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Muñoz-Grajales C, Yilmaz EB, Svenungsson E, Touma Z. Systemic lupus erythematosus and damage: What has changed over the past 20 years? Best Pract Res Clin Rheumatol 2023; 37:101893. [PMID: 37993371 DOI: 10.1016/j.berh.2023.101893] [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: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 11/24/2023]
Abstract
The young age of onset and chronic/relapsing nature of systemic lupus erythematosus (SLE) make SLE patients prone to develop and accrue organ damage as a result of long-standing disease activity and side effects of treatment. There is a growing interest in objectifying damage and identifying its risk factors. Still, the lack of therapeutic alternatives has led to difficulties in avoiding immunosuppressives particularly corticosteroids, which have been implicated in a large spectrum of organ damage in SLE patients. Moreover, it continues to be very challenging to determine what actually causes damage in different organ-systems. Cardiovascular disease continues to be one of the leading types of damage in patients with SLE, reported as early as 1976. Since then, many researchers have focused on identifying SLE or treatment-related and traditional risk factors. The same considerations are valid for other conditions, such as the occurrence of metabolic syndrome, osteoporosis, avascular necrosis, susceptibility to infections, etc. On the other hand, diverse risk factors contribute to the development of chronic kidney disease (CKD) in SLE. Most evidence suggests that high initial levels of serum creatinine, hypocomplementemia, nephrotic range proteinuria, concomitant uncontrolled hypertension, Black and Hispanic ancestry, non-adherence to treatment, and biopsy findings such as diffuse proliferative lupus nephritis (LN), a high chronicity index, tubular atrophy, and tubulointerstitial inflammation are risk factors for progression to end stage renal disease (ESRD) in LN. While cardiovascular disease, CKD and infections are leading causes of mortality in patients with SLE, hospitalizations are caused mostly by SLE disease flares and infections. Cognitive impairment and mood disorders are common in SLE but continue to impose a challenge on how to measure, manage and decipher the underlying pathogenesis. Nevertheless, they have a great impact on SLE patients' health-related quality of life (HRQoL) and social functioning. Also, skin manifestations, such as alopecia and scaring, cataracts, and sicca symptoms result in a significant decrease in HRQoL. In light of recent developments in SLE treatment, we can expect to enter a period of new-age targeted therapies that will enable us to reduce disease activity and glucocorticoid usage further and positively alter the trajectory of damage development and accrual in SLE.
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Affiliation(s)
- Carolina Muñoz-Grajales
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Division of Rheumatology, University of Toronto, Toronto, Canada; University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital Lupus Clinic, Toronto, Canada
| | - Esin Beste Yilmaz
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabet Svenungsson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Zahi Touma
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Division of Rheumatology, University of Toronto, Toronto, Canada; University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital Lupus Clinic, Toronto, Canada.
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Ichikawa T, Kishida D, Shimojima Y, Yajima N, Oguro N, Yoshimi R, Sakurai N, Hidekawa C, Sada KE, Miyawaki Y, Hayashi K, Shidahara K, Ishikawa Y, Sekijima Y, Kurita N. Impact of online health information-seeking behavior on shared decision-making in patients with systemic lupus erythematosus: The TRUMP 2-SLE project. Lupus 2023; 32:1258-1266. [PMID: 37651318 DOI: 10.1177/09612033231200104] [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] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Providing appropriate health information to patients with systemic lupus erythematosus (SLE) is advantageous in the treatment decision-making process. We aimed to investigate how online health information-seeking behaviors affect shared decision-making (SDM) in patients with SLE. METHODS This cross-sectional study included 464 patients with SLE from five institutions. The main exposure was time spent on the internet per day, divided into four categories (none, <1 h, 1- < 2 h, ≥2 h). Participants categorized their preferred first source of health information as physicians, the internet, or other media. The outcome was the degree of SDM measured via the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). A general linear model was applied. RESULTS Compared to no internet use, longer internet use was associated with a higher SDM-Q-9 score: <1 h, 6.9 points (95% confidence interval [CI] 0.32 to 13.6) and ≥2 h, 8.75 points, (95% CI 0.61 to 16.9). The SDM-Q-9 did not differ between the individuals who chose physicians and those who chose the Internet as their preferred first source of health information (-2.1 points, 95% CI -6.7 to 2.6). Individuals who chose other media had significantly lower SDM-Q-9 scores than those who chose physicians (-7.6 points, 95% CI -13.2 to -1.9). CONCLUSIONS The present study suggests that SDM between physicians and patients is positively associated with online information-seeking behavior, with no negative influence associated with accessing the Internet before clinical consultations. Rheumatologists may need to introduce their patients to websites offering high-quality health information to establish a good physician-patient relationship for SDM.
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Affiliation(s)
- Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), School of Medicine, Shinshu University, Matsumoto, Japan
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), School of Medicine, Shinshu University, Matsumoto, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), School of Medicine, Shinshu University, Matsumoto, Japan
| | - Nobuyuki Yajima
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Nao Oguro
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Natsuki Sakurai
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Chiharu Hidekawa
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
- Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku
| | - Yoshia Miyawaki
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Keigo Hayashi
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Kenta Shidahara
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Yuichi Ishikawa
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
- School of Health Innovation, Kanagawa University of Human Services Graduate School, Kawasaki, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), School of Medicine, Shinshu University, Matsumoto, Japan
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan
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Minhas D, Marder W, Hassett AL, Zick SM, Gordon C, Harlow SD, Wang L, Barbour KE, Helmick CG, McCune WJ, Somers EC. Cost-related prescription non-adherence and patient-reported outcomes in systemic lupus erythematosus: The Michigan Lupus Epidemiology & Surveillance program. Lupus 2023; 32:1075-1083. [PMID: 37378450 PMCID: PMC10585710 DOI: 10.1177/09612033231186113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
OBJECTIVES Medication access and adherence play key roles in determining patient outcomes. We investigated whether cost-related non-adherence (CRNA) to prescription medications was associated with worse patient-reported outcomes in a population-based systemic lupus erythematosus (SLE) cohort. METHODS Sociodemographic and prescription data were collected by structured interviews in 2014-2015 from patients meeting SLE criteria in the established Michigan Lupus Epidemiology & Surveillance (MILES) Cohort. We examined the associations between CRNA and potential confounders such as sociodemographics and health insurance coverage, and outcome measures of SLE activity and damage using multivariable linear regression. RESULTS 462 SLE participants completed the study visit: 430 (93.1%) female, 208 (45%) Black, and mean age 53.3 years. 100 (21.6%) participants with SLE reported CRNA in the preceding 12 months. After adjusting for covariates, CRNA was associated with both higher levels of current SLE disease activity [SLAQ: β coeff 2.7 (95% CI 1.3, 4.1), p < 0.001] and damage [LDIQ β coeff 1.4 (95% CI 0.5, 2.4), p = 0.003]. Race, health insurance status, and fulfilling Fibromyalgia (FM) Survey Criteria were independently associated with both higher (worse) SLAQ and LDIQ scores; female sex was further associated with higher SLAQ scores. CONCLUSION Patients with SLE who reported CRNA in the previous 12 months had significantly worse self-reported current disease activity and damage scores compared to those not reporting CRNA. Raising awareness and addressing barriers or concerns related to financial implications and accessibility issues in care plans may help to improve these outcomes.
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Affiliation(s)
- Deeba Minhas
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Wendy Marder
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Suzanna M Zick
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sioban D Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Lu Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - W Joseph McCune
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily C Somers
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
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Chauhan A, Bunting H, Dubey S. Adherence with mycophenolate mofetil in patients with autoimmune inflammatory rheumatic diseases in coventry: Signs of progress but challenges remain. Musculoskeletal Care 2023; 21:426-433. [PMID: 36367150 DOI: 10.1002/msc.1712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The study investigated adherence with MMF treatment among patients attending rheumatology clinics at University Hospitals Coventry and Warwickshire NHS Trust (UHCW) with Autoimmune inflammatory rheumatic diseases (AIIRDs). METHODS This retrospective study collated hospital pharmacy data in patients who requested the prescription for MMF between January 2015 and December 2018. Clinical data were obtained from paper and electronic notes. Data were analysed using Microsoft Excel. Ethical approval was obtained through Coventry University. RESULTS We recruited 144 patients into this study with age range from 18 to 91 years, including 100 females and 44 males. There were 112 White patients, 22 of South Asian origin, 3 East Asian and 4 black patients. SLE (56), scleroderma (18), mixed connective tissue disease (15), myositis (13), vasculitis (13) were the commonest diagnoses. Overall adherence with Mycophenolate mofetil was 62%. The adherence rates were below 80% for all age groups with ∼60% of patients having adherence levels of >60%. Poor adherence with MMF correlated with 3-fold increase in risk of flares compared to good adherence (p = 0.002). We also found a significant difference between Asian patients (mean adherence 47%) and White patients (mean adherence 65%, p < 0.001). CONCLUSION Adherence with MMF has improved considerably compared to historical studies, although these remain suboptimal. Certain population groups such as young adults, elderly and Asian patients continue to have lower adherence and higher risk of flares. Strategies are needed to improve adherence levels overall and specifically in the high-risk groups to reduce risk of flares and organ damage.
