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Zhang X, Wang Z, Lin GL, Wei FZ, Zhuang YP, Xu WL, Zhang Q, Wu HT, He ZM, Yin XY, Liu Y, Mi L, Gong AM. Analysis of status and influencing factors of mental health in patients with systemic lupus erythematosus. World J Psychiatry 2024; 14:829-837. [PMID: 38984348 PMCID: PMC11230090 DOI: 10.5498/wjp.v14.i6.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disorder with varied clinical courses and prognoses, not only did the patients suffer from physical impairment, but also various physical and psychiatric comorbidities. Growing evidence have suggested that mental disorders in SLE patients, can lead to various adverse consequences. AIM To explored the features and influencing factors of mental health in patients with SLE and clarifying the correlations between mental health and personality characteristics and perceived social support. The results would provide a basis for psychological intervention in patients with SLE. METHODS The clinical data of 168 patients with SLE admitted at the First Affiliated Hospital of Hainan Medical University between June 2020 and June 2022 were collected. Psychological assessment and correlation analysis were conducted using the Symptom Checklist-90 (SCL-90) and Perceived Social Support Scale, and the collected data were compared with the national norms in China. The relevant factors influencing mental health were identified by statistical analysis. A general information questionnaire, the Revised Life Orientation Test, and Short-Form 36-Item Health Survey were employed to assess optimism level and quality of life (QoL), respectively. RESULTS Patients with SLE obtained higher scores for the somatization, depression, anxiety, and phobic anxiety subscales than national norms (P < 0.05). A correlation was identified between total social support and total SCL-90 score or each subscale (P < 0.05). The factors significantly affecting patients' mental health were hormone dosage and disease activity index (DAI) (P < 0.05). The average optimism score of patients with SLE was 14.36 ± 4.42, and 30 cases were in the middle and lower levels. A positive correlation was found between optimism level and QoL scores. CONCLUSION Patients with SLE develop psychological disorders at varying degrees, which are significantly influenced by hormone dosage and DAI. Patients' mental health should be closely monitored during clinical diagnosis and treatment and provided adequate support in establishing positive, healthy thinking and behavior patterns and improving their optimism level and QoL.
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Affiliation(s)
- Xuan Zhang
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Zhe Wang
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Gui-Ling Lin
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Fang-Zhi Wei
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Yan-Ping Zhuang
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Wen-Lu Xu
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Qi Zhang
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Hui-Tao Wu
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Zi-Man He
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Xi-Yu Yin
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
| | - Ying Liu
- Department of Rheumatology and Immunology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Long Mi
- Department of Radiology, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou 570100, Hainan Province, China
| | - Ai-Min Gong
- School of Traditional Chinese Medicine, Hainan Medical University, Haikou 571101, Hainan Province, China
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Emamikia S, Gomez A, Ådahl T, von Perner G, Enman Y, Chatzidionysiou K, Arkema EV, Parodis I. Factors associated with non-adherence to medications in systemic lupus erythematosus: Results from a Swedish survey. Lupus 2024; 33:615-628. [PMID: 38545763 PMCID: PMC11015713 DOI: 10.1177/09612033241242692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/05/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To identify determinants of medication non-adherence in a Swedish population of systemic lupus erythematosus (SLE). METHODS Patients with SLE from Karolinska and Örebro University Hospitals participated in a survey-based cross-sectional study. Demographics, disease activity, organ damage, HRQoL (LupusQol, EQ-5D-5 L), medication non-adherence (<80% on CQR-19 or MASRI) and beliefs about medicines (BMQ) were registered. MASRI was used to report adherence to different drugs/drug classes, categorised into (i) antimalarial agents (AMA), (ii) glucocorticoids and (iii) other SLE medications. Multivariable logistic regression adjusted for age, sex, disease activity and organ damage. RESULTS Among 205 respondents, the median age was 52.0 years (IQR: 34.0-70.0), 86.3% were women, 66.8% were non-adherent to their medications according to CQR-19, and 6.6% and 6.3% were non-adherent to AMA and glucocorticoids, respectively, according to MASRI. Positive beliefs about glucocorticoids (OR; 95% CI: 0.77; 0.59-0.99; p = .039) and medications overall (0.71; 0.52-0.97; p = .029) were protective against non-adherence to glucocorticoids. Anxiety/depression (3.09; 1.12-8.54; p = .029), medication concerns (1.12; 1.05-1.20; p < .001) and belief that medications are overused (1.30; 1.15-1.46; p < .001) or harmful (1.36; 1.19-1.56; p < .001) were associated with medication non-adherence (CQR-19); beliefs in the necessity of medications (0.73; 0.65-0.82; p < .001) and positive beliefs in medications were protective (0.72; 0.60-0.86; p < .001). No associations were found between other investigated factors and medication non-adherence. CONCLUSIONS Beliefs about medications were a major determinant of medication non-adherence. Patient education may help alleviate the negative impact of misinformation/unawareness on adherence.
