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Parperis K, Philippou S, Christophi CA, Constantinou A, Bargiotas P, Psarelis S. Restless leg syndrome in systemic lupus erythematosus: Associations with disease activity, quality of life and depression. Sleep Med 2024; 121:111-116. [PMID: 38959717 DOI: 10.1016/j.sleep.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/05/2024] [Accepted: 06/21/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of restless leg syndrome (RLS) among patients with SLE, describe their clinical characteristics, examine its impact on health-related quality of life (HRQoL), and evaluate its association with depression. METHODS A total of 124 SLE patients were recruited, with data on demographics, and clinical features collected. RLS diagnosis was based on the international RLS study group criteria, while depression was assessed by the patient health questionnaire. HRQoL was assessed by a disease-specific validated questionnaire, the LupusQoL, pain intensity was examined through the pain visual analogue scale, and disease activity was evaluated via the patient global assessment. These variables were compared between SLE patients with RLS and without RLS using t-tests or Wilcoxon and the chi-square test of independence for categorical variables. A p-value ≤0.05 was considered statistically significant. RESULTS Among the SLE patients (mean age 48, 87.1 % women), 32 % had RLS. The SLE patients with RLS were found to have a longer delay in diagnosis (1 vs 0.5 years; p = 0.019) and were less likely to be employed (65 % vs 45 %, p = 0.040) compared to non-RLS patients. In addition, RLS patients were more likely to have coexisting Major Depressive Disorder (MDD) (p = 0.019), higher levels of pain (p = 0.006) and disease activity based on patient global assessment (p = 0.014). Further, most of the domains of LupusQoL were significantly lower in the RLS patients group suggesting a worse HRQoL. CONCLUSION RLS was present in one-third of the SLE cohort, significantly impairing HRQoL and correlating with depression, higher pain, and increased disease activity. These findings underscore the importance of early RLS detection and management in SLE patients.
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Affiliation(s)
- Konstantinos Parperis
- University of Cyprus Medical School, Nicosia, Cyprus; Nicosia General Hospital, Department of Rheumatology, Nicosia, Cyprus.
| | | | | | | | | | - Savvas Psarelis
- Nicosia General Hospital, Department of Rheumatology, Nicosia, Cyprus
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Zhang X, Wang Z, Lin GL, Wei FZ, Zhuang YP, Xu WL, Zhang Q, Wu HT, He ZM, Yin XY, Liu Y, Mi L, Gong AM. Analysis of status and influencing factors of mental health in patients with systemic lupus erythematosus. World J Psychiatry 2024; 14:829-837. [DOI: 10.5498/wjp.v14.i6.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disorder with varied clinical courses and prognoses, not only did the patients suffer from physical impairment, but also various physical and psychiatric comorbidities. Growing evidence have suggested that mental disorders in SLE patients, can lead to various adverse consequences.
AIM To explored the features and influencing factors of mental health in patients with SLE and clarifying the correlations between mental health and personality characteristics and perceived social support. The results would provide a basis for psychological intervention in patients with SLE.
METHODS The clinical data of 168 patients with SLE admitted at the First Affiliated Hospital of Hainan Medical University between June 2020 and June 2022 were collected. Psychological assessment and correlation analysis were conducted using the Symptom Checklist-90 (SCL-90) and Perceived Social Support Scale, and the collected data were compared with the national norms in China. The relevant factors influencing mental health were identified by statistical analysis. A general information questionnaire, the Revised Life Orientation Test, and Short-Form 36-Item Health Survey were employed to assess optimism level and quality of life (QoL), respectively.
RESULTS Patients with SLE obtained higher scores for the somatization, depression, anxiety, and phobic anxiety subscales than national norms (P < 0.05). A correlation was identified between total social support and total SCL-90 score or each subscale (P < 0.05). The factors significantly affecting patients’ mental health were hormone dosage and disease activity index (DAI) (P < 0.05). The average optimism score of patients with SLE was 14.36 ± 4.42, and 30 cases were in the middle and lower levels. A positive correlation was found between optimism level and QoL scores.