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Affiliation(s)
- Aarti Chauhan
- Department of Biomedical Science, Coventry University, Coventry, UK
| | - Helen Bunting
- Department of Rheumatology, Advanced Nurse Practitioner, Nuffield Orthopaedic Centre, Oxford, UK
| | - Shirish Dubey
- Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Falasinnu T, Bao G, Brady TJ, Lim SS, Drenkard C. Factors Associated With the Initiation and Retention of Patients With Lupus in the Chronic Disease Self-Management Program. Arthritis Care Res (Hoboken) 2023; 75:519-528. [PMID: 34738339 PMCID: PMC9065209 DOI: 10.1002/acr.24811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/05/2021] [Accepted: 10/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The Chronic Disease Self-Management Program (CDSMP) is designed to enhance patients' self-efficacy and skills to manage their chronic illness. There is compelling evidence for the benefits of the CDSMP among patients with systemic lupus erythematosus (SLE); however, little is known about predictors of participation among Black women with SLE. We examined factors associated with CDSMP initiation and completion in this population. METHODS We studied 228 Black women with SLE who consented to attend a CDSMP workshop. We used logistic regression to calculate unadjusted and adjusted odds ratios (ORs) for being a CDSMP initiator (a participant registered into the CDSMP who attended at least 1 of the first 2 weekly classes) and a CDSMP completer (a participant who completed at least 4 of 6 weekly classes). RESULTS The majority of participants were CDSMP initiators (74% [n = 168]). Of those, 126 (75%) were CDSMP completers. Older age (adjusted OR [ORadj ] 1.03 [95% confidence interval (95% CI) 1.00-1.06]) and unemployment/disability (ORadj 2.05 [95% CI 1.05-4.14]) increased the odds of being a CDSMP initiator. The odds of initiating the CDSMP decreased by 22% for each additional child in the household (OR 0.78 [95% CI 0.62-0.98]), but this association became nonsignificant in the adjusted model (ORadj 0.89 [95% CI 0.68-1.18]). The only factor that differed significantly between CDSMP completers and noncompleters was age, with 4% higher odds of being a completer for each additional year of age (ORadj 1.04 [95% CI 1.00-1.07]). CONCLUSION Our findings suggest that young Black women with SLE face barriers to attend and complete in-person CDSMP workshops, possibly in relation to work and child care demands.
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Affiliation(s)
| | | | | | - S Sam Lim
- Emory University and Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cristina Drenkard
- Emory University and Rollins School of Public Health, Emory University, Atlanta, Georgia
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Sun K, Eudy AM, Rogers JL, Criscione-Schreiber LG, Sadun RE, Doss J, Maheswaranathan M, Barr AC, Eder L, Corneli AL, Bosworth HB, Clowse ME. Pilot Intervention to Improve Medication Adherence Among Patients With Systemic Lupus Erythematosus Using Pharmacy Refill Data. Arthritis Care Res (Hoboken) 2023; 75:550-558. [PMID: 34739191 PMCID: PMC9068832 DOI: 10.1002/acr.24806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/07/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Despite high rates of medication nonadherence among patients with systemic lupus erythematosus (SLE), effective interventions to improve adherence in SLE are limited. We aimed to assess the feasibility of a pilot intervention and explore its effect on adherence. METHODS The intervention used pharmacy refill data to monitor nonadherence and prompt discussions surrounding SLE medications during clinic encounters. Over 12 weeks, the intervention was delivered through routine clinic visits by providers to patients with SLE who take SLE-specific medications. We measured acceptability, appropriateness, and feasibility using provider surveys. We also measured acceptability by patient surveys and feasibility by medical record documentation. We explored change in adherence by comparing percent of patients with medication possession ratio (MPR) ≥80% 3 months before and after the intervention visit using the McNemar's test. RESULTS Six rheumatologists participated; 130 patients were included in the analysis (median age 43, 95% female, and 59% racial and ethnic minorities). Implementation of the intervention was documented in 89% of clinic notes. Provider surveys showed high scores for feasibility (4.7/5), acceptability (4.4/5), and appropriateness (4.6/5). Among patient surveys, the most common reactions to the intervention visit were feeling determined (32%), empowered (32%), and proud (19%). Proportion of patients with MPR ≥80% increased from 48% to 58% (P = 0.03) after the intervention visit. CONCLUSION Our intervention showed feasibility, acceptability, and appropriateness and led to a statistically significant improvement in adherence. Future work should refine the intervention, assess its efficacy in a controlled setting, and adapt its use among other clinic settings.
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Affiliation(s)
- Kai Sun
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Amanda M. Eudy
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer L. Rogers
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Rebecca E. Sadun
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jayanth Doss
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Mithu Maheswaranathan
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Ann Cameron Barr
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Lena Eder
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Amy L. Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hayden B. Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Megan E.B. Clowse
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Sun K, Corneli AL, Dombeck C, Swezey T, Rogers JL, Criscione-Schreiber LG, Sadun RE, Eudy AM, Doss J, Bosworth HB, Clowse MEB. Barriers to Taking Medications for Systemic Lupus Erythematosus: A Qualitative Study of Racial Minority Patients, Lupus Providers, and Clinic Staff. Arthritis Care Res (Hoboken) 2022; 74:1459-1467. [PMID: 33662174 PMCID: PMC8417148 DOI: 10.1002/acr.24591] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/18/2021] [Accepted: 03/02/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Underrepresented racial and ethnic minorities are disproportionately affected by systemic lupus erythematosus (SLE). Racial and ethnic minorities also have more severe SLE manifestations that require use of immunosuppressive medications, and often have lower rates of medication adherence. We aimed to explore barriers of adherence to SLE immunosuppressive medications among minority SLE patients. METHODS We conducted a qualitative descriptive study using in-depth interviews with a purposive sample of racial minority SLE patients taking oral immunosuppressants (methotrexate, azathioprine, or mycophenolate), and lupus clinic providers and staff. Interviews were audiorecorded, transcribed, and analyzed using applied thematic analysis. We grouped themes using the Capability, Opportunity, Motivation, Behavior conceptual model. RESULTS We interviewed 12 SLE patients (4 adherent, 8 nonadherent) and 12 providers and staff. We identified capability barriers to include external factors related to acquiring medications, specifically cost-, pharmacy-, and clinic-related issues; opportunity barriers to include external barriers to taking medications, specifically logistic- and medication-related issues; and motivation factors to include intrinsic barriers, encompassing patients' knowledge, beliefs, attitudes, and physical and mental health. The most frequently described barriers were cost, side effects, busyness/forgetting, and lack of understanding, although barriers differed by patient and adherence level, with logistic and intrinsic barriers described predominantly by nonadherent patients and side effects described predominantly by adherent patients. CONCLUSION Our findings suggest that interventions may be most impactful if they are designed to facilitate logistics of taking medications and increase patients' motivation while allowing for personalization to address the individual differences in adherence barriers.
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Affiliation(s)
- Kai Sun
- Duke University Hospital and Duke University School of Medicine, Durham, North Carolina
| | - Amy L Corneli
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina
| | - Carrie Dombeck
- Duke University School of Medicine, Durham, North Carolina
| | - Teresa Swezey
- Duke University School of Medicine, Durham, North Carolina
| | - Jennifer L Rogers
- Duke University Medical Center and Duke University School of Medicine, Durham, North Carolina
| | | | | | - Amanda M Eudy
- Duke University Medical Center and Duke University School of Medicine, Durham, North Carolina
| | - Jayanth Doss
- Duke University School of Medicine, Durham, North Carolina
| | - Hayden B Bosworth
- Duke University School of Medicine and Durham Veterans Administration Medical Center, Durham, North Carolina
| | - Megan E B Clowse
- Duke University Medical Center and Duke University School of Medicine, Durham, North Carolina
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Garg S, Chewning B, Gazeley D, Gomez S, Kaitz N, Weber AC, Rosenthal A, Bartels C. Patient and healthcare team recommended medication adherence strategies for hydroxychloroquine: results of a qualitative study informing intervention development. Lupus Sci Med 2022; 9:9/1/e000720. [PMID: 35914839 PMCID: PMC9345084 DOI: 10.1136/lupus-2022-000720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/19/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Patients identified as black and from disadvantaged backgrounds have a twofold higher hydroxychloroquine (HCQ) non-adherence, which contributes to worse lupus outcomes and disparities. Yet, most adherence interventions lack tailored strategies for racially and socioeconomically diverse patients who face unique challenges with HCQ. We aimed to examine a broadly representative group of patients with SLE and physician perspectives on HCQ adherence and adherence strategies to redesign an adherence intervention. METHODS We conducted four virtual focus groups (90 min each) with 11 racially and socioeconomically diverse patients with SLE recruited from two health systems. Additionally, we hosted two focus group meetings with nine healthcare advisors. In focus groups, patients: (1) shared their perspectives on using HCQ; (2) shared concerns leading to non-adherence; (3) discussed strategies to overcome concerns; (4) prioritised strategies from the most to least valuable to inform an adherence intervention. In two separate focus groups, healthcare advisors gave feedback to optimise an adherence intervention. Using content analysis, we analysed transcripts to redesign our adherence intervention. RESULTS Worry about side effects was the most common barrier phrase mentioned by patients. Key themes among patients' concerns about HCQ included: information gaps, logistical barriers, misbeliefs and medication burden. Finally, patients suggested adherence strategies and ranked those most valuable including co-pay assistance, personal reminders, etc. Patient and healthcare advisors informed designing a laminate version of an adherence intervention to link each barrier category with four to six patient-recommended adherence strategies. CONCLUSION We developed a patient stakeholder-informed and healthcare stakeholder-informed tailored intervention that will target non-adherence at the individual patient level.