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Affiliation(s)
- Sharzad Emamikia
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Theodor Ådahl
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gunilla von Perner
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Enman
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Katerina Chatzidionysiou
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Elizabeth V. Arkema
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Tayyab Z, Khan H, Saeed S, Saif S, Haseeb Khan S, Ijaz Bhatti M. Undiagnosed Depression and Its Effects on Patients With Systemic Lupus Erythematosus. Cureus 2024; 16:e53064. [PMID: 38410327 PMCID: PMC10896275 DOI: 10.7759/cureus.53064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Different organs and organ systems are affected by a well-known chronic immune disorder called systemic lupus erythematosus (SLE). Besides the physical harm caused by this disorder, it affects the mental health of patients in a greater ratio by causing depression and anxiety. The objective of this study is to assess the prevalence of undiagnosed depression and its effects on patients with systemic lupus erythematosus. Material and methods This prospective cross-sectional study was carried out in the Rheumatology outpatient department of Fatima Memorial Hospital (FMH), Lahore, from November 2022 to February 2023. All study subjects had been given a prior diagnosis of SLE based on the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria. Three sections comprised the survey form: section I asked questions about socio-demographic information (gender and age); section II assessed the degree of mental illness activity; and section III assessed the degree of SLE disease activity. The nine-item PHQ-9 (Patient Health Questionnaire 9) scale, which is used to diagnose severe depressive disorder, was utilized to measure depression. To compare categorical variables, we applied Fisher's exact tests and chi-square; for continuous variables, we utilized the student's t-test. The statistical analysis was conducted using SPSS software for Windows Version 21.0 (IBM Corp., Armonk, NY, USA), with a significance threshold of p-value <0.05. Results Mild, moderate, and severe depression were present in 20%, 37.5%, and 37.5% of the patients, respectively. Pearson correlation of disease severity was strongly positive with depression (R2=0.634, p=0.01). The correlation was statistically significant. Conclusion Our research indicates that depression is a real problem for SLE patients. There is a positive correlation between the activity of the disease and the intensity of depression.
