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Rojas-Rivera JE, García-Carro C, Ávila AI, Espino M, Espinosa M, Fernández-Juárez G, Fulladosa X, Goicoechea M, Macía M, Morales E, Porras LFQ, Praga M. Consensus document of the Spanish Group for the Study of the Glomerular Diseases (GLOSEN) for the diagnosis and treatment of lupus nephritis. Nefrologia 2023; 43:6-47. [PMID: 37211521 DOI: 10.1016/j.nefroe.2023.05.006] [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: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 05/23/2023] Open
Abstract
A significant number of patients with systemic lupus erythematosus (between 20% and 60% according to different reported series) develop lupus nephritis in the course of its evolution, which directly influences their quality of life and vital prognosis. In recent years, the greater knowledge about the pathogenesis of systemic lupus and lupus nephritis has allowed relevant advances in the diagnostic approach and treatment of these patients, achieving the development of drugs specifically aimed at blocking key pathogenic pathways of the disease. Encouragingly, these immunomodulatory agents have shown in well-powered, randomized clinical trials good clinical efficacy in the medium-term, defined as proteinuria remission and preservation of kidney function, with an acceptable safety profile and good patient tolerability. All this has made it possible to reduce the use of corticosteroids and other potentially more toxic therapies, as well as to increase the use of combined therapies. The present consensus document carried out by the Glomerular Diseases Working Group of the Spanish Society of Nephrology (GLOSEN), collects in a practical and summarized, but rigorous way, the best currently available evidence about the diagnosis, treatment, and follow-up of lupus nephritis patients, including cases of special situations, with the main objective of providing updated information and well-founded clinical recommendations to treating physicians, to improve the diagnostic and therapeutic approach to our patients.
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Affiliation(s)
- Jorge E Rojas-Rivera
- Hospital Universitario Fundación Jiménez Díaz, Servicio de Nefrología e Hipertensión, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Servicio de Nefrología, Madrid, Spain.
| | - Clara García-Carro
- Hospital Universitario Clínico San Carlos, Servicio de Nefrología. Madrid, Spain.
| | - Ana I Ávila
- Hospital Dr. Peset, Servicio de Nefrología, Valencia, Spain
| | - Mar Espino
- Hospital Universitario 12 de Octubre, Servicio de Nefrología, Madrid, Spain
| | - Mario Espinosa
- Hospital Universitario Reina Sofía, Servicio de Nefrología, Cordoba, Spain
| | | | - Xavier Fulladosa
- Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Servicio de Nefrología, Barcelona, Spain
| | - Marian Goicoechea
- Hospital Universitario Gregorio Marañón, Servicio de Nefrología, Madrid, Spain
| | - Manuel Macía
- Hospital Universitario Nuestra Señora de la Candelaria, Servicio de Nefrología, Tenerife, Spain
| | - Enrique Morales
- Hospital Universitario 12 de Octubre, Servicio de Nefrología, Madrid, Spain; Instituto de Investigación Hospital Universitario 12 de Octubre, Servicio de Nefrología, Madrid, Spain; Departamento de Medicina, Universidad Complutense, Servicio de Nefrología, Madrid, Spain
| | - Luis F Quintana Porras
- Hospital Clínic de Barcelona, Servicio de Nefrología, Barcelona, Spain; Departamento de Medicina, Universidad de Barcelona, IDIBAPS, Servicio de Nefrología, Barcelona, Spain
| | - Manuel Praga
- Instituto de Investigación Hospital Universitario 12 de Octubre, Servicio de Nefrología, Madrid, Spain; Departamento de Medicina, Universidad Complutense, Servicio de Nefrología, Madrid, Spain