CONCLUSION Patients with SLE develop psychological disorders at varying degrees, which are significantly influenced by hormone dosage and DAI. Patients’ mental health should be closely monitored during clinical diagnosis and treatment and provided adequate support in establishing positive, healthy thinking and behavior patterns and improving their optimism level and QoL.
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Affiliation(s)
- Xuan Zhang
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Zhe Wang
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Gui-Ling Lin
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Fang-Zhi Wei
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Yan-Ping Zhuang
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Wen-Lu Xu
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Qi Zhang
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Hui-Tao Wu
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Zi-Man He
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Xi-Yu Yin
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Ying Liu
- Department of Rheumatology and Immunology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Long Mi
- Department of Radiology, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou 570100, Hainan Province, China
| | - Ai-Min Gong
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
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Tayyab Z, Khan H, Saeed S, Saif S, Haseeb Khan S, Ijaz Bhatti M. Undiagnosed Depression and Its Effects on Patients With Systemic Lupus Erythematosus. Cureus 2024; 16:e53064. [PMID: 38410327 PMCID: PMC10896275 DOI: 10.7759/cureus.53064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Different organs and organ systems are affected by a well-known chronic immune disorder called systemic lupus erythematosus (SLE). Besides the physical harm caused by this disorder, it affects the mental health of patients in a greater ratio by causing depression and anxiety. The objective of this study is to assess the prevalence of undiagnosed depression and its effects on patients with systemic lupus erythematosus. Material and methods This prospective cross-sectional study was carried out in the Rheumatology outpatient department of Fatima Memorial Hospital (FMH), Lahore, from November 2022 to February 2023. All study subjects had been given a prior diagnosis of SLE based on the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria. Three sections comprised the survey form: section I asked questions about socio-demographic information (gender and age); section II assessed the degree of mental illness activity; and section III assessed the degree of SLE disease activity. The nine-item PHQ-9 (Patient Health Questionnaire 9) scale, which is used to diagnose severe depressive disorder, was utilized to measure depression. To compare categorical variables, we applied Fisher's exact tests and chi-square; for continuous variables, we utilized the student's t-test. The statistical analysis was conducted using SPSS software for Windows Version 21.0 (IBM Corp., Armonk, NY, USA), with a significance threshold of p-value <0.05. Results Mild, moderate, and severe depression were present in 20%, 37.5%, and 37.5% of the patients, respectively. Pearson correlation of disease severity was strongly positive with depression (R2=0.634, p=0.01). The correlation was statistically significant. Conclusion Our research indicates that depression is a real problem for SLE patients. There is a positive correlation between the activity of the disease and the intensity of depression.
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Affiliation(s)
- Zaid Tayyab
- Rheumatology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | - Haseeb Khan
- Rheumatology, Dorset County Hospital, Dorchester, GBR
| | - Samina Saeed
- Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Saba Saif
- Medicine, CMH (Combined Military Hospital) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Sana Haseeb Khan
- Pathology and Laboratory Medicine, Al Aleem Medical College, Lahore, PAK
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Zhao Q, Li X, Chen H, Wang L, Wu N, Ma J, Shen B. Association between depression and pain, functional disability, disease activity and health-related quality of life in patients with systemic lupus erythematosus: a meta-analysis. BMJ Open 2023; 13:e068683. [PMID: 37821132 PMCID: PMC10583069 DOI: 10.1136/bmjopen-2022-068683] [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: 11/21/2022] [Accepted: 08/10/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore the effect of depression on pain, disease activity, functional disability and health-related quality of life measured by Visual Analogue Scale, Systemic Lupus Erythematosus Disease Activity Index, Health Assessment Questionnaire and Short Form-36 in patients with systemic lupus erythematosus. DESIGN Meta-analysis. DATA SOURCES The PubMed, EMBASE, Cochrane Library and Web of Science were searched for obtaining available studies from inception to 7 March 