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Affiliation(s)
- Zaid Tayyab
- Rheumatology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | - Haseeb Khan
- Rheumatology, Dorset County Hospital, Dorchester, GBR
| | - Samina Saeed
- Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Saba Saif
- Medicine, CMH (Combined Military Hospital) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Sana Haseeb Khan
- Pathology and Laboratory Medicine, Al Aleem Medical College, Lahore, PAK
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Shi Y, Bi D, Wang Y, Li R, Wu L, Zhao C, Wu Z, Duan X, Xu J, Zhan F, Yang M, Liu S, Li Q, Zhang S, Liu L, Zhao J, Tian X, Li X, Wang Q, Zeng X. Chinese SLE Treatment and Research Group Registry (CSTAR) XIV: the subjective well-being of patients with systemic lupus erythematosus. Front Med (Lausanne) 2022; 9:984183. [PMID: 36203761 PMCID: PMC9531862 DOI: 10.3389/fmed.2022.984183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Systemic lupus erythematosus (SLE) can significantly influence patients’ quality of life and subjective well-being (SWB), but the relationships between clinical characteristics, SWB, and related psychological factors have been little studied. Objective To measure SWB in patients with SLE and examine how major clinical determinants, emotional variables, and related positive factors affect SWB. Methods Overall, 1,110 patients with SLE from the Chinese SLE Treatment and Research Group (CSTAR) and 198 age and gender-matched individuals from the general population without self-reported SLE were invited to complete questionnaires of SWB evaluated by the satisfaction with life scale (SWLS), emotional variables assessed by the patient health questionnaire-9 (PHQ-9), and general anxiety disorder-7 (GAD-7) and related positive factors assessed by the self-esteem scale (SES), general self-efficacy scale (GESE), and Connor-Davidson resilience scale (CD-RISC). The multivariate linear regression was used to examine the relationship between clinical manifestations and SWB. Results Life satisfaction was significantly lower (p < 0.001) in patients with SLE than in the general population. Active skin involvement (OR = 0.923, 95% CI = 0.868–0.981, p < 0.05) was negatively associated with life satisfaction scores, and age at enrollment (OR = 1.160, 95% CI = 1.092–1.230, p < 0.001) were positively associated with life satisfaction scores in the multivariate regression model. The cumulative organ damage was significantly associated with depression (OR = 1.085, 95% CI = 1.022–1.153, p < 0.01) and the loss of self-esteem (OR = 1.067, 95% CI = 1.004–1.133, p < 0.05). Conclusion SWB provides useful insight into the impact of SLE on psychological health and opportunities to improve quality of life and clinical care.
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Affiliation(s)
- Yue Shi
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dandan Bi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, China
| | - Ruofan Li
- Department of International Education, The Experimental High School Attached to Beijing Normal University, Beijing, China
| | - Lijun Wu
- Department of Rheumatology, The People’s Hospital of Xinjiang Autonomous, Urumqi, China
| | - Cheng Zhao
- Department of Rheumatology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhenbiao Wu
- Department of Clinical Immunology and Rheumatology, Xijing Hospital Affiliated with The Fourth Military Medical University, Xi’an, China
| | - Xinwang Duan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jian Xu
- Department of Rheumatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Feng Zhan
- Department of Rheumatology, Hainan Provincial People’s Hospital, Haikou, China
| | - Min Yang
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shengyun Liu
- Department of Rheumatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qin Li
- Department of Rheumatology, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Shuo Zhang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Lingshan Liu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xinying Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Xinying Li,
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
- Qian Wang,
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Liao J, Kang J, Li F, Li Q, Wang J, Tang Q, Mao N, Li S, Xie X. A cross-sectional study on the association of anxiety and depression with the disease activity of systemic lupus erythematosus. BMC Psychiatry 2022; 22:591. [PMID: 36064377 PMCID: PMC9443011 DOI: 10.1186/s12888-022-04236-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects multiple systems and increases the risk of mental disorders such as depression and anxiety. We conducted an observational, single-center, cross-sectional study to investigate the relationship between depression, anxiety, and SLE disease activity. METHODS The Patient Health Questionnaire 9 (PHQ-9) was used to assess depression, and the 7-item Generalized Anxiety Disorders Scale was used to assess anxiety (GAD-7). Using the chi-square/exact Fisher's tests, socio-demographic data, clinical and other characteristics of SLE patients were compared between depression or anxiety and non-depression/non-anxiety groups. To identify optimal levels of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) for predicting depression or anxiety, receiver-operator curves (ROC) were drawn. RESULTS Among the 325 patients involved in this study, patients with depression or anxiety had significantly higher SLE activity (p < 0.001), and more frequent musculoskeletal (p < 0.05) and neuropsychiatric symptoms (p < 0.05). Depression and anxiety are more common in the moderate-severe active group than in the inactive-mild active group (depression: OR 3.350, 95%CI 2.015, 5.570, p < 0.001; anxiety: OR 4.085, 95%CI 2.493, 6.692, p < 0.001). The optimal SLEDAI cutoff value of 8.5 predicted depression with a sensitivity of 50.5% and a specificity of 78.4% (AUC 0.660, p < 0.001) and anxiety with a sensitivity of 54.2% and a specificity of 78.4% (AUC 0.684, p < 0.001). CONCLUSION SLE disease activity is positively associated with the severity of depression and anxiety. Those patients whose SLEDAI scores are greater than 8.5 are more likely to suffer from mental disorders which require additional attention to them.