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Affiliation(s)
- Shivani Garg
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Betty Chewning
- Department of Pharmacy, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA
| | - David Gazeley
- Department of Medicine, Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shelby Gomez
- Department of Pharmacy, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA
| | - Noah Kaitz
- Department of Pharmacy, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA
| | - Amanda C Weber
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ann Rosenthal
- Department of Medicine, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christie Bartels
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Drenkard C, Fuentes-Silva Y, Parente Costa Seguro L, Torres dos Reis-Neto E, Ibañez S, Elera-Fitzcarrald C, Reategui-Sokolova C, Linhares FA, Bermúdez W, Ferreyra-Garrot L, Acosta C, Caballero-Uribe CV, Sato EI, Bonfa E, Pons-Estel BA. Let's Talk About Lupus. Overview of an Innovative, High-Reach, Online Program to Fill the Education Gaps of Latin Americans Living With Lupus. J Clin Rheumatol 2022; 28:e368-e374. [PMID: 34014052 PMCID: PMC8860199 DOI: 10.1097/rhu.0000000000001728] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE The Latin American population living with lupus lacks reliable and culturally competent health education resources. We describe a Spanish and Portuguese online program to educate Latin American people about lupus. METHODS An extensive network of Latin American stakeholders participated in the program design, implementation, dissemination, and evaluation. Patients and rheumatologists selected core topics. Rheumatologists prepared the content using evidence-based data. Adaptations were conducted to meet the audience's health literacy and cultural values. Social media was used to post audiovisual resources and facilitate users' interactions with peers and educators, and a Web site was created to offer in-depth knowledge. RESULTS The most massive outreach was through Facebook, with more than 20 million people reached and 80,000 followers at 3 months, between the Spanish and Portuguese pages. Nearly 90% of followers were from Latin America. A high engagement and positive responses to a satisfaction survey indicate that Facebook users valued these resources. The Spanish and Portuguese Web sites accumulated more than 62,000 page views, and 71.7% of viewers were from Latin American. CONCLUSIONS The engagement of patients and stakeholders is critical to provide and disseminate reliable lupus education. Social media can be used to educate and facilitate interactions between people affected by lupus and qualified health care professionals. Social media-based health education has extensive and scalable outreach but is more taxing for the professional team than the Web site. However, the Web site is less likely to be used as a primary education source by Latin American people because they value social interactions when seeking lupus information.
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Affiliation(s)
- Cristina Drenkard
- From the Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | | | - Carlota Acosta
- Hospital Universitario “Ruiz y Paez,” Ciudad Bolivar, Venezuela
| | | | - Emilia Inoue Sato
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo
| | - Bernardo A. Pons-Estel
- Grupo Oroño. Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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10
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Jorge AM, Lao T, Kim R, Licciardi S, El Khoury J, Luster AD, Means TK, Ramirez-Ortiz ZG. SCARF1-Induced Efferocytosis Plays an Immunomodulatory Role in Humans, and Autoantibodies Targeting SCARF1 Are Produced in Patients with Systemic Lupus Erythematosus. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 208:955-967. [PMID: 35082161 PMCID: PMC8852219 DOI: 10.4049/jimmunol.2100532] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/02/2021] [Indexed: 12/20/2022]
Abstract
Deficiency in the clearance of cellular debris is a major pathogenic factor in the emergence of autoimmune diseases. We previously demonstrated that mice deficient for scavenger receptor class F member 1 (SCARF1) develop a lupus-like autoimmune disease with symptoms similar to human systemic lupus erythematosus (SLE), including a pronounced accumulation of apoptotic cells (ACs). Therefore, we hypothesized that SCARF1 will be important for clearance of ACs and maintenance of self-tolerance in humans, and that dysregulation of this process could contribute to SLE. In this article, we show that SCARF1 is highly expressed on phagocytic cells, where it functions as an efferocytosis receptor. In healthy individuals, we discovered that engagement of SCARF1 by ACs on BDCA1+ dendritic cells initiates an IL-10 anti-inflammatory response mediated by the phosphorylation of STAT1 and STAT3. Unexpectedly, there was no significant difference in SCARF1 expression in samples of patients with SLE compared with healthy donor samples. However, we detected anti-SCARF1 autoantibodies in 26% of patients with SLE, which was associated with dsDNA Ab positivity. Furthermore, our data show a direct correlation of the levels of anti-SCARF1 in the serum and defects in the removal of ACs. Depletion of Ig restores efferocytosis in SLE serum, suggesting that defects in the removal of ACs are partially mediated by SCARF1 pathogenic autoantibodies. Our data demonstrate that human SCARF1 is an AC receptor in dendritic cells and plays a role in maintaining tolerance and homeostasis.
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Affiliation(s)
- April M Jorge
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA
| | - Taotao Lao
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA
| | - Rachel Kim
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA
| | - Samantha Licciardi
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA; and
| | - Joseph El Khoury
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA
| | - Andrew D Luster
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA
| | - Terry K Means
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA
- Autoimmunity Cluster, Immunology & Inflammation Research Therapeutic Area, Sanofi, Cambridge, MA
| | - Zaida G Ramirez-Ortiz
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA;
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA; and
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11
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Drenkard C, Easley K, Bao G, Dunlop-Thomas C, Lim SS, Brady T. Overcoming barriers to recruitment and retention of African-American women with SLE in behavioural interventions: lessons learnt from the WELL study. Lupus Sci Med 2021; 7:7/1/e000391. [PMID: 32532797 PMCID: PMC7295441 DOI: 10.1136/lupus-2020-000391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
Background African–Americans are historically under-represented in SLE studies and engaging them in behavioural interventions is challenging. The Women Empowered to Live with Lupus (WELL) study is a trial conducted to examine the effectiveness of the Chronic Disease Self-Management Program (CDSMP) among African–American women with SLE. We describe enrolment and retention challenges and successful strategies of the WELL study. Methods The Georgians Organized Against Lupus (GOAL) cohort, a population-based cohort established in Atlanta, Georgia, was used to enrol a sample of 168 African–American women with SLE into the CDSMP. The CDSMP is a 6-week, group-based programme led by peers to enhance self-management skills in people with chronic conditions. Study performance standards were predefined and close monitoring of recruitment and retention progress was conducted by culturally competent staff members. Continuous contact with participants, research coordinators’ notes and regular research team meetings served to assess barriers and define strategies needed to meet the desired recruitment and retention outcomes. Results While no substantial barriers were identified to enrol GOAL participants into the WELL study, WELL participants faced difficulties registering for and/or completing (attending ≥4 sessions) a CDSMP workshop. Major barriers were unpredicted personal and health-related issues, misunderstanding of the scope and benefits of the intervention, and transportation problems. Early implementation of tailored strategies (eg, CDSMP scheduled on Saturdays, CDSMP delivered at convenient/familiar facilities, transportation services) helped to reduce participant barriers and achieve a CDSMP registration of 168 participants, with 126 (75%) completers. Frequent contact with participants and compensation helped to reach 92.3% retention for the 6-month survey. Conclusions Predefined standards and monitoring of participant barriers by a culturally competent research team and proactive solutions were critical to implementing successful strategies and achieving the desired recruitment and retention outcomes of a behavioural trial involving African–American women with SLE. Trial registration number NCT02988661.
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Affiliation(s)
- Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Gaobin Bao
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charmayne Dunlop-Thomas
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Teresa Brady
- Clarity Consulting and Communications, Atlanta, Georgia, USA
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12
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Andreoletti G, Lanata CM, Trupin L, Paranjpe I, Jain TS, Nititham J, Taylor KE, Combes AJ, Maliskova L, Ye CJ, Katz P, Dall'Era M, Yazdany J, Criswell LA, Sirota M. Transcriptomic analysis of immune cells in a multi-ethnic cohort of systemic lupus erythematosus patients identifies ethnicity- and disease-specific expression signatures. Commun Biol 2021; 4:488. [PMID: 33883687 PMCID: PMC8060402 DOI: 10.1038/s42003-021-02000-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/17/2021] [Indexed: 02/02/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease in which outcomes vary among different racial groups. We leverage cell-sorted RNA-seq data (CD14+ monocytes, B cells, CD4+ T cells, and NK cells) from 120 SLE patients (63 Asian and 57 White individuals) and apply a four-tier approach including unsupervised clustering, differential expression analyses, gene co-expression analyses, and machine learning to identify SLE subgroups within this multiethnic cohort. K-means clustering on each cell-type resulted in three clusters for CD4 and CD14, and two for B and NK cells. To understand the identified clusters, correlation analysis revealed significant positive associations between the clusters and clinical parameters including disease activity as well as ethnicity. We then explored differentially expressed genes between Asian and White groups for each cell-type. The shared differentially expressed genes across cells were involved in SLE or other autoimmune-related pathways. Co-expression analysis identified similarly regulated genes across samples and grouped these genes into modules. Finally, random forest classification of disease activity in the White and Asian cohorts showed the best classification in CD4+ T cells in White individuals. The results from these analyses will help stratify patients based on their gene expression signatures to enable SLE precision medicine.
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Affiliation(s)
- Gaia Andreoletti
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - Cristina M Lanata
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laura Trupin
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ishan Paranjpe
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - Tia S Jain
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - Joanne Nititham
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kimberly E Taylor
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alexis J Combes
- Department of Pathology, University of California San Francisco, San Francisco, USA
- ImmunoX Initiative, University of California San Francisco, San Francisco, CA, USA
- UCSF CoLabs, University of California San Francisco, San Francisco, CA, USA
| | - Lenka Maliskova
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Chun Jimmie Ye
- ImmunoX Initiative, University of California San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Patricia Katz
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Maria Dall'Era
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lindsey A Criswell
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA.