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Documento de consenso del Grupo de Estudio de Enfermedades Glomerulares de la Sociedad Española de Nefrología (GLOSEN) para el diagnóstico y tratamiento de la nefritis lúpica. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Garcia ABA, Dardin LP, Minali PA, Trevisani VFM. Cardiovascular Effect of Physical Exercise on Primary Sjogren's Syndrome (pSS): Randomized Trial. Front Med (Lausanne) 2021; 8:719592. [PMID: 34660630 PMCID: PMC8514691 DOI: 10.3389/fmed.2021.719592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the effects of an exercise program on aerobic capacity, echocardiographic parameters, metabolic profile, quality of life and safety in patients with primary Sjogren's syndrome in a randomized trial. Methods: 60 women with pSS were evaluated from the SF-36 Short-Form Health Survey (SF-36) and EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) questionnaires. The participants performed ergospirometry and echocardiography; blood samples were collected to evaluate the metabolic profile. Patients were randomly divided into 2 groups: a training group that participated in the supervised training program and a control group. All variables were analyzed at baseline and after 28 weeks for both groups and we performed an intention-to-treat analysis. The training program consisted of 16 weeks of resistance exercises and, after, the exercise became aerobic. Patients and coaches were not blinded, contrary to the evaluators of all examinations/procedures and data analysts. Statistical analysis included Wilcoxon's rank sum test, chi-square test, and ANOVA test. P values < 0.05 were considered to be statistically significant. Results: The 2 groups were homogeneous at baseline. The training group showed a significant improvement in oxygen maximum volume (VO2max) and anaerobic threshold (AT). Comparison of the training group and control group after 28 weeks showed a significant difference relating to VO2max and in AT. We did not find statistically significant diference in echocardiographic parameters, metabolic profile and in questionnaires SF-36 and ESSDAI. Conclusions: This study showed significant improvement in aerobic capacity and glycated hemoglobin after a supervised training program in patients with pSS with safety.
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Affiliation(s)
| | - Luciana Paula Dardin
- Department of Medicine, Health-Based Evidence, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paulo Alexandre Minali
- Department of Medicine, Health-Based Evidence, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Virginia Fernandes Moça Trevisani
- Department of Medicine, Health-Based Evidence, Universidade Federal de São Paulo, São Paulo, Brazil.,Universidade de Santo Amaro, São Paulo, Brazil
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Calcaterra I, Ambrosino P, Vitelli N, Lupoli R, Orsini RC, Chiurazzi M, Maniscalco M, Di Minno MND. Risk Assessment and Antithrombotic Strategies in Antiphospholipid Antibody Carriers. Biomedicines 2021; 9:biomedicines9020122. [PMID: 33513790 PMCID: PMC7911177 DOI: 10.3390/biomedicines9020122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/31/2022] Open
Abstract
Antiphospholipid antibodies (aPL) are a cluster of autoantibodies directed against plasma proteins with affinity for membrane phospholipids. The most frequently tested aPL are lupus anticoagulant (LA), anti-cardiolipin antibodies (aCL), and anti-β2-glycoprotein I antibodies (anti-β2GPI). aPL play a key pathogenic role in the development of the antiphospholipid syndrome (APS), a systemic autoimmune disease characterized by recurrent thrombotic and/or pregnancy complications in patients with persistent aPL. However, aPL positivity is occasionally documented in patients with no previous history of thrombotic or pregnancy morbidity. LA activity, multiple aPL positivity, high-titer aPL, and a concomitant systemic autoimmune disease are recognized risk factors for future thrombotic events in asymptomatic carriers. Moreover, an accelerated atherosclerosis with increased cardiovascular (CV) risk has also been associated with aPL positivity, thus exposing aPL carriers to fatal complications and chronic disability requiring cardiac rehabilitation. Overall, an accurate risk stratification is recommended for aPL-positive subjects in order to prevent both venous and arterial thrombotic complications. In this review, we provide an overview of the main antithrombotic and risk assessment strategies in aPL carriers.
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Affiliation(s)
- Ilenia Calcaterra
- Department of Clinical Medicine and Surgery, Faculty of Medicine and Surgery, Federico II University, 80131 Naples, Italy; (I.C.); (N.V.); (R.C.O.); (M.C.)