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies evaluating the impact of depression on pain, disease activity, functional disability and quality of life were included. DATA EXTRACTION AND SYNTHESIS Two authors independently screened publications and extracted data according to set inclusion and exclusion criteria. Statistical analyses were conducted with RevMan V.5.3.0. Data were pooled using a fixed-effects or random-effects model according to heterogeneity. RESULTS A total of 13 identified studies met the inclusion criteria, reporting on a total of 1911 patients with systemic lupus erythematosus. The Visual Analogue Scale score was significantly higher in patients with depression than those without depression (standardised mean difference (SMD)=0.84 (95% CI 0.27 to 1.42), p=0.004). The Health Assessment Questionnaire score was significantly higher in patients with depression than those without depression (SMD=1.05 (95% CI 0.14 to 1.95), p<0.05). The Systemic Lupus Erythematosus Disease Activity Index score was significantly higher in patients with depression than those without depression (SMD=0.46 (95% CI 0.27 to 0.64), p<0.00001). Scores in most Short Form-36 dimensions (physical function, role physical function, emotional role function, vitality, mental health, social function, general health, physical component scale, mental component scale) were lower in patients with depression than those without depression. CONCLUSION This meta-analysis showed that depression was associated with increased in pain, functional disability and disease activity, and decline in health-related quality of life in patients with systemic lupus erythematosus. Awareness of the importance of the relationship between depression in systemic lupus erythematosus patients and pain, functional disability and the quality of life might assist rheumatology physicians and nurses in assessing and preventing these symptoms. PROSPERO REGISTRATION NUMBER CRD42021265694.
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Affiliation(s)
- Qian Zhao
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xin Li
- Department of Respiratory and Critical Care Medicine, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Haoyang Chen
- Department of Nursing, Nantong University Affiliated Rehabilitation Hospital, Nantong, China
| | - Lili Wang
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Ning Wu
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Ji Ma
- The Orthopaedic Spinal Ward, Shanxi Provincial People's hospital, Taiyuan, China
| | - Biyu Shen
- Department of Nursing, Shanghai Children's Medical Center, Shanghai, China
- School of Nursing, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Papachristodoulou E, Kakoullis L, Christophi C, Psarelis S, Hajiroussos V, Parperis K. The relationship of neutrophil-to-lymphocyte ratio with health-related quality of life, depression, and disease activity in SLE: a cross-sectional study. Rheumatol Int 2023; 43:1841-1848. [PMID: 37405441 PMCID: PMC10435585 DOI: 10.1007/s00296-023-05381-8] [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: 05/22/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023]
Abstract
The neutrophil-to-lymphocyte ratio (NLR) emerged as a potential biomarker in SLE, but its association with several outcomes remains unclear. We aimed to evaluate the relationship between NLR and SLE disease activity, damage, depression, and health-related quality of life. A cross-sectional study was conducted, including 134 patients with SLE who visited the Division of Rheumatology between November 2019 and June 2021. Demographics and clinical data including NLR, Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus disease activity index (SELENA-SLEDAI), Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), physician global assessment (PhGA), patient global assessment (PGA), patient health questionnaire (PHQ)-9, patient self-rated health, and lupus quality of life (LupusQoL) scores, were collected. Patients were stratified into two groups and compared using the NLR cut-off of 2.73, the 90th percentile value of healthy individuals. The analysis included t-test for continuous variables, χ2-test for categorical variables, and logistic regression adjusting for age, sex, BMI, and glucocorticoid use. Among the 134 SLE patients, 47 (35%) had an NLR ≥ 2.73. The NLR ≥ 2.73 group had significantly higher rates of severe depression (PHQ ≥ 15), poor/fair self-rated health, and the presence of damage (SDI ≥ 1). These patients also scored significantly lower in LupusQoL domains (physical health, planning, and body image), and higher in SELENA-SLEDAI, PhGA, and PGA. Logistic regression confirmed that high NLR is associated with severe depression (PHQ ≥ 15) (OR:7.23, 2.03-25.74), poor/fair self-rated health (OR:2.77,1.29-5.96), high SELENA-SLEDAI score(≥ 4) (OR:2.22,1.03-4.78), high PhGA (≥ 2) (OR:3.76, 1.56-9.05), and presence of damage (SDI ≥ 1) (OR:2.67, 1.11-6.43). High NLR in SLE may indicate depression, worse quality of life, active disease, and the presence of damage.