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13
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Leung J, Baker EA, Kim AHJ. Exploring intentional medication non-adherence in patients with systemic lupus erythematosus: the role of physician-patient interactions. Rheumatol Adv Pract 2021; 5:rkaa078. [PMID: 33604502 PMCID: PMC7878846 DOI: 10.1093/rap/rkaa078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023] Open
Abstract
Objective Medication non-adherence contributes to worse health outcomes among SLE patients. The underlying mechanisms that drive medication non-adherence are poorly understood. The purpose of this study was to explore possible mechanisms of medication non-adherence by eliciting patient experiences. Methods Consented adult patients with ACR- or SLICC-classified SLE were recruited. Ten semi-structured interviews were conducted across six participants. Interviews were audio recorded, transcribed, and analysed using an iterative process. The findings were presented to an interactive public forum with SLE patients, family members and friends of patients, and health-care professionals to assess validity and for elaboration of the concepts developed. Results The following three interrelated themes emerged from the interviews. First, why do rheumatologists not know more about lupus or share what they do know with their patients? Second, why do I have to take so many drugs and why do the drugs not work? Third, if my rheumatologist cannot communicate with me, why should I follow the prescribed medication regimen? Conclusion Our exploratory findings lay out a possible underlying logic by which patients might choose intentionally to engage with medication non-adherence behaviours. Patients suggested that poor communication with their rheumatologists along with a lack of validation of their symptoms contributed to them not valuing the recommendations of physicians. This also contributed to development of a cynical outlook and little belief that medication would improve their condition. Although further work is needed to validate these findings, our preliminary work suggests that interventions focusing on the development of communication skills among both patients and rheumatologists are necessary to reduce medication non-adherence.
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Affiliation(s)
- Jerik Leung
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University
| | - Elizabeth A Baker
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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14
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Voshaar MJH, Vriezekolk JE, van Dulmen AM, van den Bemt BJF, van de Laar MAFJ. Ranking facilitators and barriers of medication adherence by patients with inflammatory arthritis: a maximum difference scaling exercise. BMC Musculoskelet Disord 2021; 22:21. [PMID: 33407344 PMCID: PMC7786955 DOI: 10.1186/s12891-020-03874-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/14/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Facilitators and barriers of adherence to disease-modifying anti-rheumatic drugs (DMARDs) have been identified by patients with inflammatory arthritis earlier. However, the relative importance from the patients’ perspective of these factors is unknown. Knowledge on this ranking might guide the development of interventions and may facilitate targeted communication on adherence. This study aims to examine 1) the relative importance patients attach to facilitators and barriers for DMARDs adherence, and 2) the relationship between patient characteristics and ranking of these factors. Methods One hundred twenty-eight outpatients with inflammatory arthritis; (60% female, mean age 62 years (SD = 12), median disease duration 15 years, IQR (7, 23) participated in a Maximum Difference scaling exercise and ranked 35 items based upon previously identified facilitators and barriers to medication adherence. Hierarchical Bayes estimation was used to compute mean Rescaled Probability Scores (RPS; 0–100) (i.e. relative importance score). Kendall’s coefficient of concordance was used to examine a possible association between patients’ characteristics (i.e. age, sex and educational level) and ranking of the items. Results The three most important items ranked by patients were: Reduction of symptoms formulated as “Arthritis medications help to reduce my symptoms” (RPS = 7.30, CI 7.17–7.44), maintaining independence formulated as “I can maintain my independence as much as possible” (RPS = 6.76, CI 6.54–6.97) and Shared decision making formulated as “I can decide –together with my physician- about my arthritis medications” (RPS = 6.48, CI 6.24–6.72). No associations between patient characteristics and ranking of factors were found. Conclusions Reducing symptoms, maintaining independency and shared decision making are patients’ most important factors for DMARDs adherence. This knowledge might guide the development of interventions and may facilitate communication between health professionals and their patients on medication adherence.
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Affiliation(s)
- M J H Voshaar
- Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
| | - J E Vriezekolk
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - A M van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Faculty of Health and Social Sciences, University of South- Eastern Norway, Drammen, Norway
| | - B J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, RadboudUMC, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M A F J van de Laar
- Arthritis Centre Twente, Medisch Spectrum Twente & University of Twente, P.O box 50,000, 7500, KA, Enschede, The Netherlands
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15
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Sae-Lim O, Laobandit I, Kitchanwit P, Laichapis M, Siripaitoon B. Prevalence and associated factors of medication nonadherence among Thai patients with systemic lupus erythematosus. Lupus 2020; 30:352-359. [PMID: 33176565 DOI: 10.1177/0961203320973072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic disease requiring complex treatment strategies to prevent disease flare ups and to reduce hospitalizations. Medication adherence is the main concern for improving patient outcomes. Although various studies on medication nonadherence for SLE have been conducted, no definite conclusions have been reached. OBJECTIVE To quantify the prevalence of medication nonadherence among patients with SLE and to analyse the associated factors. METHODS A prospective, self-reported questionnaire study was conducted in Songklanagarind Hospital. Patient aged 18 years or older, who had an established diagnosis of SLE, and who had been receiving medications for at least 6 months, were included in the study. Medication adherence was assessed through a visual analogue scale (VAS) and through the medication-taking behaviour measure for Thai patients (MTB-Thai) scale. RESULTS One hundred and seventy-two SLE patients were enrolled in the study. Most SLE patients were young to middle aged (56.40%) and had no clinical disease activity (67.4%), as assessed by a clinical SLEDAI score. Nonadherence rates were 32% and 25.3% by VAS and the MTB-Thai scale, respectively. Patients aged 55 years or older, who used the universal coverage of health care system, who used multiple medications (>10 pills/day), and who had a good attitude towards the disease were associated with a low risk of nonadherence. CONCLUSION Up to 25% SLE patients poorly adhered to their prescriptions. Age, reimbursement scheme, pill number, and attitude towards SLE were associated with nonadherence in our patients with SLE.
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Affiliation(s)
- Orawan Sae-Lim
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Intouch Laobandit
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Punyawee Kitchanwit
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Manthana Laichapis
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Boonjing Siripaitoon
- Allergy and Rheumatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, HatYai, Thailand
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16
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Sun K, Eudy AM, Criscione-Schreiber LG, Sadun RE, Rogers JL, Doss J, Corneli AL, Bosworth HB, Clowse MEB. Racial Disparities in Medication Adherence between African American and Caucasian Patients With Systemic Lupus Erythematosus and Their Associated Factors. ACR Open Rheumatol 2020; 2:430-437. [PMID: 32584516 PMCID: PMC7368138 DOI: 10.1002/acr2.11160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/14/2020] [Indexed: 01/19/2023] Open
Abstract
Objective Medication nonadherence is more common in African Americans compared with Caucasians. We examined the racial adherence gaps among patients with systemic lupus erythematosus (SLE) and explored factors associated with nonadherence. Methods Cross‐sectional data were obtained from consecutive patients prescribed SLE medications seen at an academic lupus clinic between August 2018 and February 2019. Adherence was measured using both self‐report and pharmacy refill data. High composite adherence was defined as having both high self‐reported adherence and high refill rates. Covariates were patient‐provider interaction, patient‐reported health status, and clinical factors. We compared adherence rates by race and used race‐stratified analyses to identify factors associated with low composite adherence. Results Among 121 patients (37% Caucasian, 63% African American), the median age was 44 years (range 22‐72), 95% were female, 51% had a college education or more, 46% had private insurance, and 38% had high composite adherence. Those with low composite adherence had higher damage scores, patient‐reported disease activity scores, and more acute care visits. High composite adherence rate was lower among African Americans compared with Caucasians (30% vs 51%, P = 0.02), and the gap was largest for those taking mycophenolate (26% vs 75%, P = 0.01). Among African Americans, low composite adherence was associated with perceiving fewer “Compassionate respectful” interactions with providers and worse anxiety and negative affect. In contrast, among Caucasians, low composite adherence was only associated with higher SLE medication regimen burden and fibromyalgia pain score. Conclusion Significant racial disparities exist in SLE medication adherence, which likely contributes to racial disparities in SLE outcomes. Interventions may be more effective if tailored by race, such as improving patient‐provider interaction and mental health among African Americans.
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Affiliation(s)
- Kai Sun
- Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center, Durham, USA
| | - Amanda M Eudy
- Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center, Durham, USA
| | - Lisa G Criscione-Schreiber
- Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center, Durham, USA
| | - Rebecca E Sadun
- Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center, Durham, USA
| | - Jennifer L Rogers
- Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center, Durham, USA
| | - Jayanth Doss
- Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center, Durham, USA
| | - Amy L Corneli
- Department of Population Health Sciences and Department of Medicine, Duke University, Durham, USA
| | - Hayden B Bosworth
- Department of Population Health Sciences and Department of Medicine, Duke University, Durham, USA
| | - Megan E B Clowse
- Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center, Durham, USA
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17
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Toro-Domínguez D, Lopez-Domínguez R, García Moreno A, Villatoro-García JA, Martorell-Marugán J, Goldman D, Petri M, Wojdyla D, Pons-Estel BA, Isenberg D, Morales-Montes de Oca G, Trejo-Zambrano MI, García González B, Rosetti F, Gómez-Martín D, Romero-Díaz J, Carmona-Sáez P, Alarcón-Riquelme ME. Differential Treatments Based on Drug-induced Gene Expression Signatures and Longitudinal Systemic Lupus Erythematosus Stratification. Sci Rep 2019; 9:15502. [PMID: 31664045 PMCID: PMC6820741 DOI: 10.1038/s41598-019-51616-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/29/2019] [Indexed: 01/23/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a heterogeneous disease with unpredictable patterns of activity. Patients with similar activity levels may have different prognosis and molecular abnormalities. In this study, we aimed to measure the main differences in drug-induced gene expression signatures across SLE patients and to evaluate the potential for clinical data to build a machine learning classifier able to predict the SLE subset for individual patients. SLE transcriptomic data from two cohorts were compared with drug-induced gene signatures from the CLUE database to compute a connectivity score that reflects the capability of a drug to revert the patient signatures. Patient stratification based on drug connectivity scores revealed robust clusters of SLE patients identical to the clusters previously obtained through longitudinal gene expression data, implying that differential treatment depends on the cluster to which patients belongs. The best drug candidates found, mTOR inhibitors or those reducing oxidative stress, showed stronger cluster specificity. We report that drug patterns for reverting disease gene expression follow the cell-specificity of the disease clusters. We used 2 cohorts to train and test a logistic regression model that we employed to classify patients from 3 independent cohorts into the SLE subsets and provide a clinically useful model to predict subset assignment and drug efficacy.
