1
|
Zhao Q, Li X, Chen H, Wang L, Wu N, Ma J, Shen B. Association between depression and pain, functional disability, disease activity and health-related quality of life in patients with systemic lupus erythematosus: a meta-analysis. BMJ Open 2023; 13:e068683. [PMID: 37821132 PMCID: PMC10583069 DOI: 10.1136/bmjopen-2022-068683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/10/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore the effect of depression on pain, disease activity, functional disability and health-related quality of life measured by Visual Analogue Scale, Systemic Lupus Erythematosus Disease Activity Index, Health Assessment Questionnaire and Short Form-36 in patients with systemic lupus erythematosus. DESIGN Meta-analysis. DATA SOURCES The PubMed, EMBASE, Cochrane Library and Web of Science were searched for obtaining available studies from inception to 7 March 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies evaluating the impact of depression on pain, disease activity, functional disability and quality of life were included. DATA EXTRACTION AND SYNTHESIS Two authors independently screened publications and extracted data according to set inclusion and exclusion criteria. Statistical analyses were conducted with RevMan V.5.3.0. Data were pooled using a fixed-effects or random-effects model according to heterogeneity. RESULTS A total of 13 identified studies met the inclusion criteria, reporting on a total of 1911 patients with systemic lupus erythematosus. The Visual Analogue Scale score was significantly higher in patients with depression than those without depression (standardised mean difference (SMD)=0.84 (95% CI 0.27 to 1.42), p=0.004). The Health Assessment Questionnaire score was significantly higher in patients with depression than those without depression (SMD=1.05 (95% CI 0.14 to 1.95), p<0.05). The Systemic Lupus Erythematosus Disease Activity Index score was significantly higher in patients with depression than those without depression (SMD=0.46 (95% CI 0.27 to 0.64), p<0.00001). Scores in most Short Form-36 dimensions (physical function, role physical function, emotional role function, vitality, mental health, social function, general health, physical component scale, mental component scale) were lower in patients with depression than those without depression. CONCLUSION This meta-analysis showed that depression was associated with increased in pain, functional disability and disease activity, and decline in health-related quality of life in patients with systemic lupus erythematosus. Awareness of the importance of the relationship between depression in systemic lupus erythematosus patients and pain, functional disability and the quality of life might assist rheumatology physicians and nurses in assessing and preventing these symptoms. PROSPERO REGISTRATION NUMBER CRD42021265694.
Collapse
Affiliation(s)
- Qian Zhao
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xin Li
- Department of Respiratory and Critical Care Medicine, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Haoyang Chen
- Department of Nursing, Nantong University Affiliated Rehabilitation Hospital, Nantong, China
| | - Lili Wang
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Ning Wu
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Ji Ma
- The Orthopaedic Spinal Ward, Shanxi Provincial People's hospital, Taiyuan, China
| | - Biyu Shen
- Department of Nursing, Shanghai Children's Medical Center, Shanghai, China
- School of Nursing, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
2
|
Zheng H, Sun J, Pang T, Liu J, Lu L, Chang S. Identify novel, shared and disorder-specific genetic architecture of major depressive disorder, insomnia and chronic pain. J Psychiatr Res 2022; 155:511-517. [PMID: 36191519 DOI: 10.1016/j.jpsychires.2022.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/01/2022] [Accepted: 09/16/2022] [Indexed: 12/12/2022]
Abstract
Major depressive disorder (MDD), insomnia (INS) and chronic pain (CP) often have high comorbidity and show high genetic correlation. Here we aimed to better characterize their novel, shared and disorder-specific genetic architecture. Based on genome-wide association study (GWAS) summary data, we applied the conditional false discovery rate (condFDR) and conjunctional FDR (conjFDR) approach to investigate the novel and overlapped genetic loci for MDD, INS and CP. In addition, putative disorder-specific SNP associations were analyzed by conditioning the other two traits. The functions of the identified genomic loci were explored by performing gene set enrichment analysis (GSEA) for the loci mapped genes. We identified 22, 43 and 91 novel risk loci for MDD, INS and CP. GSEA for the loci mapped genes highlighted olfactory signaling pathway for MDD novel loci, breast cancer related gene set for both INS and CP novel loci, and nervous system related development, structure and activity for CP. Furthermore, we identified three loci jointly associated with the three disorders, including 13q14.3 locus with nearby gene OLFM4, 14q21.1 locus with nearby gene LRFN5 and 5q21.2 locus located in intergenic region. In addition, we identified one specific loci for MDD, 7 for INS and 11 for CP respectively by conditioning the other two traits, which were mapped to 68 genes for MDD, 85 for INS and 100 for CP. The MDD specific genes are enriched in immune system related pathways. This study increases understanding of the genetic architectures underlying MDD, INS and CP. The shared underlying genetic risk may help to explain the high comorbidity rates of the disorders.