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Affiliation(s)
- Eleni Papachristodoulou
- Department of Medicine, University of Cyprus Medical School, Nicosia, Cyprus
- Department of Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Loukas Kakoullis
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Costas Christophi
- Department of Biostatistics and Epidemiology, Cyprus University of Technology, Limassol, Cyprus
| | - Savvas Psarelis
- Department of Rheumatology, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus
| | | | - Konstantinos Parperis
- Department of Internal Medicine, Division of Rheumatology, University of Cyprus Medical School, Palaios Dromos Lefkosias Lemesou No. 215/6, Aglantzia, 2029, Nicosia,, Cyprus.
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Li W, Kan H, Zhang W, Zhong Y, Liao W, Huang G, Wu P. Mendelian randomization study on the causal effects of systemic lupus erythematosus on major depressive disorder. J Hum Genet 2023; 68:11-16. [PMID: 36316471 DOI: 10.1038/s10038-022-01080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022]
Abstract
The vast majority of epidemiological studies suggested a link between systemic lupus erythematosus (SLE) and major depressive disorder (MDD). However, the causality for SLE on the risk of MDD remained unknown due to confounding factors or reverse causality. Herein, we investigated the causality between SLE and MDD in those of European ancestry by a Mendelian randomization (MR) approach. Summary genetic data of cases with SLE/MDD were derived from independent largest public genome-wide association study. Forty-six single nucleotide polymorphisms associated with SLE were used as instrumental variables. The main causal inference was carried out using the MRE-IVW method. Additional, reverse-direction MR and multivariable MR analyses were further performed. Result indicated that SLE was causally associated with a lower risk of MDD (using the MRE-IVW method, odds ratio [OR] = 0.983, 95% confidence interval [CI] = 0.974-0.991, p = 1.18 × 10-4). Complementary analysis found no heterogeneity or horizontal pleiotropy. Multivariate MR analysis yielded consistent results (OR = 0.981; 95% CI = 0.969-0.993; p = 2.75 × 10-3). Reverse-direction MR analysis suggested non-causal relationship of MDD on the risk of SLE (using the IVW method, OR = 0.846, 95% CI = 0.345-2.072; p = 0.714). Thus, this is the first study providing evidence of potential causal links between SLE and MDD and further related research is needed.
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Affiliation(s)
- Wenchang Li
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Hoktim Kan
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weizhe Zhang
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Yanlin Zhong
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Weiming Liao
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Guiwu Huang
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China. .,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.
| | - Peihui Wu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China. .,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.
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Shi Y, Bi D, Wang Y, Li R, Wu L, Zhao C, Wu Z, Duan X, Xu J, Zhan F, Yang M, Liu S, Li Q, Zhang S, Liu L, Zhao J, Tian X, Li X, Wang Q, Zeng X. Chinese SLE Treatment and Research Group Registry (CSTAR) XIV: the subjective well-being of patients with systemic lupus erythematosus. Front Med (Lausanne) 2022; 9:984183. [PMID: 36203761 PMCID: PMC9531862 DOI: 10.3389/fmed.2022.984183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Systemic lupus erythematosus (SLE) can significantly influence patients’ quality of life and subjective well-being (SWB), but the relationships between clinical characteristics, SWB, and related psychological factors have been little studied. Objective To measure SWB in patients with SLE and examine how major clinical determinants, emotional variables, and related positive factors affect SWB. Methods Overall, 1,110 patients with SLE from the Chinese SLE Treatment and Research Group (CSTAR) and 198 age and gender-matched individuals from the general population without self-reported SLE were invited to complete questionnaires of SWB evaluated by the satisfaction with life scale (SWLS), emotional variables assessed by the patient health questionnaire-9 (PHQ-9), and general anxiety disorder-7 (GAD-7) and related positive factors assessed by the self-esteem scale (SES), general self-efficacy scale (GESE), and Connor-Davidson resilience scale (CD-RISC). The multivariate linear regression was used to examine the relationship between clinical manifestations and SWB. Results Life satisfaction was significantly lower (p < 0.001) in patients with SLE than in the general population. Active skin involvement (OR = 0.923, 95% CI = 0.868–0.981, p < 0.05) was negatively associated with life satisfaction scores, and age at enrollment (OR = 1.160, 95% CI = 1.092–1.230, p < 0.001) were positively associated with life satisfaction scores in the multivariate regression model. The cumulative organ damage was significantly associated with depression (OR = 1.085, 95% CI = 1.022–1.153, p < 0.01) and the loss of self-esteem (OR = 1.067, 95% CI = 1.004–1.133, p < 0.05). Conclusion SWB provides useful insight into the impact of SLE on psychological health and opportunities to improve quality of life and clinical care.