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Affiliation(s)
- Daniel Toro-Domínguez
- Centro de Genómica e Investigaciones Oncológicas Pfizer-Universidad de Granada-Junta de Andalucía (GENYO), Granada, Spain
| | - Raúl Lopez-Domínguez
- Centro de Genómica e Investigaciones Oncológicas Pfizer-Universidad de Granada-Junta de Andalucía (GENYO), Granada, Spain
| | - Adrián García Moreno
- Centro de Genómica e Investigaciones Oncológicas Pfizer-Universidad de Granada-Junta de Andalucía (GENYO), Granada, Spain
| | - Juan A Villatoro-García
- Centro de Genómica e Investigaciones Oncológicas Pfizer-Universidad de Granada-Junta de Andalucía (GENYO), Granada, Spain
| | - Jordi Martorell-Marugán
- Centro de Genómica e Investigaciones Oncológicas Pfizer-Universidad de Granada-Junta de Andalucía (GENYO), Granada, Spain
| | - Daniel Goldman
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - David Isenberg
- Centre for Rheumatology, Division of Medicine University College London, London, United Kingdom
| | - Gabriela Morales-Montes de Oca
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - María Isabel Trejo-Zambrano
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Benjamín García González
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Florencia Rosetti
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Diana Gómez-Martín
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Juanita Romero-Díaz
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Pedro Carmona-Sáez
- Centro de Genómica e Investigaciones Oncológicas Pfizer-Universidad de Granada-Junta de Andalucía (GENYO), Granada, Spain.
| | - Marta E Alarcón-Riquelme
- Centro de Genómica e Investigaciones Oncológicas Pfizer-Universidad de Granada-Junta de Andalucía (GENYO), Granada, Spain. .,Unit of Chronic Inflammation, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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18
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Guo G, Wang H, Ye L, Shi X, Yan K, Lin K, Huang Q, Li B, Lin Q, Zhu L, Xue X, Zhang H. Hsa_circ_0000479 as a Novel Diagnostic Biomarker of Systemic Lupus Erythematosus. Front Immunol 2019; 10:2281. [PMID: 31608065 PMCID: PMC6771011 DOI: 10.3389/fimmu.2019.02281] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/09/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Accumulating evidence suggests that differentially expressed non-coding circular RNAs (circRNAs) play critical roles in the progress of autoimmune diseases. However, the role of circRNAs in systemic lupus erythematosus (SLE) remains unclear. Methods: We initially used next-generation sequencing (NGS) to comprehensively analyze circRNA expression profiles in peripheral blood mononuclear cells (PBMCs) from 10 SLE patients, stratified by their disease activity characteristics (stable or active SLE), and 10 healthy controls (HCs). Candidate circRNAs identified were first validated by quantitative reverse-transcription (qRT)-PCR in PBMC samples from a training-phase cohort of five SLE patients and five HCs. The significantly dysregulated circRNAs were then confirmed by qRT-PCR in a validation cohort of 23 SLE patients and 21 HCs, and in an external validation cohort with 64 SLE patients, 58 HCs, and 50 patients with rheumatoid arthritis (RA). In addition, we conducted bioinformatics analysis and western blotting investigating the relationships between the candidate circRNAs and SLE progression. Results: Multilayer integrative analysis of circRNA regulation showed that 84 circRNAs were upregulated and 30 were downregulated in patients with SLE compared with HCs. We then analyzed the intersection of these differentially expressed circRNAs in an SLE-stable cohort, an SLE-active cohort, and HCs. This enabled us to narrow down dysregulated circRNAs to 15 upregulated circRNAs. Only hsa_circ_0000479 was significantly upregulated in PBMCs of patients with SLE compared with HCs (P < 0.05). Furthermore, the diagnostic potential of hsa_circ_0000479 expression to distinguish SLE patients from HCs and RA patients was also significantly increased in the validation-phase and external-validation-phase cohorts (P < 0.05). When distinguishing SLE patients from HCs, the diagnostic specificities of hsa_circ_0000479 were 0.619 and 1.0 in two validation cohorts, respectively (AUCs = 0.731 and 0.730, respectively). It was also significantly increased in either stable SLE patients or active SLE patients compared with HCs in these two cohorts (P < 0.05). We also used bioinformatics analysis to show that hsa_circ_0000479 regulates SLE progression by modulating metabolic pathways and the Wnt signaling pathway. Western blotting revealed that the expression of Wnt-16 protein was significantly decreased in SLE. Conclusion: Our results suggest that hsa_circ_0000479 has potential as a novel biomarker for the diagnosis of SLE.
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Affiliation(s)
- Gangqiang Guo
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Institute of Molecular Virology and Immunology, Institute of Tropical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Huijing Wang
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lele Ye
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Institute of Molecular Virology and Immunology, Institute of Tropical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xinyu Shi
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Institute of Molecular Virology and Immunology, Institute of Tropical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Kejing Yan
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Institute of Molecular Virology and Immunology, Institute of Tropical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Kangmin Lin
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Institute of Molecular Virology and Immunology, Institute of Tropical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Qunjia Huang
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Institute of Molecular Virology and Immunology, Institute of Tropical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Baoqing Li
- Department of Laboratory Medicine, Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qiaoai Lin
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Institute of Molecular Virology and Immunology, Institute of Tropical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Lejiang Zhu
- Department of Nephrology, Wenzhou Central Hospital, Wenzhou, China
| | - Xiangyang Xue
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Institute of Molecular Virology and Immunology, Institute of Tropical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Huidi Zhang
- Department of Nephrology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
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19
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Ali AY, Abdelaziz TS, Behiry ME. The Prevalence and Causes of Non-adherence to Immunosuppressive Medications in Patients with Lupus Nephritis Flares. Curr Rheumatol Rev 2019; 16:245-248. [PMID: 31241434 DOI: 10.2174/1573397115666190626111847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lupus nephritis is one of the major manifestations of SLE. Poor adherence to medications is an important cause of not achieving treatment targets. METHODS We assessed patients' adherence to immune-suppressive medications in patients with Lupus nephritis using the Morisky, Green, and Levine (MGL) Adherence Scale. The aim was to study the effect of non-adherence on the occurrence of renal flares. RESULTS We recruited 104 patients with lupus nephritis. Sixty-six patients had flares of LN. There was a high prevalence of non-adherence to medications (n=68). Patients who were non-adherent to treatment had more renal flares (p= 0.02). Duration of lupus since diagnosis was significantly higher in patients who had renal flares. Using regression analysis, non-adherence to medications was associated with 3.7 higher risk of developing a single renal flare and 4.9 higher risk of developing more than one renal flare. Causes of non-adherence were medications side effects in 43% of patients, financial issues in 31% or forgetfulness in 26%. CONCLUSION Non-adherence to immunosuppressive medications has a high prevalence in patients with lupus nephritis and is correlated with the number of renal flares.
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Affiliation(s)
- Ahmed Yamany Ali
- Department of Internal Medicine, Kasr Alainy Medical School, Cairo University Hospitals, Cairo, Egypt
| | - Tarek Samy Abdelaziz
- Department of Internal Medicine, Kasr Alainy Medical School, Cairo University Hospitals, Cairo, Egypt
| | - Mervat Essam Behiry
- Department of Internal Medicine, Kasr Alainy Medical School, Cairo University Hospitals, Cairo, Egypt
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20
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Twumasi AA, Shao A, Dunlop-Thomas C, Drenkard C, Cooper HLF. Health service utilization among African American women living with systemic lupus erythematosus: perceived impacts of a self-management intervention. Arthritis Res Ther 2019; 21:155. [PMID: 31238992 PMCID: PMC6593601 DOI: 10.1186/s13075-019-1942-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare access, utilization, and quality play critical roles in shaping mortality and morbidity among patients diagnosed with systemic lupus erythematosus (SLE), and yet healthcare access, utilization, and quality can be suboptimal for many people living with SLE. The aim of this qualitative study was to explore the perceived impact of a peer-led, group-based educational intervention (the Chronic Disease Self-Management Program [CDSMP]) on healthcare engagement behaviors among African American women with SLE. METHODS Participants were recruited from the WELL (Women Empowered to Live with Lupus) study, a behavioral trial of the effectiveness of the CDSMP on African American women diagnosed with SLE. We conducted two waves of qualitative, one-on-one, semi-structured interviews with 24 purposively sampled WELL participants; one interview was conducted before CDSMP participation and one after. Wave 1 interviews explored health service use behaviors at baseline; Wave 2 interviews focused on changes in these behaviors post-intervention and women's perceptions of whether and how the CDSMP shaped these changes. Transcripts were analyzed using thematic analysis methods. RESULTS Study participants perceived the CDSMP to be a valuable resource for supporting two distinct health service use behaviors: communicating with doctors (N = 16 [88.9%]) and managing medication side effects (N = 17 [41.2%]). Women perceived that the CDSMP had the most potent and widespread effects on patients' communication with doctors. Strategies that women believed generated improvements in patient-doctor communication included enhancing preparation for appointments and boosting patient participation during doctor's visits. Women's reported post-CDSMP improvements in health service use behaviors varied by disease severity and depression. Insurance coverage, while not probed directly during baseline interviews, emerged organically as a key factor affecting health service use behaviors; the CDSMP did not seem to improve participants' ability to circumvent insurance-related barriers to accessing care. CONCLUSIONS Our findings suggest that the CDSMP may help enhance healthcare service utilization among African American women with SLE by improving doctor/patient communication and medication side effect management. If future research confirms this conclusion, African American women living with SLE should be encouraged to participate in CDSMP workshops to enhance health service use behaviors. TRIAL REGISTRATION NCT02988661 . Registered 12/07/2016.