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Affiliation(s)
- Jiafen Liao
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Jin Kang
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Fen Li
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Qi Li
- grid.207374.50000 0001 2189 3846Department of Cardiology, Heart Center of Henan Provincial People’s Hospital, Henan Key Laboratory for Coronary Heart Disease Prevention and Control, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan China
| | - Jia Wang
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Qi Tang
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Ni Mao
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Shu Li
- grid.452708.c0000 0004 1803 0208Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Xi Xie
- Department of Rheumatology, the Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Hasan B, Fike A, Hasni S. Health disparities in systemic lupus erythematosus-a narrative review. Clin Rheumatol 2022; 41:3299-3311. [PMID: 35907971 PMCID: PMC9340727 DOI: 10.1007/s10067-022-06268-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To describe root causes of health disparities by reviewing studies on incidence and outcomes of systemic lupus erythematosus (SLE) related to ethnic, race, gender, or socioeconomic differences and to propose solutions. RECENT FINDINGS SLE outcomes have steadily improved over the past 40 years but are not uniformly distributed across various racial and ethnic groups. Belonging to racial and ethnic minority has been cited as a risk factor for more severe disease and poor outcome in SLE. Population-based registries have demonstrated that Black patients with SLE have significantly lower life expectancy compared to White patients. Lower socioeconomic status has been shown to be one of the strongest predictors of progression to end stage renal disease in lupus nephritis. An association between patient experiences of racial discrimination, increased SLE activity, and damage has also been described. The lack of representation of marginalized communities in lupus clinical trials further perpetuates these disparities. To that end, the goal of a rheumatology workforce that resembles the patients it treats has emerged as one of many solutions to current shortfalls in care. Disparities in SLE incidence, treatment, and outcomes have now been well established. The root causes of these disparities are multifactorial including genetic, epigenetic, and socioeconomic. The underrepresentation of marginalized communities in lupus clinical trials further worsen these disparities. Efforts have been made recently to address disparities in a more comprehensive manner, but systemic causes of disparities must be acknowledged and political will is required for a sustained positive change.
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Affiliation(s)
- Bilal Hasan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD USA
| | - Alice Fike
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD USA
| | - Sarfaraz Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD USA
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Nikoloudaki M, Repa A, Pitsigavdaki S, Molla Ismail Sali A, Sidiropoulos P, Lionis C, Bertsias G. Persistence of Depression and Anxiety despite Short-Term Disease Activity Improvement in Patients with Systemic Lupus Erythematosus: A Single-Centre, Prospective Study. J Clin Med 2022; 11:jcm11154316. [PMID: 35893407 PMCID: PMC9329785 DOI: 10.3390/jcm11154316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
Mental disorders such as anxiety and depression are prevalent in systemic lupus erythematosus (SLE) patients, yet their association with the underlying disease activity remains uncertain and has been mostly evaluated at a cross-sectional level. To examine longitudinal trends in anxiety, depression, and lupus activity, a prospective observational study was performed on 40 adult SLE outpatients with active disease (SLE Disease Activity Index [SLEDAI]-2K ≥ 3 [excluding serology]) who received standard-of-care. Anxiety and depression were determined at baseline and 6 months by the Hospital Anxiety and Depression Scale. Treatment adherence was assessed with the Morisky Medication Adherence Scale-4. Increased anxiety (median [interquartile range] HADS-A: 11.0 [7.8]) and depression (HADS-D: 8.0 [4.8]) were found at inclusion, which remained stable and non-improving during follow-up (difference: 0.0 [4.8] and −0.5 [4.0], respectively) despite reduced SLEDAI-2K by 2.0 (4.0) (p < 0.001). Among possible baseline predictors, paid employment—but not disease activity—correlated with reduced HADS-A and HADS-D with corresponding standardized beta-coefficients of −0.35 (p = 0.017) and −0.27 (p = 0.093). Higher anxiety and depression correlated with lower treatment adherence (p = 0.041 and p = 0.088, respectively). These results indicate a high-mental disease burden in active SLE that persists despite disease control and emphasize the need to consider socioeconomic factors as part of comprehensive patient assessment.