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Affiliation(s)
- Yue Shi
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dandan Bi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, China
| | - Ruofan Li
- Department of International Education, The Experimental High School Attached to Beijing Normal University, Beijing, China
| | - Lijun Wu
- Department of Rheumatology, The People’s Hospital of Xinjiang Autonomous, Urumqi, China
| | - Cheng Zhao
- Department of Rheumatology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhenbiao Wu
- Department of Clinical Immunology and Rheumatology, Xijing Hospital Affiliated with The Fourth Military Medical University, Xi’an, China
| | - Xinwang Duan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jian Xu
- Department of Rheumatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Feng Zhan
- Department of Rheumatology, Hainan Provincial People’s Hospital, Haikou, China
| | - Min Yang
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shengyun Liu
- Department of Rheumatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qin Li
- Department of Rheumatology, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Shuo Zhang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Lingshan Liu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xinying Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Xinying Li,
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
- Qian Wang,
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Liao J, Kang J, Li F, Li Q, Wang J, Tang Q, Mao N, Li S, Xie X. A cross-sectional study on the association of anxiety and depression with the disease activity of systemic lupus erythematosus. BMC Psychiatry 2022; 22:591. [PMID: 36064377 PMCID: PMC9443011 DOI: 10.1186/s12888-022-04236-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects multiple systems and increases the risk of mental disorders such as depression and anxiety. We conducted an observational, single-center, cross-sectional study to investigate the relationship between depression, anxiety, and SLE disease activity. METHODS The Patient Health Questionnaire 9 (PHQ-9) was used to assess depression, and the 7-item Generalized Anxiety Disorders Scale was used to assess anxiety (GAD-7). Using the chi-square/exact Fisher's tests, socio-demographic data, clinical and other characteristics of SLE patients were compared between depression or anxiety and non-depression/non-anxiety groups. To identify optimal levels of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) for predicting depression or anxiety, receiver-operator curves (ROC) were drawn. RESULTS Among the 325 patients involved in this study, patients with depression or anxiety had significantly higher SLE activity (p < 0.001), and more frequent musculoskeletal (p < 0.05) and neuropsychiatric symptoms (p < 0.05). Depression and anxiety are more common in the moderate-severe active group than in the inactive-mild active group (depression: OR 3.350, 95%CI 2.015, 5.570, p < 0.001; anxiety: OR 4.085, 95%CI 2.493, 6.692, p < 0.001). The optimal SLEDAI cutoff value of 8.5 predicted depression with a sensitivity of 50.5% and a specificity of 78.4% (AUC 0.660, p < 0.001) and anxiety with a sensitivity of 54.2% and a specificity of 78.4% (AUC 0.684, p < 0.001). CONCLUSION SLE disease activity is positively associated with the severity of depression and anxiety. Those patients whose SLEDAI scores are greater than 8.5 are more likely to suffer from mental disorders which require additional attention to them.
