Symptom clustering in patients with childhood-onset systemic lupus erythematosus

Sleep deficiency and symptoms of pain, fatigue, and depressed mood in youth with and without childhood systemic lupus erythematosus

STUDY OBJECTIVES

We undertook a study to describe and compare sleep deficiency and symptoms of pain, fatigue, and depressed mood in youth with childhood systemic lupus erythematosus (cSLE) to a healthy comparison group of youth and test the associations between sleep and symptoms of pain, fatigue, and depressed mood in youth with cSLE.

METHODS

Forty-three youth (23 youth with cSLE; 20 age- and sex-matched healthy youth) wore actigraphs and completed sleep diaries for 10 days and completed self-report questionnaires on sleep quality, pain, fatigue, and depressed mood.

RESULTS

On average, both groups had a total sleep time of less than 7 hours. Youth with cSLE had worse sleep efficiency (73.3%) and sleep regularity index scores (55.4) compared to the healthy comparison group of youth (79.2% and 60.1, respectively). Youth with cSLE had worse pain (P = .03) and fatigue (P = .004) compared to the healthy comparison group. Negative associations were found among self-reported sleep quality, sleep satisfaction, and symptoms of pain, fatigue, and depressed mood in youth with cSLE and wake after sleep onset was positively associated with fatigue.

CONCLUSIONS

Poor sleep efficiency and sleep irregularity accompanied by symptoms of pain, fatigue, and depressed mood was prevalent in youth with cSLE. Youth with lupus should be encouraged to maintain a regular sleep schedule. Because this is the first study to incorporate objective sleep and sleep regularity measures in youth with cSLE, additional studies with objective and self-reported sleep measures are needed to replicate our findings.

CITATION

Wi D, Palermo TM, Stevens A, Ward TM. Sleep deficiency and symptoms of pain, fatigue, and depressed mood in youth with and without childhood systemic lupus erythematosus. J Clin Sleep Med. 2024;20(10):1607-1614.

Temporal Daily Relationships Between Sleep and Pain in Adolescents With Systemic Lupus Erythematosus

INTRODUCTION

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder characterized by recurrent episodes of pain. This study aimed to describe the temporal daily relationships between sleep and pain in adolescents with SLE.

METHOD

Twenty-three adolescents with SLE recruited from a pediatric hospital wore actigraphy and completed diaries. Generalized estimating equation models were used.

RESULTS

On average, evening pain negatively predicted subsequent sleep quality that night, and, on average, sleep quality negatively predicted morning pain. Shorter total sleep time significantly predicted higher morning pain (95% confidence intervals [CI], -0.38 to -0.03, p = .02), whereas sleep efficiency and sleep quality were not significantly associated with morning pain (95% CI, -0.03 to 0.03; 95% CI, -0.08 to 0.06, respectively). Subsequent evening pain did not predict daily nighttime sleep DISCUSSION: Our findings suggest that sleep is a target for pain interventions to include among adolescents with SLE.

Patients who experience systemic lupus erythematosus and leg ulcer: phenomenological approach

OBJECTIVE

To understand the experience of a woman with systemic lupus erythematosus and leg ulcers with cutaneous calcinosis.

METHODS

An experience report based on the social phenomenology of Alfred Schutz, conducted with a young woman undergoing treatment in an outpatient service.

RESULTS

The disease manifested itself in adolescence and brought emotional instability associated with body image concern and social isolation. The discontinuation of the studies triggered financial limitations with implications for treatment. The presence of ulcers aggravated by skin calcification makes the process of getting sick tiring and painful. Interpersonal relationships are resources for coping with situations experienced.

FINAL CONSIDERATIONS

Patients with lupus may have social, affective, and family life, even in the face of the limitations imposed by the disease. However, the emergence of leg ulcer with calcinosis changes this situation.

Self-concept and body image of people living with lupus: A systematic review

AIM

To summarize existing evidence regarding body image in patients with systemic lupus erythematosus, with the following considerations: (a) the perceptions patients have of their body changes; (b) how patients cope with changes in their body; (c) and what their perceptions are of body changes.

