The whole lupus: Articulating biosocial interplay in systemic lupus erythematosus epidemiology and population disparities

Towards an understanding of the biopsychosocial determinants of CVD in SLE: a scoping review

OBJECTIVE

Systemic lupus erythematosus (SLE) is a chronic autoimmune condition with significant physical, mental, psychosocial and economic impacts. A main driver of SLE morbidity and mortality is cardiovascular disease (CVD). Both SLE and CVD exhibit disparities related to gender, race and other social dimensions linked with biological outcomes and health trajectories. However, the biospsychosocial dimensions of CVD in SLE populations remain poorly understood. The objective of this study was to systematically investigate the existing literature around known social factors influencing the development of CVD in SLE.

METHODS

A scoping review protocol was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews guidelines. The search strategy encompassed three main concepts: SLE, CVD and social factors. Four databases were searched (PubMed, SCOPUS, PsychINFO and CINAHL). 682 studies were identified for screening. Articles were screened in two phases (title/abstract and full text) to determine whether they fulfilled the selection criteria.

RESULTS

Nine studies were included after screening. All were conducted in the USA between 2009 and 2017. Six studies (67%) were cross-sectional and three (33%) were longitudinal. Most employed SLE cohorts (n=7, 78%) and two drew from healthcare databases (n=2; 22%). We identified five main themes encompassing social factors: socioeconomic status and education (n=5; 56%), race and/or ethnicity (n=7; 78%), mental health (n=2; 22%), gender (n=3; 33%) and healthcare quality and/or insurance (n=2; 22%). Overall, low income, fewer years of education, black race and/or ethnicity, depression, male gender, lack of insurance and healthcare fragmentation were all associated with CVD risk factors and outcomes in SLE.

CONCLUSIONS

While several social factors contribute to CVD in SLE populations, considerable gaps remain as many social determinants remain un(der)explored. There is rich opportunity to integrate social theory, advance conceptualisations of race and/or ethnicity and gender, expand investigations of mental health and explore novel geographical contexts. In healthcare policy and practice, identified social factors should be considered for SLE populations during decision-making and treatment, and education resources should be targeted for these groups.

A case report of systemic lupus erythematosus and intestinal tuberculosis with lower gastrointestinal bleeding: A treatment approach utilizing parenteral nutrition

RATIONALE

Limited literatures are available on lower gastrointestinal bleeding in systemic lupus erythematosus (SLE) combined with intestinal tuberculosis. Sharing the treatment experiences of a 26-year-old female patient diagnosed with this complex condition in this report may contribute valuable insights.

PATIENT CONCERNS

The patient initially presented with abdominal pain and active gastrointestinal bleeding, leading to admission to the hospital. Over a 2-week period, she experienced persistent bleeding, with daily volumes ranging from 300 mL to 800 mL.

DIAGNOSES

Lower gastrointestinal bleeding was diagnosed in this patient with concurrent systemic lupus erythematosus and intestinal tuberculosis.

INTERVENTIONS

As her symptoms rapidly progressed, food and water intake had to be completely restricted. The parenteral nutrition was implemented.

OUTCOMES

The medical team effectively controlled the bleeding, leading to a notable improvement in the patient's condition. Consequently, she was able to resume oral intake and was discharged from the hospital.

LESSONS

This case highlights the significance of using parenteral nutrition in the management of lower gastrointestinal bleeding in patients with concurrent systemic lupus erythematosus and intestinal tuberculosis. Close monitoring and collaborative efforts among healthcare professionals are crucial to achieve successful outcomes in similar cases.

Choices are inevitable: A qualitative exploration of the lifecosts of systemic lupus erythematosus

OBJECTIVES

Individuals with systemic lupus erythematosus experience considerable economic challenges. The aim of this research is to qualitatively investigate experiences of the lifecosts (direct and indirect economic costs and beyond) to those with systemic lupus erythematosus in Canada.

METHODS

Using a biopsychosocial conceptual framework and integrated knowledge translation approach, qualitative semi-structured interviews were conducted with 3 physicians, 5 representatives from systemic lupus erythematosus advocacy groups, and 29 adult systemic lupus erythematosus patients. Themes emerged deductively and inductively, and the theme code set was used to code all transcripts.

RESULTS

Three dominant themes emerged: (1) impacts of systemic lupus erythematosus on quality of life, relationships, and health; (2) costs linked to healthcare; and (3) impacts of living with systemic lupus erythematosus on employment/economic standing.

DISCUSSION

Whereas previous work has focused almost exclusively on the direct, individual costs of systemic lupus erythematosus, the biopsychosocial approach taken here emphasizes not only the individual and intermediate factors (such as the workplace and family), but also the system-level factors (i.e. system-level policies) that influence quality of life, healthcare, and employment/economic experiences of those with systemic lupus erythematosus. Results indicate a need to target interventions beyond the individual and their immediate context, and recognize that lifecosts are shaped significantly by systems-level action.