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy;
- Correspondence: ; Tel./Fax: +39-0824-909458
| | - Nicoletta Vitelli
- Department of Clinical Medicine and Surgery, Faculty of Medicine and Surgery, Federico II University, 80131 Naples, Italy; (I.C.); (N.V.); (R.C.O.); (M.C.)
| | - Roberta Lupoli
- Department of Molecular Medicine and Medical Biotechnology, Faculty of Medicine and Surgery, Federico II University, 80131 Naples, Italy;
| | - Roberta Clara Orsini
- Department of Clinical Medicine and Surgery, Faculty of Medicine and Surgery, Federico II University, 80131 Naples, Italy; (I.C.); (N.V.); (R.C.O.); (M.C.)
| | - Martina Chiurazzi
- Department of Clinical Medicine and Surgery, Faculty of Medicine and Surgery, Federico II University, 80131 Naples, Italy; (I.C.); (N.V.); (R.C.O.); (M.C.)
| | | | - Matteo Nicola Dario Di Minno
- Department of Translational Medical Sciences, Faculty of Medicine and Surgery, Federico II University, 80131 Naples, Italy;
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Price EJ, Baer AN. How to treat Sjögren's syndrome. Rheumatology (Oxford) 2019; 60:2574-2587. [PMID: 30770917 DOI: 10.1093/rheumatology/key363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/03/2018] [Indexed: 01/03/2023] Open
Abstract
SS is a chronic, autoimmune disease of unknown aetiology for which there is no known curative treatment. Although dryness of the eyes and mouth are the classically described features, patients often experience drying of other mucosal surfaces and systemic manifestations, including fatigue and arthralgia. There is an association with other autoimmune diseases, especially thyroid disease, coeliac disease and primary biliary cholangitis. Systemic features may affect up to 70% and include inflammatory arthritis, skin involvement, haematological abnormalities, neuropathies, interstitial lung disease and a 5-10% lifetime risk of B cell lymphoma. Treatment should aim to empower patients to manage their condition; conserve, replace and stimulate secretions; prevent damage; and suppress underlying systemic disease activity.
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Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Alan N Baer
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Miyamoto ST, Valim V, Carletti L, Ng WF, Perez AJ, Lendrem DW, Trennel M, Giovelli RA, Dias LH, Serrano ÉV, Subtil AM, Abreu VC, Natour J. Supervised walking improves cardiorespiratory fitness, exercise tolerance, and fatigue in women with primary Sjögren's syndrome: a randomized-controlled trial. Rheumatol Int 2019; 39:227-238. [PMID: 30604204 DOI: 10.1007/s00296-018-4213-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/24/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and effectiveness of a supervised walking program in women with primary Sjögren's syndrome (pSS). METHODS Forty-five sedentary women fulfilling the American European Consensus Criteria for pSS were randomized to a training group (TG, n = 23) or control group (CG, n = 22). Patients in the TG were submitted to supervise walking three times a week for 16 weeks. The patients of the CG were instructed to not perform any kind of regular physical exercise. Physical fitness [maximum oxygen uptake (VO2max) and distance], EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), hematological tests, and Medical Outcomes Study 36 (SF-36) were assessed at baseline and week 16. In addition, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-fatigue), and Beck Depression Inventory (BDI) were measured prior to intervention, after 8 and 16 weeks. Patient global assessment of response to therapy was completed at the final assessment. An intent-to-treat analysis was performed. RESULTS After 16 weeks, the mean change of VO2max (ml/kg/min), distance, and FACIT-fatigue were higher in the TG than in the CG (p = 0.016, p = 0.043 and p = 0.030, respectively). Improved cardiorespiratory fitness was associated with improvements in fatigue scores and physical components of quality of life (SF-36). Furthermore, improved fatigue scores were associated with reduced depression and improvements in the physical and mental components of SF-36. Overall, 95.4% of patients in the TG rated themselves as clinically improved versus 62% of the patients in the CG (p = 0.049). There was no flare in disease activity and no serious adverse events with exercise. CONCLUSIONS This supervised walking program was demonstrated to be feasible and safe with improvements in cardiorespiratory fitness, exercise tolerance, fatigue, and patient perception of improvement in pSS patients. TRIAL REGISTRATION Clinical Trials.gov ID, number NCT02370225.
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Affiliation(s)
- Samira Tatiyama Miyamoto
- Department of Integrated Education in Health, Universidade Federal do Espírito Santo, Av. Maruípe, 1468, Vitoria, ES, 29040-090, Brazil
- Department of Rheumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina, Rua Botucatu, 740, São Paulo, SP, 04023-900, Brazil
| | - Valéria Valim
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
- Department of Medical Clinic, Universidade Federal do Espírito Santo, Av. Marechal Campos, 1468, Vitoria, ES, 29040-090, Brazil
| | - Luciana Carletti
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Anselmo José Perez
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Dennis William Lendrem
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Michael Trennel
- MoveLab, Physical Activity and Exercise Research, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Raquel Altoé Giovelli
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
| | - Laiza Hombre Dias
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
| | - Érica Vieira Serrano
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
| | - Alice Mendonça Subtil
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Vanessa Cândido Abreu
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Jamil Natour
- Department of Rheumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina, Rua Botucatu, 740, São Paulo, SP, 04023-900, Brazil.
