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Zhao X, Wu H, Li S, Gao C, Wang J, Ge L, Song Z, Ni B, You Y. The impact of the COVID-19 pandemic on SLE. Mod Rheumatol 2024; 34:247-264. [PMID: 36961736 DOI: 10.1093/mr/road030] [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: 12/13/2022] [Revised: 02/21/2023] [Accepted: 03/11/2023] [Indexed: 03/25/2023]
Abstract
Little is known about the association between coronavirus disease 2019 (COVID-19) and autoimmune diseases, especially in the case of systemic lupus erythematosus (SLE). SLE patients met with many questions during the pandemic in COVID-19, such as how to minimize risk of infection, the complex pathological features and cytokine profiles, diagnosis and treatment, rational choice of drugs and vaccine, good nursing, psychological supervision, and so on. In this study, we review and discuss the multifaceted effects of the COVID-19 pandemic on patients living with SLE using the available literature. Cross-talk in implicated inflammatory pathways/mechanisms exists between SLE and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and SARS-CoV-2 displays similar clinical characteristics and immuno-inflammatory responses to SLE. Current epidemiological data inadequately assess the risk and severity of COVID-19 infection in patients with SLE. More evidence has shown that hydroxychloroquine and chloroquine cannot prevent COVID-19. During the pandemic, patients with SLE had a higher rate of hospitalization. Vaccination helps to reduce the risk of infection. Several therapies for patients with SLE infected with COVID-19 are discussed. The cases in the study can provide meaningful information for clinical diagnosis and management. Our main aim is to help preventing infection and highlight treatment options for patients with SLE infected with COVID-19.
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Affiliation(s)
- Xingwang Zhao
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Haohao Wu
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shifei Li
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Cuie Gao
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Juan Wang
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lan Ge
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhiqiang Song
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Bing Ni
- Department of Pathophysiology, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yi You
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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2
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Geetha D, Kronbichler A, Rutter M, Bajpai D, Menez S, Weissenbacher A, Anand S, Lin E, Carlson N, Sozio S, Fowler K, Bignall R, Ducharlet K, Tannor EK, Wijewickrama E, Hafidz MIA, Tesar V, Hoover R, Crews D, Varnell C, Danziger-Isakov L, Jha V, Mohan S, Parikh C, Luyckx V. Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions. Nat Rev Nephrol 2022; 18:724-737. [PMID: 36002770 PMCID: PMC9400561 DOI: 10.1038/s41581-022-00618-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.
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Affiliation(s)
- Duvuru Geetha
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | - Megan Rutter
- Department of Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Divya Bajpai
- Department of Nephrology, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, India
| | - Steven Menez
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Shuchi Anand
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Standford, California, USA
| | - Eugene Lin
- Department of Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
| | - Nicholas Carlson
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Stephen Sozio
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin Fowler
- Principal, Voice of the Patient Inc, St. Louis, Missouri, USA
| | - Ray Bignall
- Division of Nephrology and Hypertension, Nationwide Children's Hospital and Department of Paediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kathryn Ducharlet
- Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Australia
- Department of Nephrology and Palliative Care, St Vincent's Hospital Melbourne, Australia and Department of Medicine, University of Melbourne, Parkville, Australia
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Eranga Wijewickrama
- Consultant Nephrologist and Professor in the Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- University Medical Unit, National Hospital of Sri Lanka and National Institute of Nephrology, Dialysis & Transplantation, Colombo, Sri Lanka
| | | | - Vladimir Tesar
- Department of Nephrology, Charles University, Prague, Czech Republic
| | - Robert Hoover
- Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Deidra Crews