METHOD

A systematic review of literature integrating quantitative and qualitative studies. We searched databases (PubMed, CINAHL, Embase, SCOPUS, the Web of Science, Medline, Medline Complete, and Academic Search Premier) and publications from 2010 to 2020 with "Systemic Lupus Erythematosus" AND "Self-Concept" OR "Body Image" AND "Woman" as medical subheading terms. The studies included were subjected to a thematic content analysis, which allowed subjective interpretation of data through a systematic classification process for coding themes or patterns.

RESULTS

We identified 647 studies, of which 22 were analyzed in this study. Our results indicate that changes in the body image of people with lupus and their perception are issues that must be treated as characteristics of the disease; therefore, they need to receive the same attention as is given to physical disabilities and pain. The analysis identified 3 thematic categories: (a) depression and anxiety associated with body changes (hair loss, weight gain); (b) body image reflecting the disease; and (c) confrontations and interventions to promote acceptance and adaptation to the new image.

CONCLUSIONS

The dimensions of self-concept and body image are essential for assessing the quality of life of individuals with lupus. The formation of a adjusted self-concept can be managed by health professionals supporting these people.

Systemic lupus erythematosus symptom clusters and their association with patient-reported outcomes and treatment: Analysis of real-world data

OBJECTIVE

To identify discrete clusters of systemic lupus erythematosus (SLE) patients based on symptoms and investigate differences across clusters.

METHODS

Data were collected in the United States of America and five European countries via the Adelphi Real World Lupus Disease Specific Programme™, a cross-sectional survey. Rheumatologists provided data for five consecutively consulting adult patients with SLE, who were invited to participate. Identified SLE symptoms were reduced to factors based on commonly concurrent symptoms, using principal-component factor analysis. Factors were used as covariates in a latent class cluster analysis to identify discrete patient clusters. Patient-reported outcomes and physician-reported data were compared across clusters.

RESULTS

Among 1,376 patients, 87% of patients were female and 74% of patients were white. We identified four patient clusters ("very mild", "mild", "moderate", "severe") based on 39 signs/symptoms. Physician-reported symptom burden, organ involvement, disease activity and number of flares increased with increasing cluster severity (p<0.0001). Patient-reported impact (health status, fatigue, work productivity impairment, anxiety/depression, emotional impact) increased with increasing cluster severity (p<0.0001). Glucocorticoid and immunosuppressant use increased, and anti-malarial use decreased, with increasing cluster severity. In all clusters, <20% of patients received biologics; >15% of patients not receiving biologics were considered eligible for treatment by their physician. The proportion of physicians and patients satisfied with treatment decreased with increasing cluster severity (p<0.0001).

CONCLUSION

Our large, international real-world survey of SLE patients and physicians demonstrated strong associations between increased impairment, organ involvement and humanistic burden in SLE, highlighting unmet need for effective treatment options in high disease activity patients.

Nursing interventions in autologous stem cell transplantation for autoimmune diseases

AIMS

To identify clinical symptoms and nursing interventions for stem cell therapy in autoimmune diseases.

DESIGN

This is a retrospective, cross-sectional study.

METHODS

This study was undertaken with patients diagnosed with type 1 diabetes or multiple sclerosis, undergoing autologous haematopoietic stem cell transplantation from January 2004 - December 2018. Data were registered in a questionnaire, taken during the conditioning regimen comprising cyclophosphamide and rabbit anti-thymocyte globulin. Descriptive statistics and Fisher's exact test were used for data analysis.

RESULTS

There were 68 and 23 patients in the multiple sclerosis and type 1 diabetes groups respectively. Skin rash, nausea, vomiting and fever were more frequent and diverse in the type 1 diabetes group. Steroids were used as prophylaxis for anti-thymocyte globulin-associated allergic reactions in 97% of multiple sclerosis patients. Most of the identified symptoms and nursing interventions were more associated with one or other disease group (p < .05) and were more frequent in the type 1 diabetes group.

CONCLUSION

Patients with autoimmune diseases who underwent stem cell therapy present differences in their repertoire of adverse events and require disease-specific nursing actions.

IMPACT

Our results may enable nurses to establish transplant and disease-specific guidelines to improve prevention and management of adverse events and therefore optimize patient care and therapeutic success.