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Hackett KL, Deane KHO, Newton JL, Deary V, Bowman SJ, Rapley T, Ng WF. Mixed-Methods Study Identifying Key Intervention Targets to Improve Participation in Daily Living Activities in Primary Sjögren's Syndrome Patients. Arthritis Care Res (Hoboken) 2018; 70:1064-1073. [PMID: 29409110 PMCID: PMC6033158 DOI: 10.1002/acr.23536] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/30/2018] [Indexed: 12/11/2022]
Abstract
Objective Functional ability and participation in life situations are compromised in many primary Sjögren's syndrome (SS) patients. This study aimed to identify the key barriers and priorities to participation in daily living activities, in order to develop potential future interventions. Methods Group concept mapping, a semiquantitative, mixed‐methods approach was used to identify and structure ideas from UK primary SS patients, adult household members living with a primary SS patient, and health care professionals. Brainstorming generated ideas, which were summarized into a final set of statements. Participants individually arranged these statements into themes and rated each statement for importance. Multidimensional scaling and hierarchical cluster analysis were applied to sorted and rated data to produce visual representations of the ideas (concept maps), enabling identification of agreed priority areas for interventions. Results A total of 121 patients, 43 adult household members, and 67 health care professionals took part. In sum, 463 ideas were distilled down to 94 statements. These statements were grouped into 7 clusters: Patient Empowerment, Symptoms, Wellbeing, Access and Coordination of Health Care, Knowledge and Support, Public Awareness and Support, and Friends and Family. Patient Empowerment and Symptoms were rated as priority conceptual themes. Important statements within priority clusters indicate patients should be taken seriously and supported to self‐manage symptoms of oral and ocular dryness, fatigue, pain, and poor sleep. Conclusion Our data highlighted the fact that in addition to managing primary SS symptoms, interventions aiming to improve patient empowerment, general wellbeing, access to health care, patient education, and social support are important to facilitate improved participation in daily living activities.
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Affiliation(s)
- Katie L Hackett
- Newcastle University Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Northumbria University, Newcastle upon Tyne, UK
| | | | - Julia L Newton
- Newcastle University and Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Vincent Deary
- Newcastle upon Tyne Hospitals National Health Service Foundation Trust and Northumbria University, Newcastle upon Tyne, UK
| | | | - Tim Rapley
- Newcastle University and Northumbria University, Newcastle upon Tyne, UK
| | - Wan-Fai Ng
- Newcastle University and Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
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Pinto AJ, Miyake CNH, Benatti FB, Silva CA, Sallum AME, Borba E, de Sá-Pinto AL, Bonfá E, Gualano B. Reduced Aerobic Capacity and Quality of Life in Physically Inactive Patients With Systemic Lupus Erythematosus With Mild or Inactive Disease. Arthritis Care Res (Hoboken) 2016; 68:1780-1786. [DOI: 10.1002/acr.22905] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/23/2016] [Accepted: 03/29/2016] [Indexed: 12/25/2022]
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Rodríguez Huerta MD, Trujillo-Martín MM, Rúa-Figueroa Í, Cuellar-Pompa L, Quirós-López R, Serrano-Aguilar P. Healthy lifestyle habits for patients with systemic lupus erythematosus: A systemic review. Semin Arthritis Rheum 2015; 45:463-70. [PMID: 26522137 DOI: 10.1016/j.semarthrit.2015.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/27/2015] [Accepted: 09/26/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To assess the effects of lifestyle habits on the disease activity and damage, the occurrence of flares and quality of life of people with systemic lupus erythematosus (SLE). METHODS A systematic literature review was performed. MEDLINE, EMBASE, and SCI/SSCI were searched. Experimental and observational studies evaluating the effect of lifestyles for SLE patients were included. Two independent reviewers selected studies and extracted relevant data. Critical appraisal of the studies was assessed following SIGN criteria. RESULTS Eligibility criteria were met by 21 studies, five analyzed the effect of tobacco consumption, nine the effect of physical exercise and seven the effect of diet. Three studies on tobacco observed an association with increased SLE activity and the onset of cutaneous damage. The studies on physical exercise, of heterogeneous quality, reported that aerobic activity is safe for SLE patients, leading to an increase of tolerance to exercise, physical and functional capacity for those with moderate or low activity. A reduction in fatigue, anxiety and depression, as well as improved quality of life, is also suggested though evidence for these outcomes is limited. Better-quality studies on diet analyzed the effect of polyunsaturated fatty acids on disease activity. Three of the four randomized placebo-controlled trials revealed a positive effect both on overall SLE indices and individual symptoms that affect patients. CONCLUSIONS Tobacco smoking increases the risk of skin damage and disease activity in patients with SLE. A diet rich in polyunsaturated fatty acids, avoiding a sedentary lifestyle and supervised exercise should be recommended for patients with stable SLE.