Anticipatory racism stress, smoking and disease activity: the Black women's experiences living with lupus (BeWELL) study

African American women with systemic lupus erythematosus (SLE) have worse disease outcomes compared to their White counterparts. Stressors associated with race may contribute to poorer health in this population through maladaptive behavioral pathways. This study investigated relationships between stress associated with anticipating racism, smoking, and SLE disease activity. Data were from 432 African American women with SLE in the Black Women's Experiences Living with Lupus (BeWELL) Study. Controlling for sociodemographic and health-related covariates, multivariable regression analyses revealed a significant association between anticipatory racism stress (ARS) and disease activity (p = 0.00, b = 1.13, 95% CI [0.43, 1.82]). A significant interaction between ARS and smoking also indicated that smoking exacerbated the effect of ARS on disease activity (p = 0.04, b = 1.95, CI = 0.04, 3.96). Test for evidence of smoking mediating the effect of ARS on disease activity were not statistically significant (z = 1.77, p = 0.08). Findings have implications for future SLE disparities research among African American women with SLE.

From social determinants to social epigenetics: Health geographies of chronic disease

Social epigenetics explores relationships between social factors and health inequities embodied at the molecular level. Through modulating gene expression, epigenetic changes resulting from human-environment interactions may play a role in shaping health trajectories. This paper applies a health geography lens to explore the potential and support for conducting social epigenetic studies of chronic diseases with complex and dynamic etiologies. In so doing, we argue that social epigenetics presents a novel space for investigations of health and disease that is transdisciplinary and builds upon new understandings of bodies and place-based experiences. Given gender disparities in chronic diseases, we adopt a feminist perspective that cogitates the transactive relationships between gender and health/ill-health as mediated by biosocial processes at a variety of scales. Looking forward to the practical undertaking of social epigenetic studies, we assess existing theoretical and methodological support as well as insights to be gained. Reflecting upon the central tenets of health geography, we propose a unique positionality for health geographers to drive this field forward.

Coptisine Alleviates Pristane-Induced Lupus-Like Disease and Associated Kidney and Cardiovascular Complications in Mice

Systemic lupus erythaematosus (SLE) is a chronic multi-system autoimmune disease with a high prevalence of kidney and cardiovascular complications. Considering that Rho-associated coiled-coil-containing protein kinases (ROCKs) play important roles in SLE, inflammation, and cardiovascular disease, we hypothesized that coptisine, which has been found to inhibit ROCKs, may have an effect on SLE. The effect of coptisine was assessed in female BALB/c mice intraperitoneally injected with 0.5 mL of pristane. Serum autoantibodies were tested every month, blood pressure was measured every 2 months, and serum inflammatory markers, spleen pathologic characteristics, renal injury and vascular function were observed at 6 months. The results showed that coptisine decreased the levels of serum autoantibodies and serum inflammatory markers in the SLE mice, improved the pathologic characteristics of the spleen, and simultaneously improved renal injury, decreased inflammatory responses in the kidneys, reduced blood pressure, and improved vascular endothelial function. Western blot assays revealed that inhibiting the activation of the NF-κB and Rho/ROCK signalling pathways and downstream signalling molecules might be the potential mechanisms of the effects of coptisine. Our findings suggest that therapy with coptisine may be a strategy for preventing SLE and ameliorating associated kidney and cardiovascular complications.

Racial Discrimination, Disease Activity, and Organ Damage: The Black Women's Experiences Living With Lupus (BeWELL) Study

Black women are disproportionately affected by systemic lupus erythematosus (SLE), a chronic, potentially debilitating autoimmune disease, and they also experience more rapid progression and worse outcomes compared with other groups. We examined if racial discrimination is associated with disease outcomes among 427 black women with a validated diagnosis of SLE, who live in the Atlanta, Georgia, metropolitan area, and were recruited to the Black Women's Experiences Living with Lupus Study (2015-2017). Frequency of self-reported experiences of racial discrimination in domains such as employment, housing, and medical settings was assessed using the Experiences of Discrimination measure. SLE activity in the previous 3 months, including symptoms of fatigue, fever, skin rashes, and ulcers, was measured using the Systemic Lupus Activity Questionnaire; irreversible damage to an organ or system was measured using the Brief Index of Lupus Damage. Results of multivariable linear regression analyses examining the Systemic Lupus Activity Questionnaire and log-transformed Brief Index of Lupus Damage scores indicated that increasing frequency of racial discrimination was associated with greater SLE activity (b = 2.00, 95% confidence interval: 1.32, 2.68) and organ damage (b = 0.08, 95% confidence interval: 0.02, 0.13). Comprehensive efforts to address disparities in SLE severity should include policies that address issues of racial discrimination.