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Affiliation(s)
- Myrto Nikoloudaki
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Argyro Repa
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Sofia Pitsigavdaki
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Ainour Molla Ismail Sali
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Prodromos Sidiropoulos
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
- Institute of Molecular Biology and Biotechnology—FORTH, 71110 Heraklion, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, University of Crete Medical School, 71110 Heraklion, Greece;
| | - George Bertsias
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
- Institute of Molecular Biology and Biotechnology—FORTH, 71110 Heraklion, Greece
- Correspondence: ; Tel.: +30-2810-394635
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Albuquerque ES, Pinto LDS, Neto VL, Fragoso TS. Medication adherence in systemic lupus erythematosus during Brazilian COVID-19 pandemic. Lupus 2022; 31:221-227. [PMID: 35077262 PMCID: PMC8792910 DOI: 10.1177/09612033221074177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with chronic diseases are potential candidates for inadequate follow-up of drug therapy, tending to incur damage to the intended results. This deserves greater attention in the pandemic period, as they are in the considered risk group. METHODS We aim to assess Treatment Adherence Measure and analyze associations with characteristics related to the patient, treatment, disease, health professionals and service, and sociodemographic issues in patients with Systemic Lupus Erythematosus (SLE). W conducted a cross-sectional study with a sample of 116 participants, whose data were collected through individual interviews and review of medical records, during the first months of the COVID-19 pandemic in Brazil. Adherence was measured using the Treatment Adherence Measure, and associations were evidenced through described and inferential statistics. RESULTS The percentage of adherent patients was 55.2%. An association was found between MTA (Medication Treatment Adherence) and physical exercise practice (p = 0.032), and difficulties with treatment (p = 0.002). Conclusion: Participants who did not practice physical exercise were 3.71 times more likely to not adhere to the treatment. Individuals who identified difficulties in the treatment were 3.43 times more likely to not adhere to the treatment; we believe that the pandemic may have influenced this result. More targeted studies are needed to measure the impact on MTA in these patients.
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Affiliation(s)
- Emmanuele S Albuquerque
- Emmanuele S Albuquerque, Faculty of Medicine, Federal University of Alagoas, Av. Lourival Melo Mota, s/n - Tabuleiro do Martins, Maceio 57072-970, Brazil.