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Affiliation(s)
- Jiafen Liao
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Jin Kang
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Fen Li
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Qi Li
- grid.207374.50000 0001 2189 3846Department of Cardiology, Heart Center of Henan Provincial People’s Hospital, Henan Key Laboratory for Coronary Heart Disease Prevention and Control, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan China
| | - Jia Wang
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Qi Tang
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Ni Mao
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Shu Li
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Xi Xie
- Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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9
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Nikoloudaki M, Repa A, Pitsigavdaki S, Molla Ismail Sali A, Sidiropoulos P, Lionis C, Bertsias G. Persistence of Depression and Anxiety despite Short-Term Disease Activity Improvement in Patients with Systemic Lupus Erythematosus: A Single-Centre, Prospective Study. J Clin Med 2022; 11:jcm11154316. [PMID: 35893407 PMCID: PMC9329785 DOI: 10.3390/jcm11154316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
Mental disorders such as anxiety and depression are prevalent in systemic lupus erythematosus (SLE) patients, yet their association with the underlying disease activity remains uncertain and has been mostly evaluated at a cross-sectional level. To examine longitudinal trends in anxiety, depression, and lupus activity, a prospective observational study was performed on 40 adult SLE outpatients with active disease (SLE Disease Activity Index [SLEDAI]-2K ≥ 3 [excluding serology]) who received standard-of-care. Anxiety and depression were determined at baseline and 6 months by the Hospital Anxiety and Depression Scale. Treatment adherence was assessed with the Morisky Medication Adherence Scale-4. Increased anxiety (median [interquartile range] HADS-A: 11.0 [7.8]) and depression (HADS-D: 8.0 [4.8]) were found at inclusion, which remained stable and non-improving during follow-up (difference: 0.0 [4.8] and −0.5 [4.0], respectively) despite reduced SLEDAI-2K by 2.0 (4.0) (p < 0.001). Among possible baseline predictors, paid employment—but not disease activity—correlated with reduced HADS-A and HADS-D with corresponding standardized beta-coefficients of −0.35 (p = 0.017) and −0.27 (p = 0.093). Higher anxiety and depression correlated with lower treatment adherence (p = 0.041 and p = 0.088, respectively). These results indicate a high-mental disease burden in active SLE that persists despite disease control and emphasize the need to consider socioeconomic factors as part of comprehensive patient assessment.
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Affiliation(s)
- Myrto Nikoloudaki
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Argyro Repa
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Sofia Pitsigavdaki
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Ainour Molla Ismail Sali
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Prodromos Sidiropoulos
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
- Institute of Molecular Biology and Biotechnology—FORTH, 71110 Heraklion, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, University of Crete Medical School, 71110 Heraklion, Greece;
| | - George Bertsias
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
- Institute of Molecular Biology and Biotechnology—FORTH, 71110 Heraklion, Greece
- Correspondence: ; Tel.: +30-2810-394635
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10
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Depression-, Pain-, and Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus. Int J Rheumatol 2022; 2022:6290736. [PMID: 35572065 PMCID: PMC9098355 DOI: 10.1155/2022/6290736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives. A significant number of patients with systemic lupus erythematosus (SLE) have depression, and many are untreated. We aim to assess the frequency of moderate to severe depression (MSD) in a multiethnic group of SLE patients with different sociodemographic backgrounds, identify modifiable factors associated with depression, and determine the impact of depression, disease activity, damage, cognitive function, and pain severity on health-related quality of life (HRQoL). Methods. Ninety-nine patients with SLE were evaluated in a cross-sectional study. Sociodemographic data, Beck Depression Inventory (BDI II), SLE disease activity index (SLEDAI-2K), SLICC Damage Index (SLICC-DI), pain severity (10 cm visual analogue scale), cognitive function (Automated Neuropsychologic Assessment Metrics (ANAM)), and the physical (PCS) and mental (MCS) component scores of the Short Form Health Survey (SF-36) were recorded. Bivariate analysis identified potential associations of relevant variables with BDI II and SF-36. Regression analysis determined independent correlates with MSD, PCS, and MCS. Results. Over 50% of subjects (50.5%) were African-American, 37.1% had a family income of ≤$20,000, and 31.3% had MSD. In the bivariate analysis, family income, SLEDAI-2K, cognitive function, and pain severity were associated with MSD. Using binary logistic regression, SLEDAI-2K and pain severity remained independently correlated with MSD (
). In the multiple linear regression analysis, pain severity was the only independent correlate of PCS (
), while cognitive function and BDI II were the main factors associated with MCS (
and
, respectively). Conclusion. Pain severity and disease activity are associated with MSD in our unique population, are potentially modifiable, and deserve further attention in the clinic. Depression and pain significantly affect HRQoL and should be aggressively managed.