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Affiliation(s)
| | - Maria M Trujillo-Martín
- Canary Island Foundation for Health Research (FUNCANIS), Canary Islands, Spain; Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain; Centre for Biomedical Research of Canary Islands (CIBICAN), University of La Laguna, La Laguna, Tenerife, Spain.
| | - Íñigo Rúa-Figueroa
- Department of Rheumatology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Raúl Quirós-López
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain; Department of Internal Medicine, Hospital Costa del Sol, Marbella, Spain
| | - Pedro Serrano-Aguilar
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain; Centre for Biomedical Research of Canary Islands (CIBICAN), University of La Laguna, La Laguna, Tenerife, Spain; Evaluation Service of the Canary Islands Health Service (SESCS), Santa Cruz de Tenerife, Spain
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Wallace DJ. Management of nonrenal and non–central nervous system lupus. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00134-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Knapik DM, Perera P, Nam J, Blazek AD, Rath B, Leblebicioglu B, Das H, Wu LC, Hewett TE, Agarwal SK, Robling AG, Flanigan DC, Lee BS, Agarwal S. Mechanosignaling in bone health, trauma and inflammation. Antioxid Redox Signal 2014; 20:970-85. [PMID: 23815527 PMCID: PMC3924811 DOI: 10.1089/ars.2013.5467] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
SIGNIFICANCE Mechanosignaling is vital for maintaining the structural integrity of bone under physiologic conditions. These signals activate and suppress multiple signaling cascades regulating bone formation and resorption. Understanding these pathways is of prime importance to exploit their therapeutic potential in disorders associated with bone loss due to disuse, trauma, or disruption of homeostatic mechanisms. RECENT ADVANCES In the case of cells of the bone, an impressive amount of data has been generated that provides evidence of a complex mechanism by which mechanical signals can maintain or disrupt cellular homeostasis by driving transcriptional regulation of growth factors, matrix proteins and inflammatory mediators in health and inflammation. Mechanical signals act on cells in a magnitude dependent manner to induce bone deposition or resorption. During health, physiological levels of these signals are essential for maintaining bone strength and architecture, whereas during inflammation, similar signals can curb inflammation by suppressing the nuclear factor kappa B (NF-κB) signaling cascade, while upregulating matrix synthesis via mothers against decapentaplegic homolog and/or Wnt signaling cascades. Contrarily, excessive mechanical forces can induce inflammation via activation of the NF-κB signaling cascade. CRITICAL ISSUES Given the osteogenic potential of mechanical signals, it is imperative to exploit their therapeutic efficacy for the treatment of bone disorders. Here we review select signaling pathways and mediators stimulated by mechanical signals to modulate the strength and integrity of the bone. FUTURE DIRECTIONS Understanding the mechanisms of mechanotransduction and its effects on bone lay the groundwork for development of nonpharmacologic mechanostimulatory approaches for osteodegenerative diseases and optimal bone health.