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles Varnell
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Paediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Lara Danziger-Isakov
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA
| | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Chirag Parikh
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Valerie Luyckx
- Associate Scientist, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Honorary Associate Professor, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Nephrologist, University Childrens Hospital, Zurich, Switzerland
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3
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Rutter M, Lanyon PC, Grainge MJ, Hubbard R, Peach E, Bythell M, Stilwell P, Aston J, Stevens S, Pearce FA. COVID-19 Infection, Admission and Death Amongst People with Rare Autoimmune Rheumatic Disease in England. Results from the RECORDER Project. Rheumatology (Oxford) 2021; 61:3161-3171. [PMID: 34698821 PMCID: PMC8586729 DOI: 10.1093/rheumatology/keab794] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the first wave of the COVID-19 pandemic in England compared with the general population. Methods We used Hospital Episode Statistics to identify all people alive 01 March 2020 with ICD-10 codes for RAIRD from the whole population of England. We used linked national health records (demographic, death certificate, admissions and PCR testing data) to calculate rates of COVID-19 infection and death up to 31 July 2020. Our primary definition of COVID-19-related death was mention of COVID-19 on the death certificate. General population data from Public Health England and the Office for National Statistics were used for comparison. We also describe COVID-19-related hospital admissions and all-cause deaths. Results We identified a cohort of 168 680 people with RAIRD, of whom 1874 (1.11%) had a positive COVID-19 PCR test. The age-standardised infection rate was 1.54 (95% CI 1.50–1.59) times higher than in the general population. 713 (0.42%) people with RAIRD died with COVID-19 on their death certificate and the age-sex-standardised mortality rate for COVID-19-related death was 2.41 (2.30–2.53) times higher than in the general population. There was no evidence of an increase in deaths from other causes in the RAIRD population. Conclusions During the first wave of COVID-19 in England, people with RAIRD had a 54% increased risk of COVID-19 infection and more than twice the risk of COVID-19-related death compared with the general population. These increases were seen despite shielding policies.
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Affiliation(s)
- Megan Rutter
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter C Lanyon
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Matthew J Grainge
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard Hubbard
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Emily Peach
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mary Bythell
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Peter Stilwell
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Jeanette Aston
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Sarah Stevens
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Fiona A Pearce
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
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4
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Peach E, Rutter M, Lanyon P, Grainge MJ, Hubbard R, Aston J, Bythell M, Stevens S, Pearce F. Risk of death among people with rare autoimmune diseases compared with the general population in England during the 2020 COVID-19 pandemic. Rheumatology (Oxford) 2021; 60:1902-1909. [PMID: 33271595 PMCID: PMC7798585 DOI: 10.1093/rheumatology/keaa855] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/21/2020] [Indexed: 01/28/2023] Open
Abstract
Objectives To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared with the general population, and compared with their pre-COVID risk. Methods We conducted a cohort study in Hospital Episode Statistics for England 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates. Results We included 168 691 people with a recorded diagnosis of RAIRD alive on 01/03/2020. Their median age was 61.7 (IQR 41.5–75.4) years, and 118 379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. 1,815 (1.1%) participants died during March and April 2020. The age-standardised mortality rate (ASMR) among people with RAIRD (3669.3, 95% CI 3500.4–3838.1 per 100 000 person-years) was 1.44 (95% CI 1.42–1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared with the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared with men. Conclusion The risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to healthcare services.