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11
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Monahan RC, Middelkoop HAM, Beaart-van de Voorde LJJ, Fronczek R, Groenwold RHH, Kloppenburg M, Huizinga TWJ, Steup-Beekman GM. High Prevalence but Low Impact of Cognitive Dysfunction on Quality of Life in Patients With Lupus and Neuropsychiatric Symptoms. Arthritis Care Res (Hoboken) 2022; 75:1017-1025. [PMID: 35470979 DOI: 10.1002/acr.24904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/09/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the prevalence and impact of cognitive impairment on health-related-quality of life (HRQoL) in patients with systemic lupus erythematosus (SLE) and neuropsychiatric (NP) symptoms. METHODS Patients with SLE and NP symptoms referred to the Leiden NPSLE clinic (2007-2019) were included. In a multidisciplinary evaluation, NP symptoms were attributed to SLE (NPSLE: inflammatory, ischemic, or both combined) or other causes. Four cognitive domains were determined: global cognitive function (score 0-30), learning and memory, executive function and complex attention, and psychomotor speed (all T scores). HRQoL was determined using the mental component score and physical component score of the Short Form 36 health survey. The associations between cognition and NPSLE phenotype and cognition and HRQoL were assessed with multiple regression analyses and linear mixed models corrected for confounding and expressed in SDs. RESULTS A total of 357 patients (86% female, mean age 44 years) were included. Of those 357 patients, 169 had a follow-up visit (median follow-up 11 months). Impairment in global cognitive function was present in 8% of patients, and in all other cognitive domains in ±50%. The most severe impairment (all domains) was seen in patients with a combined NPSLE phenotype. Diffuse cognitive impairment (learning and memory, executive function and complex attention, and psychomotor speed) was most common and was present more often in patients with an inflammatory phenotype. A weak association between cognition and HRQoL was found both cross-sectionally and longitudinally. In general, 1 SD lower scores on the cognitive domains were associated with at most one-fifth SD lower HRQoL. CONCLUSION Objective cognitive impairment is common in SLE patients with NP symptoms, but may have a limited influence on HRQoL.
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Affiliation(s)
- Rory C Monahan
- Leiden University Medical Center, Leiden, The Netherlands
| | - Huub A M Middelkoop
- Leiden University Medical Center and Leiden University, Leiden, The Netherlands
| | | | | | | | | | | | - Gerda M Steup-Beekman
- Leiden University Medical Center, Leiden, and Haaglanden Medical Center, The Hague, The Netherlands
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12
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Parodis I, Studenic P. Patient-Reported Outcomes in Systemic Lupus Erythematosus. Can Lupus Patients Take the Driver's Seat in Their Disease Monitoring? J Clin Med 2022; 11:jcm11020340. [PMID: 35054036 PMCID: PMC8778558 DOI: 10.3390/jcm11020340] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/04/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that has detrimental effects on patient’s health-related quality of life (HRQoL). Owing to its immense heterogeneity of symptoms and its complexity regarding comorbidity burden, management of SLE necessitates interdisciplinary care, with the goal being the best possible HRQoL and long-term outcomes. Current definitions of remission, low disease activity, and response to treatment do not incorporate self-reported patient evaluation, while it has been argued that the physician’s global assessment should capture the patient’s perspective. However, even the judgment of a very well-trained physician might not replace a patient-reported outcome measure (PROM), not only owing to the multidimensionality of self-perceived health experience but also since this notion would constitute a direct contradiction to the definition of PROMs. The proper use of PROMs is not only an important conceptual issue but also an opportunity to build bridges in the partnership between patients and physicians. These points of consideration adhere to the overall framework that there will seldom be one single best marker that helps interpret the activity, severity, and impact of SLE at the same time. For optimal outcomes, we not only stress the importance of the use of PROMs but also emphasize the urgency of adoption of the conception of forming alliances with patients and facilitating patient participation in surveillance and management processes. Nevertheless, this should not be misinterpreted as a transfer of responsibility from healthcare professionals to patients but rather a step towards shared decision-making.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 171 76 Stockholm, Sweden;
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
- Correspondence: ; Tel.: +46-722321322
| | - Paul Studenic
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 171 76 Stockholm, Sweden;
- Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, 1090 Vienna, Austria
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