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Affiliation(s)
- Derrick M Knapik
- 1 Department of Orthopaedic Surgery, The Ohio State University College of Medicine , Columbus, Ohio
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O'Donnell S, Rusu C, Bernatsky S, Hawker G, Canizares M, MacKay C, Badley E. Exercise/Physical Activity and Weight Management Efforts in Canadians With Self-Reported Arthritis. Arthritis Care Res (Hoboken) 2013; 65:2015-23. [DOI: 10.1002/acr.22074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 07/03/2013] [Indexed: 12/28/2022]
Affiliation(s)
| | - Corneliu Rusu
- Public Health Agency of Canada; Ottawa, Ontario Canada
| | | | - Gillian Hawker
- Women's College Hospital, University of Toronto, and Institute for Clinical and Evaluative Sciences; Toronto, Ontario Canada
| | | | - Crystal MacKay
- Toronto Western Research Institute and University of Toronto; Toronto, Ontario Canada
| | - Elizabeth Badley
- University of Toronto, Toronto Western Research Institute, and Institute for Clinical and Evaluative Sciences; Toronto, Ontario Canada
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Yuen HK, Wang E, Holthaus K, Vogtle LK, Sword D, Breland HL, Kamen DL. Self-reported versus objectively assessed exercise adherence. Am J Occup Ther 2013; 67:484-9. [PMID: 23791324 DOI: 10.5014/ajot.2013.007575] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE. We examined agreement of data between self-reported and objectively assessed exercise adherence among women with systemic lupus erythematosus. METHOD. Eleven participants completed weekly exercise logs on date and duration of exercise during a 10-wk Wii Fit™ home-based program. Afterward, exercise data from the log were compared with those recorded in the Wii console. RESULTS. Of the paired data, the mean duration of exercise recorded in the Wii was 29.5 min and that recorded in the log was 33.3 min. The composite intraclass correlation for exercise duration between exercise log and the Wii Fit was 0.4. The 95% limits of agreement indicated large between-subjects variability. CONCLUSION. Exercise logs exhibit a marginally acceptable agreement with Wii estimation of exercise duration at a group level. However, caution should be applied when using the exercise log as a measure of a person's exercise behavior because of the tendency to overreport.
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Affiliation(s)
- Hon K Yuen
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, 1530 Third Avenue South, Birmingham, AL 35294, USA.
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Exercise as a therapeutic tool to counteract inflammation and clinical symptoms in autoimmune rheumatic diseases. Autoimmun Rev 2012; 12:218-24. [DOI: 10.1016/j.autrev.2012.06.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 06/29/2012] [Indexed: 12/20/2022]
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Yuen HK, Breland HL, Vogtle LK, Holthaus K, Kamen DL, Sword D. The process associated with motivation of a home-based Wii Fit exercise program among sedentary African American women with systemic lupus erythematosus. Disabil Health J 2012; 6:63-8. [PMID: 23260612 DOI: 10.1016/j.dhjo.2012.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 06/14/2012] [Accepted: 08/30/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the process associated with the motivation for playing Wii Fit among patients with systemic lupus erythematosus (SLE). METHODS Individual in-depth semi-structured telephone interviews were conducted with 14 sedentary African American women with SLE to explore their experiences and reflect on their motivation for playing Wii Fit after completing a 10-week home-based Wii Fit exercise program. Interviews were audio-recorded, transcribed verbatim, and analyzed using the constant comparative method to identify categories related to participants' motivation. Three authors independently sorted, organized and coded transcript text into categories, then combined the categories into themes and subthemes. RESULTS In addition to the two themes (Ethical principal of keeping a commitment, and Don't want to let anyone down) generic to home-based exercise trials, we identified five themes (Enjoyment, Health Benefits, Sense of Accomplishment, Convenience, and Personalized) that revealed why the participants were motivated to play the Wii Fit. Enjoyment had three subthemes: Interactive, Challenging, and Competitive with an embedded social element. However, several participants commented they were not able to do many activities, master certain games, or figure out how to play some; as a result, they were bored with the limited selection of activities that they could do. CONCLUSIONS The motivational elements of the Wii Fit may contribute to improved exercise motivation and adherence in select sedentary African American women with SLE. Results provide a better understanding on the important elements to incorporate in the development of sustainable home-based exercise programs with interactive health video games for this population.