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9
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Pirri S, Talarico R, Marinello D, Turchetti G, Mosca M. A systematic literature review of existing tools used to assess medication adherence in connective tissue diseases: the state of the art for the future development of co-designed measurement tools. Reumatismo 2021; 73. [PMID: 34814655 DOI: 10.4081/reumatismo.2021.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/18/2021] [Indexed: 11/23/2022] Open
Abstract
Lack of medication adherence is frequent in chronic connective tissue diseases and is associated with poorer health outcomes, low quality of life and economic loss. This research is based on a systematic literature search and aims to identify the surveys and tools used for the assessment of medication adherence in patients with connective tissue diseases (CTDs) and in particular the tools co-designed with patients. A systematic literature review was performed in PubMed and Embase databases searching for studies concerning the application of surveys or tools designed for medication adherence assessment. A specific analysis was also performed to identify which of these existing tools were developed in co-design with patients affected by CTDs. 1958 references were identified, and 31 studies were finally included. Systemic lupus erythematosus was the most investigated disease, followed by the Behçet's disease. The tools used to assess adherence in CTDs were, in most cases, valid and useful. However, the results showed a certain degree of heterogeneity among the studies and the medication adherence assessment and measurement tools adopted, which were mostly based on selfreported questionnaire. No co-designed tools with patients were found. Low- and non-adherence were explored in some CTDs with valid and useful tools, while other CTDs still need to be assessed. Therefore, more efforts should be made to better understand the specific reasons for the low- and non-adherence in CTDs patients.
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Affiliation(s)
- S Pirri
- Institute of Management, Scuola Superiore Sant'Anna, Pisa.
| | - R Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa.
| | - D Marinello
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa.
| | - G Turchetti
- Institute of Management, Scuola Superiore Sant'Anna, Pisa.
| | - M Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa.
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10
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Yan D, Wu X, Tang S. Statistical analysis of one-compartment pharmacokinetic models with drug adherence. J Pharmacokinet Pharmacodyn 2021; 49:209-225. [PMID: 34708336 DOI: 10.1007/s10928-021-09794-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
Pharmacokinetics is a scientific branch of pharmacology that describes the time course of drug concentration within a living organism and helps the scientific decision-making of potential drug candidates. However, the classical pharmacokinetic models with the eliminations of zero-order, first-order and saturated Michaelis-Menten processes, assume that patients perfectly follow drug regimens during drug treatment, and the significant factor of patients' drug adherence is not taken into account. In this study, therefore, considering the random change of dosage at the fixed dosing time interval, we reformulate the classical deterministic one-compartment pharmacokinetic models to the framework of stochastic, and analyze their qualitative properties including the expectation and variance of the drug concentration, existence of limit drug distribution, and the stochastic properties such as transience and recurrence. In addition, we carry out sensitivity analysis of drug adherence-related parameters to the key values like expectation and variance, especially for the impact on the lowest and highest steady state drug concentrations (i.e. the therapeutic window). Our findings can provide an important theoretical guidance for the variability of drug concentration and help the optimal design of medication regimens. Moreover, The developed models in this paper can support for the potential study of the impact of drug adherence on long-term treatment for chronic diseases like HIV, by integrating disease models and the stochastic PK models.
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Affiliation(s)
- Dingding Yan
- School of Mathematics and Statistics, Shaanxi Normal University, Xi'an, People's Republic of China
| | - Xiaotian Wu
- College of Arts and Sciences, Shanghai Maritime University, Shanghai, People's Republic of China.
| | - Sanyi Tang
- School of Mathematics and Statistics, Shaanxi Normal University, Xi'an, People's Republic of China.