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Affiliation(s)
- Emily Peach
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Megan Rutter
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Peter Lanyon
- Division of Epidemiology and Public Health, University of Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, UK
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Richard Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Jeanette Aston
- National Disease Registration Service, Public Health England, UK
| | - Mary Bythell
- National Disease Registration Service, Public Health England, UK
| | - Sarah Stevens
- National Disease Registration Service, Public Health England, UK
| | - Fiona Pearce
- Division of Epidemiology and Public Health, University of Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, UK
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5
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Sloan M, Gordon C, Lever E, Harwood R, Bosley MA, Pilling M, Brimicombe J, Naughton F, Blane M, Walia C, D’Cruz D. COVID-19 and shielding: experiences of UK patients with lupus and related diseases. Rheumatol Adv Pract 2021; 5:rkab003. [PMID: 33728396 PMCID: PMC7928599 DOI: 10.1093/rap/rkab003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The shielding guidance in the UK for the clinically extremely vulnerable (CEV) commenced on 23 March 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to explore the impact of the pandemic and shielding on patients with lupus and related systemic autoimmune rheumatic diseases (SARDs). METHODS This was a mixed-methods cohort study (n = 111) including pre-lockdown baseline surveys (March 2020), follow-up surveys (June 2020) and in-depth interviews during July 2020 (n = 25). RESULTS Most participants had a high level of anxiety regarding their mortality risk from COVID-19 and supported the concept of shielding. Shielding allocations and communications were perceived as inconsistently applied and delivered. More than half of those not classified as CEV reported feeling abandoned, at increased risk and with no support. Shielding communications increased feelings of being 'cared about', but also increased fear, and the 'vulnerable' labelling was perceived by some to damage social and self-identity. More than 80% of those classified as CEV stated that the classification and subsequent communications had changed their social-mixing behaviour. Despite many negative impacts of COVID-19 and shielding/lockdown being identified, including isolation, fear and reduced medical care, the quantitative data during the pandemic showed increases in most measures of wellbeing (which was low at both time points) from pre-lockdown, including reductions in the impact of fatigue and pain (P-values < 0.001). CONCLUSION Shielding classifications and communications were, in general, viewed positively, although they were perceived as inconsistently delivered and anxiety-provoking by some participants. More frequent positively framed communication and wellbeing support could benefit all SARD patients. Slower-paced lockdown lifestyles might confer health/wellbeing benefits for some people with chronic diseases.
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Affiliation(s)
- Melanie Sloan
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Science, University of Birmingham, Birmingham
| | - Elliott Lever
- Rheumatology Department, Northwick Park Hospital, London
| | - Rupert Harwood
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Michael A Bosley
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Mark Pilling
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge
| | - James Brimicombe
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich
| | - Moira Blane
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | | | - David D’Cruz
- The Louise Coote Lupus unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Sloan M, Gordon C, Harwood R, Lever E, Wincup C, Bosley M, Brimicombe J, Pilling M, Sutton S, Holloway L, D’Cruz D. The impact of the COVID-19 pandemic on the medical care and health-care behaviour of patients with lupus and other systemic autoimmune diseases: a mixed methods longitudinal study. Rheumatol Adv Pract 2020; 5:rkaa072. [PMID: 33604501 PMCID: PMC7798562 DOI: 10.1093/rap/rkaa072] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim was to explore the self-reported impact of the COVID-19 pandemic on changes to care and behaviour in UK patients with systemic autoimmune rheumatic diseases, to help ensure that patient experiences are considered in future pandemic planning. METHODS This was a longitudinal mixed methods study, with a cohort completing baseline surveys in March 2020 and follow-up surveys in June 2020 (n = 111), combined with thematic analysis of the LUPUS UK forum and participant interviews (n = 28). RESULTS Cancellations of routine care and difficulties in accessing medical support contributed to some participants deteriorating physically, including reports of hospitalizations. The majority of participants reported that fear of COVID-19 and disruptions to their medical care had also adversely impacted their mental health. Feeling medically supported during the pandemic was correlated with multiple measures of mental health and perceptions of care, including the Warwick-Edinburgh mental well-being score (r = 0.44, P = 0.01). Five themes were identified: detrimental reduction in care; disparities in contact and communication (medical security vs abandonment sub-theme); perceived and actual endangerment; the perfect storm of reduced clinician ability to help and increased patient reticence to seek help; and identifying the patients most vulnerable to reduced medical care. CONCLUSION The diversion of resources away from chronic disease care was perceived by many participants to have caused adverse outcomes. Fear about increased vulnerability to COVID-19 was high, contributing to health-care-avoidant behaviours. This study also highlights the influence of clinician accessibility and patients feeling medically supported on multiple measures of physical and mental health.
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Affiliation(s)
- Melanie Sloan
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Science, University of Birmingham, Birmingham
| | - Rupert Harwood
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Elliott Lever
- Rheumatology Department, University College London Hospital
| | - Chris Wincup
- Rheumatology Department, University College London Hospital
| | - Michael Bosley
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - James Brimicombe
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge
| | - Mark Pilling
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge
| | - Stephen Sutton
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge
| | - Lynn Holloway
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - David D’Cruz
- Louise Coote Lupus Unit, Guys’ and St Thomas’ NHS foundation Trust, London, UK
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