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Affiliation(s)
- Abena A Twumasi
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Anna Shao
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Cristina Drenkard
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
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22
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Toro-Domínguez D, Martorell-Marugán J, Goldman D, Petri M, Carmona-Sáez P, Alarcón-Riquelme ME. Stratification of Systemic Lupus Erythematosus Patients Into Three Groups of Disease Activity Progression According to Longitudinal Gene Expression. Arthritis Rheumatol 2018; 70:2025-2035. [PMID: 29938934 DOI: 10.1002/art.40653] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/21/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The highly heterogeneous clinical presentation of systemic lupus erythematosus (SLE) is characterized by the unpredictable occurrence of disease flares and organ damage. Attempts to stratify lupus patients have been limited to classification based on clinical information, leading to unsuccessful clinical trials and controversial research results. This study was undertaken to develop and validate a robust method to stratify patients with lupus according to longitudinal disease activity and whole-genome gene expression data in order to establish subgroups of patients who share disease progression mechanisms. METHODS We used a cluster-based approach to stratify SLE patients based on the correlation between disease activity scores and longitudinal gene expression information. Clustering robustness was evaluated by the bootstrap method, and the clusters were characterized in terms of clinical and functional features. RESULTS We observed a clear partition into 3 different disease clusters in 2 independent sets of patients, one pediatric and one adult, which was not influenced by treatment, race, or other source of bias. Two of the clusters differentiated into a group showing a correlation between the percentage of neutrophils and disease activity progression and a group showing a correlation between the percentage of lymphocytes and disease activity progression. The third cluster, in which the percentage of neutrophils correlated to a lesser degree with disease activity, was functionally more heterogeneous. Patients in the neutrophil-driven clusters had an increased risk of developing proliferative nephritis. CONCLUSION Our findings indicate that SLE patients can be stratified into 3 subgroups of patients who show different mechanisms of disease progression and are clinically differentiated. Our results have important implications for treatment options, the design of clinical trials, our understanding of the etiology of the disease, and the prediction of severe glomerulonephritis.
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Affiliation(s)
- Daniel Toro-Domínguez
- Centro de Genómica e Investigaciones Oncológicas Pfizer-Universidad de Granada-Junta de Andalucía, Granada, Spain
| | - Jordi Martorell-Marugán
- Centro de Genómica e Investigaciones Oncológicas Pfizer-Universidad de Granada-Junta de Andalucía, Granada, Spain
| | - Daniel Goldman
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pedro Carmona-Sáez
- Centro de Genómica e Investigaciones Oncológicas Pfizer-Universidad de Granada-Junta de Andalucía, Granada, Spain
| | - Marta E Alarcón-Riquelme
- Centro de Genómica e Investigaciones Oncológicas Pfizer-Universidad de Granada-Junta de Andalucía, Granada, Spain, and Karolinska Institutet, Stockholm, Sweden
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23
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The Effect of Psychosocial and Neuropsychiatric Factors on Medication Adherence in a Cohort of Women With Systemic Lupus Erythematosus. J Clin Rheumatol 2018; 22:411-417. [PMID: 27870763 DOI: 10.1097/rhu.0000000000000470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medication adherence in systemic lupus erythematosus (SLE) reduces disease activity and the risk of flares. OBJECTIVES We evaluated adherence in women with SLE who exhibit high morbidity and mortality. We evaluated demographic data and 2 conventional adherence predictors: self-efficacy and health literacy, along with 2 potential neuropsychiatric SLE complications: cognitive dysfunction and depression. METHODS One hundred six women randomly selected from the Barbados National Lupus Registry completed the Self-efficacy for Appropriate Medication Use Scale, Rapid Estimate of Adult Literacy in Medicine-Short Form, Cognitive Symptom Inventory, Beck Depression Inventory II, and Morisky's Medication Adherence Questionnaire (MAQ). This study explored the effects of psychosocial and neuropsychiatric functioning on adherence using ordinal logistic regression. RESULTS Sixty percent reported high MAQ scores. The probability of high MAQ scores was lower among younger patients (P = 0.001) and those with shorter disease duration (P = 0.05). The probability of high MAQ scores fell with lower perceived self-efficacy (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.73-0.89; P < 0.001), worsening cognitive function (OR, 0.90; 95% CI, 0.84-0.97; P = 0.004), and increasing depression (OR, 0.93; 95% CI, 0.88-0.97; P = 0.002). There was no strong relationship between MAQ score and health literacy (OR, 0.37; 95% CI, 0.13-1.03; P = 0.06). CONCLUSION Women with SLE who are younger and those with shorter disease duration should be assessed for medication adherence. Screening at diagnosis followed by routine assessment of cognitive dysfunction and depression along with perceived self-efficacy may further identify the most vulnerable subgroup who should be targeted with personalized intervention strategies.
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Mazzoni D, Cornet A, van Leeuw B, Myllys K, Cicognani E. Living with systemic lupus erythematosus: A patient engagement perspective. Musculoskeletal Care 2018; 16:67-73. [PMID: 28685926 DOI: 10.1002/msc.1208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Patient engagement is recognized as a crucial component of high-quality healthcare services. Among rheumatic diseases, systemic lupus erythematosus (SLE) appears particularly challenging for the engagement of patients in their own care. According to the patient health engagement (PHE) model, patient engagement is a dynamic phenomenon that proceeds through four experiential positions (blackout, arousal, adhesion and eudaimonic project). The aim of the present study was to describe the engagement process from the point of view and the experiences of SLE patients. Ten in-depth interviews and four focus groups were conducted with an international sample of SLE patients from different European countries. Transcripts were analysed through thematic content analysis. Findings showed that a fully engaged patient results from reframing emotional, cognitive and behavioural dimensions. The advances along the process depends on how the patient succeeds in each position. In conclusion, PHE represents an appropriate model by which to understand the engagement process of SLE patients. In order to meet patients' needs, healthcare providers and patient support groups should consider the specific position of SLE patients, providing adequate and tailored support.
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Affiliation(s)
- Davide Mazzoni
- Lupus Europe, Romford, Essex, United Kingdom
- Department of Psychology, University of Bologna, Bologna, Italy
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25
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Xie X, Yang H, Nie A, Chen H, Li J. Predictors of medication nonadherence in patients with systemic lupus erythematosus in Sichuan: a cross-sectional study. Patient Prefer Adherence 2018; 12:1505-1511. [PMID: 30197502 PMCID: PMC6112788 DOI: 10.2147/ppa.s169776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of this study was to determine the prevalence and predictors of medication nonadherence among patients with systemic lupus erythematosus (SLE) in Sichuan. PATIENTS AND METHODS A cross-sectional investigation was performed. Participants were recruited by consecutive sampling from the Rheumatic Clinic of a university hospital between June and September 2016. Patients' self-reported medication adherence was assessed by the eight-item Morisky Medication Adherence Scale. Additional surveys included patients' demographics, and clinical and treatment characteristics. Logistic regression analysis was used to identify the predictors of medication nonadherence. RESULTS A total of 140 patients were included in analysis. The percentage of patients classified as nonadherent to medication was 75%. Low education, rural residency, childlessness, limited comprehension of medication instructions, side effects experienced, dissatisfaction with treatment and better physical health were associated with an increased risk of nonadherence. CONCLUSION This study demonstrated a high prevalence of medication nonadherence among SLE patients in Sichuan, and factors associated with the nonadherence are multifaceted. Interventions for these factors, such as appropriate adjustment of the service resources for patients with rheumatic disease in rural communities and improved communication between the health care providers and the patients, may contribute to improve the medication adherence of this cohort.
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Affiliation(s)
- Xia Xie
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Hui Yang
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Anliu Nie
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Hong Chen
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Jiping Li
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
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Toro-Domínguez D, Carmona-Sáez P, Alarcón-Riquelme ME. Support for phosphoinositol 3 kinase and mTOR inhibitors as treatment for lupus using in-silico drug-repurposing analysis. Arthritis Res Ther 2017; 19:54. [PMID: 28284231 PMCID: PMC5346251 DOI: 10.1186/s13075-017-1263-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 02/14/2017] [Indexed: 11/12/2022] Open
Abstract
Background Systemic lupus erythematosus (SLE) is an autoimmune disease with few treatment options. Current therapies are not fully effective and show highly variable responses. In this regard, large efforts have focused on developing more effective therapeutic strategies. Drug repurposing based on the comparison of gene expression signatures is an effective technique for the identification of new therapeutic approaches. Here we present a drug-repurposing exploratory analysis using gene expression signatures from SLE patients to discover potential new drug candidates and target genes. Methods We collected a compendium of gene expression signatures comprising peripheral blood cells and different separate blood cell types from SLE patients. The Lincscloud database was mined to link SLE signatures with drugs, gene knock-down, and knock-in expression signatures. The derived dataset was analyzed in order to identify compounds, genes, and pathways that were significantly correlated with SLE gene expression signatures. Results We obtained a list of drugs that showed an inverse correlation with SLE gene expression signatures as well as a set of potential target genes and their associated biological pathways. The list includes drugs never or little studied in the context of SLE treatment, as well as recently studied compounds. Conclusion Our exploratory analysis provides evidence that phosphoinositol 3 kinase and mammalian target of rapamycin (mTOR) inhibitors could be potential therapeutic options in SLE worth further future testing. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1263-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Toro-Domínguez
- Area of Medical Genomics, Pfizer-University of Granada-Andalusian Government Centre for Genomics and Oncological Research (GENYO), Avda. de la Ilustración 114, PTS-18016, Granada, Spain.,Bioinformatics Unit, Pfizer-University of Granada-Andalusian Government Centre of Genomics and Oncological Research (GENYO), Avda. de la Ilustración 114, PTS-18016, Granada, Spain
| | - Pedro Carmona-Sáez
- Area of Medical Genomics, Pfizer-University of Granada-Andalusian Government Centre for Genomics and Oncological Research (GENYO), Avda. de la Ilustración 114, PTS-18016, Granada, Spain. .,Bioinformatics Unit, Pfizer-University of Granada-Andalusian Government Centre of Genomics and Oncological Research (GENYO), Avda. de la Ilustración 114, PTS-18016, Granada, Spain.
| | - Marta E Alarcón-Riquelme
- Area of Medical Genomics, Pfizer-University of Granada-Andalusian Government Centre for Genomics and Oncological Research (GENYO), Avda. de la Ilustración 114, PTS-18016, Granada, Spain. .,Unit of Chronic Inflammatory Diseases, Institute of Environmental Medicine, Karolinska Institute, Stockholm, 17177, Sweden.