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11
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Wang Y, Wang X, Wang X, Naqvi AA, Zhang Q, Zang X. Translation and validation of the Chinese version of the general medication adherence scale (GMAS) in patients with chronic illness. Curr Med Res Opin 2021; 37:829-837. [PMID: 33719815 DOI: 10.1080/03007995.2021.1901680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To translate the English version of general medication adherence scale (GMAS) into a Chinese version and test its reliability and validity in Chinese patients with chronic diseases. METHODS After translating the original English version into Chinese (GMAS-C) following the forward-backward translation and expert review procedure, we conducted a pilot study among 10 chronic disease patients. Each patient took about 10 min to complete the scale and was asked about the difficulty of understanding or filling the scale. Then a total of 312 patients aged 18 years or older with chronic illness were selected from the outpatient departments of two tertiary hospitals and a community center in Tianjin from April 2019 to May 2020 by convenience sampling. Cronbach's α coefficient, item-total correlation and test-retest reliability were used to evaluate the scale reliability; expert evaluation method was used to evaluate the content validity of the scale; and exploratory factor analysis, confirmatory factor analysis, and known group validity were used to evaluate the construct validity of the scale. RESULTS As a result of the adaptation process, the GMAS-C's structure was determined. It included 3 dimensions and 11 items and was reliable and valid for Chinese patients with chronic diseases. Total Cronbach's α coefficient of the scale was 0.781 and test-retest reliability coefficient was 0.883 after two weeks. The item-level content validity indexes (CVIs) were ≥ 0.78 for all items. A Kaiser-Meyer-Olkin test and Bartlett' test of sphericity test indicated that the sample met the requirements of factor analysis. Exploratory factor analysis extracted three factors with eigenvalue >1, and 60% of the total variance was explained by three-factor solution. Confirmatory factor analysis showed acceptable fit indices (χ2/df = 1.58, IFI = 0.96, TLI = 0.94, CFI = 0.96 and RMSEA = 0.05). CONCLUSIONS The GMAS-C demonstrates satisfactory reliability and validity. This scale can be a clinically useful tool to identify the levels of medication adherence and possible barriers for adherence of the medication regime in patients with chronic diseases.
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Affiliation(s)
- Yan Wang
- School of Nursing, Tianjin Medical University, Tianjin, PR China
| | - Xiaoxu Wang
- School of Nursing, Tianjin Medical University, Tianjin, PR China
| | - Xiaobing Wang
- School of Nursing, Tianjin Medical University, Tianjin, PR China
| | - Atta Abbas Naqvi
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Qing Zhang
- School of Nursing, Tianjin Medical University, Tianjin, PR China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Tianjin, PR China
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12
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Chen YJ, Chang J, Yang SY. Psychometric Evaluation of Chinese Version of Adherence to Refills and Medications Scale (ARMS) and Blood-Pressure Control Among Elderly with Hypertension. Patient Prefer Adherence 2020; 14:213-220. [PMID: 32103905 PMCID: PMC7020932 DOI: 10.2147/ppa.s236268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/25/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study aimed to develop the ARMS-C and test its psychometric properties in hypertensive patients, to assess the level of medication adherence and to identify associated predictors for medication adherence and blood-pressure control among Chinese hypertensive patients. METHODS Hypertensive elderly who met inclusion criteria were recruited from an aged-care facility in Henan Province between January 2019 and July 2019. The patients completed the adapted ARMS-C. The scale's factor structure, internal consistency, and construct validity were tested. RESULTS Good internal consistency (Cronbach's α=0.89) and test-retest reliability (r=0.86, p<0.01) were obtained. Item-total correlation coefficients for the ten-item ARMS-C were 0.505-0.801. Factor analysis of construct validity identified two factors, explaining a total variance of 63.3%. Binary regression showed that patients with scores at level 2 (≤20 ARMS-10 scores <30) were six times as likely to have blood pressure uncontrolled as those at level 1 (ARMS-10 scores <20, OR 6.6, 95% CI 1.7-25.1; p=0.006), and patients with scores at level 3 (ARMS-10 scores >30) were 115 times as likely to have blood pressure uncontrolled as those at level 1 (ARMS-10 scores <20,OR 115, 95% CI 9-1,470; p=0). CONCLUSION The ten-item ARMS-C is a reliable and valid self-reporting screening tool for adherence to medication and refills in elderly hypertensive Chinese patients.
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Affiliation(s)
- Yi-Jing Chen
- Department of Health Care Clinic, First Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
- Academy of Medical Science, Zhengzhou University, Henan, People’s Republic of China
| | - Jing Chang
- Department of Health Care Clinic, First Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
- Correspondence: Jing Chang Email
| | - Si-Yu Yang
- Xiangya Medical School, Central South University, Changsha, People’s Republic of China
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