatigue, BDI, and biomarkers; the correlation was 0.679 (R(2) = 0.462). Fatigue, BDI, and IL-6 among biomarkers showed the strongest association with the underlying construct (standardized canonical coefficients = -0.989, 0.015, and 0.852, respectively), thus explaining a correlation of IL-6 with both depression and fatigue. CONCLUSION Fatigue was significantly associated with symptoms of depression and serum IL-6 levels in patients receiving chronic HD.
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Affiliation(s)
- Maurizio Bossola
- Hemodialysis Service, Division of Transplantation and Dialysis, Catholic University of the Sacred Heart, Rome, Italy.
| | - Enrico Di Stasio
- Department of Clinical Chemistry, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefania Giungi
- Hemodialysis Service, Division of Transplantation and Dialysis, Catholic University of the Sacred Heart, Rome, Italy
| | - Fausto Rosa
- Hemodialysis Service, Division of Transplantation and Dialysis, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Tazza
- Hemodialysis Service, Division of Transplantation and Dialysis, Catholic University of the Sacred Heart, Rome, Italy
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