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Voshaar M, Vriezekolk J, van Dulmen S, van den Bemt B, van de Laar M. Barriers and facilitators to disease-modifying antirheumatic drug use in patients with inflammatory rheumatic diseases: a qualitative theory-based study. BMC Musculoskelet Disord 2016; 17:442. [PMID: 27769224 PMCID: PMC5075197 DOI: 10.1186/s12891-016-1289-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 10/08/2016] [Indexed: 01/23/2023] Open
Abstract
Background Although disease-modifying anti-rheumatic drugs (DMARDs) are the cornerstone of treatment for inflammatory rheumatic diseases, medication adherence to DMARDs is often suboptimal. Effective interventions to improve adherence to DMARDs are lacking, and new targets are needed to improve adherence. The aim of the present study was to explore patients’ barriers and facilitators of optimal DMARD use. These factors might be used as targets for adherence interventions. Methods In a mixed method study design, patients (n = 120) with inflammatory arthritis (IA) completed a questionnaire based on an existing adapted Theoretical Domains Framework (TDF) to identify facilitators and barriers of DMARD use. A subgroup of these patients (n = 21) participated in focus groups to provide insights into their facilitators and barriers. The answers to the questionnaires and responses of the focus groups were thematically coded by three researchers independently and subsequently categorized. Results The barriers and facilitators that were reported by IA patients presented large inter-individual variations. The identified barriers and facilitators could be captured in the following domains based on an adapted TDF: (i) knowledge, (ii) emotions, (iii) attention, memory, and decision processes, (iv) social influences, (v) beliefs about capability, (vi) beliefs about consequences, (vii) motivation and goals, (viii) goal conflict, (ix) environmental context and resources, and (x) skills. Conclusions Patients with IA have a variety of barriers and facilitators with regard to their DMARD use. All of these barriers and facilitators could be categorized into adapted domains of the TDF. Interventions that address individual facilitators and barriers, based on capability, opportunity, and motivation, are needed to develop strategies for medication adherence that are tailored to individual patient needs. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1289-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marieke Voshaar
- Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
| | - Johanna Vriezekolk
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Bart van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboudumc, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mart van de Laar
- Arthritis Center Twente, Medisch Spectrum Twente and University of Twente, Enschede, The Netherlands
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Oliveira-Santos M, Verani JFDS, Camacho LAB, de Andrade CAF, Ferrante-Silva R, Klumb EM. Effectiveness of pharmaceutical care for drug treatment adherence in patients with systemic lupus erythematosus in Rio de Janeiro, Brazil: study protocol for a randomized controlled trial. Trials 2016; 17:181. [PMID: 27038611 PMCID: PMC4818901 DOI: 10.1186/s13063-016-1317-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/30/2016] [Indexed: 12/02/2022] Open
Abstract
Background Treatment adherence is a primary determinant of the success and effectiveness of healthcare. Lack of adherence can lead to treatment failure and death. Although studies have shown that pharmaceutical intervention can improve drug treatment for patients with chronic diseases, studies on pharmaceutical care are not only inconsistent, they are scarce and limited to developed countries, include few patients, and are not studied in randomized clinical trials. Systemic lupus erythematosus is an autoimmune disease with high hospitalization and case-fatality rates. The adherence rate is low (31.7 %) in this group of patients in Brazil, and drug treatment for the disease is complex. Our objective is to evaluate the effectiveness of pharmaceutical care in drug treatment adherence in patients with systemic lupus erythematosus treated at a rheumatology outpatient clinic in Rio de Janeiro, Brazil. Methods A randomized clinical trial (pragmatic trial) will be conducted. Adult participants (women) from a public hospital in Rio de Janeiro with a diagnosis of systemic lupus erythematosus will be followed for 12 months. A total of 120 patients will be randomized to two groups: intervention (Dader method for pharmaceutical care) and control (health/dietary counseling and risk reduction). The primary outcome will be drug treatment adherence evaluated by the eight-item Morisky Medication Adherence Scale. Secondary outcomes will be clinical improvement and quality of life. Discussion Patients with systemic lupus erythematosus present with low treatment adherence, thus justifying the mobilization of human resources to optimize their clinical management. Despite the proven effectiveness of pharmaceutical care for various diseases, there are still no studies evaluating its effectiveness in systemic lupus erythematosus. Our hypothesis is that the intervention will also be effective in this patient group. Trial registration ClinicalTrials.gov identifier: NCT02330250. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1317-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marise Oliveira-Santos
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil. .,Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro n° 77, Vila Isabel, Rio de Janeiro, Brazil.
| | - José Fernando de Souza Verani
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil
| | - Luiz Antônio Bastos Camacho
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil
| | - Carlos Augusto Ferreira de Andrade
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil n° 4.036, Manguinhos, Rio de Janeiro, Brazil.,Severino Sombra University, Av. Expedicionário Oswaldo de Almeida Ramos, n° 280, Centro, Vassouras, Rio de Janeiro, Brazil
| | - Rosele Ferrante-Silva
- Lagoa Federal Hospital, Ministry of Health, Rua Jardim Botânico n° 501, Jardim Botânico, Rio de Janeiro, Brazil
| | - Evandro Mendes Klumb
- Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro n° 77, Vila Isabel, Rio de Janeiro, Brazil
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Affiliation(s)
- Lucy Croyle
- Centre for Inflammatory Diseases; Monash University School of Clinical Sciences; Melbourne Victoria Australia
| | - Eric F. Morand
- Centre for Inflammatory Diseases; Monash University School of Clinical Sciences; Melbourne Victoria Australia
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Rivera F, Anaya S. Lupus nephritis flare in young patients: relapse or nonadherence to treatment? Int J Nephrol Renovasc Dis 2014; 7:117-21. [PMID: 24729723 PMCID: PMC3974696 DOI: 10.2147/ijnrd.s58206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose Adherence is a challenging issue in the treatment of systemic lupus erythematosus. Nonadherence has been widely addressed in patients with lupus and must be detected quickly to prevent severe complications. The cases we present illustrate the importance of adherence in young adults. Case 1 A 23-year-old Spanish woman diagnosed with severe lupus nephritis 8 years previously achieved renal remission after immunosuppressive treatment with corticosteroids and cyclophosphamide. Three years later, she developed a renal flare. Her treatment was intensified, and rituximab and mycophenolate mofetil were added. One year later, she was readmitted for a new renal flare. A blood test revealed no detectable levels of mycophenolic acid, and the patient admitted she had not taken her treatment correctly. Treatment was resumed. Four years later, the patient remains in remission. Case 2 A 19-year-old Spanish woman was diagnosed with nephrotic syndrome due to lupus nephritis. She achieved complete remission after treatment with corticosteroids and cyclophosphamide followed by mycophenolate mofetil. Two years later, she developed a severe renal relapse that was treated with corticosteroids, cyclophosphamide, and rituximab. The response to treatment was good. Mycophenolic acid was undetectable in blood. The patient admitted that she had often missed doses before this relapse. The renal response has been maintained since she resumed her previous medications 2 years ago. Conclusion We conclude that the frequent and severe relapses of lupus nephritis observed in young patients may actually be due to nonadherence rather than to refractory disease. Our cases are typical examples of nonadherence that were discovered after a detailed interview with the patients and their families. We emphasize the need for clinical suspicion of nonadherence when caring for young adults with lupus.
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Affiliation(s)
- Francisco Rivera
- Sección de Nefrología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Sara Anaya
- Sección de Nefrología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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Mooney J, Spalding N, Poland F, Grayson P, Leduc R, McAlear CA, Richesson RL, Shereff D, Merkel PA, Watts RA. The informational needs of patients with ANCA-associated vasculitis-development of an informational needs questionnaire. Rheumatology (Oxford) 2014; 53:1414-21. [PMID: 24625507 DOI: 10.1093/rheumatology/keu026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of the study was to compare the informational needs of patients with ANCA-associated vasculitis (AAV). METHODS We developed a Vasculitis Informational Needs Questionnaire that was distributed to members of Vasculitis UK (VUK) by mail and registrants of the Vasculitis Clinical Research Consortium (VCRC) online registry with self-reported AAV. Patients were asked to use a 5-point scale (1 = not important, 5 = extremely important) to rank aspects of information in the following domains: disease, investigations, medication, disease management and psychosocial care. The source and preferred method of educational delivery were recorded. RESULTS There were 314 VUK and 273 VCRC respondents. Respondents rated information on diagnosis, prognosis, investigations, treatment and side effects as extremely important. Information on patient support groups and psychosocial care was less important. There was no difference in the ratings of needs based on group, sex, age, disease duration, disease or method of questionnaire delivery. The most-preferred methods of providing information for both groups were by a doctor (with or without written material) or web based; educational courses and compact disc/digital video disc (CD/DVD) were the least-preferred methods. CONCLUSION This study demonstrates that people with AAV seek specific information concerning their disease, treatment regimes and side effects and the results of investigations. Individuals preferred to receive this information from a doctor. Patients with AAV should be treated in a similar manner to patients with other chronic illnesses in which patient education is a fundamental part of care.