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Affiliation(s)
- Hon K Yuen
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Yuen HK, Holthaus K, Kamen DL, Sword DO, Breland HL. Using Wii Fit to reduce fatigue among African American women with systemic lupus erythematosus: a pilot study. Lupus 2011; 20:1293-9. [PMID: 21700656 DOI: 10.1177/0961203311412098] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Fatigue and physical deconditioning are common, difficult to treat conditions among patients with systemic lupus erythematosus (SLE). The aim of this pilot study was to evaluate the effectiveness of a home-based exercise program using the Wii Fit system in patients with SLE. Fifteen sedentary African American women with SLE experiencing moderate to severe fatigue participated in a home exercise program using the Wii Fit 3 days a week for 30 minutes each for 10 weeks. A one-group pretest-post test design was used to evaluate the effectiveness of this program. Primary outcome measure was severity of fatigue. Secondary outcome measures were body weight, waist circumference, fatigue-related symptoms of distress, activity level, and physical fitness. At the completion of the 10-week Wii Fit exercise program, participants perceived fatigue severity as measured by the Fatigue Severity Scale to be significantly decreased (p = 0.002), and body weight and waist circumference were significantly reduced (p = 0.01). In addition, anxiety level, as measured by Hospital Anxiety and Depression Scale, and overall intensity of total pain experience, as measured by Short-form of the McGill Pain Questionnaire, were also significantly reduced (p < 0.05). Findings provide preliminary evidence that the Wii Fit motivates this population to exercise, which leads to alleviation of fatigue and reduced body weight, waist circumference, anxiety level, and overall intensity of total pain experience.
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Affiliation(s)
- H K Yuen
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, 1530 3rd Avenue South, Birmingham, AL 35294, USA.
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Abstract
This review gives an overview of the rehabilitation of autoimmune diseases. After general remarks on rehabilitation, the effects of acute and chronic exercises on inflammatory markers are summarized. Most of the available literature deals with rheumatoid arthritis (RA) and multiple sclerosis (MS), and therefore, rehabilitation of these diseases is described in more detail. Exercise is the main component in the rehabilitation of patients with RA and aims at increasing physical capacity, muscle strength, aerobic endurance, cardiovascular fitness and functional abilities, and helps to prevent secondary deconditioning due to reduced activity levels. Since MS causes a wide range of symptoms, the rehabilitation of these patients requires a multidisciplinary approach and encompasses physiotherapy, exercise therapy, hippotherapy, cognitive rehabilitation, psychological therapy, strategies to improve fatigue and coping programs. The ultimate goal of rehabilitation is to enable patients with chronic conditions to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels, and to attain independence and self-determination as far as possible.
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Poole JL, Brandenstein JS. Connective tissue disorders. Rheumatology (Oxford) 2010. [DOI: 10.1016/b978-0-443-06934-5.00021-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Iscru DF, Anghelina M, Agarwal S, Agarwal G. Changes in surface topologies of chondrocytes subjected to mechanical forces: an AFM analysis. J Struct Biol 2008; 162:397-403. [PMID: 18406170 DOI: 10.1016/j.jsb.2008.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 01/01/2008] [Accepted: 02/21/2008] [Indexed: 12/31/2022]
Abstract
The cartilage is composed of chondrocytes embedded in a matrix of collagen fibrils interspersed within a network of proteoglycans and is constantly exposed to biomechanical forces during normal joint movement. Characterization of the surface morphology, cytoskeletal structure, adherance and elastic properties of these mechanosensitive cells are crucial in understanding the effects of mechanical forces around a cell and how a cell responds to changes in its physical environment. In this work, we employed the atomic force microscope (AFM) to image cultured chondrocytes before and after subjecting them to mechanical forces in the presence or absence of interleukin-1beta to mimic inflammatory conditions. Nanoscale imaging and quantitative measurements from AFM data revealed that there are distinct changes in cell-surface topology and cytoskeleton arrangement in the cells following treatment with mechanical forces, IL-1beta or both. Our findings for the first time demonstrate that cultured chondrocytes are amenable to high-resolution AFM imaging and dynamic tensile forces may help overcome the effect of inflammatory factors on chondrocyte response.
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Affiliation(s)
- Daniel F Iscru
- AFM Core Facility at the Davis Heart and Lung Research Institute, 473 W., 12th Avenue, The Ohio State University, Columbus, OH 43210, USA
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Erratum. Curr Opin Rheumatol 2007. [DOI: 10.1097/01.bor.0000275313.78200.8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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