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Affiliation(s)
- Janice Mooney
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Nicola Spalding
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fiona Poland
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter Grayson
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Renee Leduc
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Carol A McAlear
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Rachel L Richesson
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Denise Shereff
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter A Merkel
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Richard A Watts
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
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Ngwa TN, Beyder A, Vege SS. 84-year-old man with night sweats, weight loss, and diarrhea. Mayo Clin Proc 2014; 89:409-13. [PMID: 24582198 DOI: 10.1016/j.mayocp.2013.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 04/24/2013] [Accepted: 05/08/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Taiwo N Ngwa
- Resident in Internal Medicine, Mayo Graduate School of Medical Education, Rochester, MN
| | - Arthur Beyder
- Fellow in Gastroenterology and Hepatology, Mayo Graduate School of Medical Education, Rochester, MN
| | - Santhi S Vege
- Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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Martin KR, Shreffler J, Schoster B, Callahan LF. Coping with prescription medication costs: a cross-sectional look at strategies used and associations with the physical and psychosocial health of individuals with arthritis. Ann Behav Med 2012; 44:236-47. [PMID: 22740363 PMCID: PMC3443256 DOI: 10.1007/s12160-012-9380-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Prescription medication costs increase financial burden, often leading individuals to engage in intentional nonadherence. Little is known about what specific medication cost-coping strategies individuals with arthritis employ. PURPOSE The purposes of this study are (1) to identify characteristics of individuals with arthritis who self-report prescription medication cost-coping strategies and (2) to examine the association between medication cost-coping strategies and health status. METHODS Seven hundred twenty-nine people self-reporting arthritis and prescription medication use completed a telephone survey. Adjusted regression models examined medication cost-coping strategies and five health status outcomes. RESULTS Participants reported engaging in cost-coping strategies due to medication costs. Those borrowing money had worse psychosocial health and greater disability; those with increasing credit card debt reported worse physical functioning, self-rated health, and greater helplessness. Medication underuse was associated with worse psychosocial health, greater disability, and depressive symptoms. CONCLUSION Individuals with arthritis use multiple strategies to cope with medication costs, and these strategies are associated with adverse physical and psychosocial health status.
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Affiliation(s)
- Kathryn Remmes Martin
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD 20892-9205, USA.
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Oliveira-Santos M, Verani JFS, Klumb EM, Albuquerque EMN. Evaluation of adherence to drug treatment in patients with systemic lupus erythematosus in Brazil. Lupus 2010; 20:320-9. [DOI: 10.1177/0961203310383736] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this study were to measure the prevalence of adherence to drug treatment and analyze associations with characteristics pertaining to the treatment, disease, health professionals and services, and socio-demographic issues in patients with systemic lupus erythematosus (SLE) in the city of Rio de Janeiro, Brazil. A sample of 246 women with SLE was analyzed. The data were collected through individual interviews and a review of patient charts. Adherence was estimated according to the Morisk criteria, and the associated factors were analyzed by hierarchical modeling. The percentage of patients classified as adherent to treatment was 31.7%. The reasons cited for non-adherence were: carelessness with drug administration times (52.43%), forgetfulness (38.21%), adverse drug reaction (13.8%), and interruption of treatment due to improvement in symptoms (7.72%). Factors associated with adherence were: behavior towards the presence of adverse drug reaction, hematological alterations, presence of mucocutaneous manifestations, legibility of the medical prescription, schooling, and family support. The study concludes that adherence to drug treatment in SLE is a complex and multifactorial phenomenon, and the results corroborate findings from studies conducted in developed countries. The hierarchical modeling proved to be a good alternative for evaluating adherence, since it allowed visualizing the various stages in the analysis.
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Affiliation(s)
- M Oliveira-Santos
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rio de Janeiro, Brazil
- Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
| | - JFS Verani
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rio de Janeiro, Brazil
| | - EM Klumb
- Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
| | - EMN Albuquerque
- Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
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de Achaval S, Suarez-Almazor ME. Treatment adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis and systemic lupus erythematosus. INTERNATIONAL JOURNAL OF CLINICAL RHEUMATOLOGY 2010; 5:313-326. [PMID: 20676388 PMCID: PMC2910438 DOI: 10.2217/ijr.10.15] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Treatment adherence is critical in the management of rheumatic diseases. Recent advances in therapy for rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are promising, although the impact on quality of life may be limited due to nonadherence. Databases including Ovid Medline, Scopus and the Epub-ahead-of-print subset of PubMed were searched for the period of the last 10 years using combined keywords patient compliance, medication adherence, disease modifying antirheumatic drug (DMARD), rheumatoid arthritis and systemic lupus erythematosus. Additional references from retrieved papers were considered. Inclusion criteria were the following: identification of a quantitative measure of adherence to medications including DMARDs and biologics; inclusion of well-defined measures of adherence; and patients with RA or SLE. Studies in RA and SLE patients demonstrated overall inadequate treatment adherence. Adherence was measured using multiple methods including pharmacy records, electronic monitoring, self-report and physician report. The evidence for interventions to improve treatment adherence was limited and demonstrated various results. Future research should further explore determinants of nonadherence and continue to examine the efficacy of implementing various strategies to improve medication management in this patient population.
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Affiliation(s)
- Sofia de Achaval
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Abstract
OBJECTIVE The aim of this review is to provide an up-to-date overview of treatment approaches for systemic lupus erythematosus (SLE), highlighting the multiplicity and heterogeneity of clinical symptoms that underlie therapeutic decisions. Discussion will focus on the spectrum of currently available therapies, their mechanisms and associated side-effects. Finally, recent developments with biologic treatments including rituximab, epratuzumab, tumor necrosis factor (TNF) inhibitors, and belimumab, will be discussed. RESEARCH DESIGN AND METHODS A MEDLINE literature search for 'systemic lupus erythematosus' and 'damage' and 'treatment' was undertaken for 1996-2008. Secondary citations were obtained from selected manuscripts. Individual case studies were excluded. FINDINGS SLE is an autoimmune disease involving multiple organ systems, a clinical pattern of flares and remissions, and the presence of anti-nuclear autoantibodies. Whereas early symptoms most frequently involve the skin and joints, disease morbidity and mortality are usually associated with cardiovascular events and damage to major organs, particularly the kidneys. Many of the current therapeutic options are considered to be inadequate because of toxicities, accrual of organ damage, and insufficient control of the underlying disease pathology. Improved understanding of SLE pathogenesis and immunology has led to the identification of new treatment targets. Current interest is mainly focused on the targeted immunosuppressive actions provided by biologic therapy. Although the potential long-term beneficial or harmful effects of the new molecular treatments are unclear, their precise molecular targeting may reveal key relationships within the immune system and advance the cause of individualized molecular medicine. CONCLUSIONS Biologic compounds that target specific immunologic mechanisms offer a new paradigm in the treatment of SLE, one that may, at best, reverse the course of the disease and, at the very least, might provide some new alternatives to reduce symptoms and limit tissue damage without undue contribution to overall morbidity and mortality.
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Masood S, Jayne D, Karim Y. Beyond immunosuppression – challenges in the clinical management of lupus nephritis. Lupus 2009; 18:106-15. [DOI: 10.1177/0961203308095330] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lupus nephritis remains the most common severe manifestation of SLE with increased risk of death and end-stage renal disease. Although, recent research has focused on the choice of immunosuppressive in its treatment, other factors, including the quality and delivery of healthcare, the management of glucocorticoids and co-morbidity are probably of more importance. There has been significant progress in induction regimes with the successful use of mycophenolate mofetil, low dose intravenous cyclophosphamide and development of sequential regimens whereby cyclophosphamide is followed by an alternative immunosuppressive. However, the attention on the day-to-day management of lupus nephritis in the clinic has merited less attention. In this article, we aim to address more widely the major issues which are encountered regularly in the long-term management of these patients. The overall goals are the reduction of mortality and preservation of renal function.
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Affiliation(s)
- S Masood
- Department of Internal Medicine, Franklin Square Hospital Center, Baltimore, Maryland, USA
| | - D Jayne
- Director of Vasculitis & Lupus Clinic, Renal Services, Addenbrooke’s Hospital, Cambridge, UK
| | - Y Karim
- Lupus Research Unit, St Thomas’ Hospital, London, UK
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Medication adherence of patients with selected rheumatic conditions: a systematic review of the literature. Semin Arthritis Rheum 2008; 38:396-402. [PMID: 18336875 DOI: 10.1016/j.semarthrit.2008.01.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 12/21/2007] [Accepted: 01/05/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Nonadherence with medication treatment has been found to occur in large proportions of patients with a broad range of chronic conditions. Our aim was to perform a systematic review of the literature examining adherence with treatments for inflammatory rheumatic conditions to assess the magnitude of the problem in this patient population. METHODS A MEDLINE search of English language literature was performed to identify studies published between January 1, 1985 and November 30, 2007 that evaluated adherence with chronic medications needed in the treatment of rheumatic conditions. RESULTS A total of 20 articles met the criteria for evaluation, the majority of which focused on the treatment of rheumatoid arthritis. Most of the studies examined the use of nonsteroidal anti-inflammatory medications and disease-modifying antirheumatic drugs. Adherence was assessed based on self-report, pill counts, pharmacy dispensings, openings of pill containers using electronic devices, laboratory assays, and physician assessment. Adherence varied greatly based on the adherence measure used, arthritic condition evaluated, and medication under study. Overall, the highest rates of adherence were based on self-reports for a wide variety of medications and conditions (range of persons reporting adherence was 30 to 99%), while the lowest adherence rates were for allopurinol based on pharmacy dispensings (18-26%). CONCLUSIONS Adherence has not been widely examined for most chronic inflammatory rheumatic conditions and the few studies that exist used different definitions and populations, thus limiting any conclusions. However, the current literature does suggest that nonadherence is a substantial problem.
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