Collapse
Affiliation(s)
- Haohao Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Jie Sun
- Center for Pain Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Tao Pang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Jiajia Liu
- School of Nursing, Peking University, Beijing, 100191, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China; Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, Beijing, 100191, China; National Institute on Drug Dependence, Peking University, Beijing, 100191, China
| | - Suhua Chang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China; Chinese Academy of Medical Sciences Research Unit (No.2018RU006), Peking University, Beijing, 100191, China.
| |
Collapse
|
3
|
Ferrara V, Perrone ME, Mina C, Ceccarelli F, Olivieri G, Fattapposta F, Conti F. Science and visual Arts: Binomial or Dichotomy? A Pilot study in Systemic Lupus Erythematosus patients. Lupus 2022; 31:1744-1749. [PMID: 36189670 DOI: 10.1177/09612033221131179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2022]
Abstract
Scientific literature demonstrated the impairment in cognitive/executive functions and pragmatic language in SLE patients, potentially involving also asymptomatic subjects. The present study focuses on the assessment in an SLE cohort of emotional intelligence, which is an ability regulated by the network of the executive functions, cognitive abilities involved in the initiation, planning, organization, and regulation of achievement-oriented behaviors: with emotional. Thus, emotional intelligence, defined as the ability to reason with emotions, was evaluated in a SLE cohort diagnosed according to the 1997 American College of Rheumatology criteria. As control healthy subjects were enrolled. The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), a skill-scale that measures the ability to perform tasks and solve emotional problems, was administered to patients and controls. Second, a group of SLE patients underwent the Visual Thinking Strategies (VTS) method in order to assess the potential impact of art in cognitive skills like critical thinking, problem solving, and emotional intelligence quotient. The protocol also included the evaluation of the improvement of some skills using a validated VTS skill grid. Self-reported scales for anxiety and depression were performed to rule out the influence of mood disorders on emotional intelligence. The present study demonstrated similar quotient scores of emotional intelligence in SLE patients and healthy controls. Furthermore, VTS method could help in improving this cognitive ability in patients, by implementing critical thinking and problem solving, promoting empathy, and improving tolerance to ambiguity and relational capacity.
Collapse
Affiliation(s)
- Vincenza Ferrara
- Art and Medical Humanities Lab - Pharmacy and Medicine Faculty, Sapienza University of Rome, Roma, Italy
| | | | - Concetta Mina
- Human Neurosciences Department Sapienza, University of Rome, Rome, Italy
| | - Fulvia Ceccarelli
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Giulio Olivieri
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | | | - Fabrizio Conti
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
4
|
Mertz P, Piga M, Chessa E, Amoura Z, Voll RE, Schwarting A, Maurier F, Blaison G, Bonnotte B, Poindron V, Fiehn C, Lorenz HM, Korganow AS, Sibilia J, Martin T, Arnaud L. Fatigue is independently associated with disease activity assessed using the Physician Global Assessment but not the SLEDAI in patients with systemic lupus erythematosus. RMD Open 2022; 8:rmdopen-2022-002395. [PMID: 36123013 PMCID: PMC9486369 DOI: 10.1136/rmdopen-2022-002395] [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: 04/06/2022] [Accepted: 07/27/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To analyse whether reported fatigue, one of the most challenging manifestations of systemic lupus erythematosus (SLE), may bias the assessment of disease activity in SLE according to the Physician Global Assessment (PGA). METHODS Patients from the Lupus BioBank of the upper Rhein database, a cross-sectional multicentre collection of detailed clinical and biological data from patients with SLE, were included. Patients had to fulfil the 1997 American College of Rheumatology criteria for SLE and the PGA (0-3 scale) at the time of inclusion had to be available. Fatigue was assessed according to the Fatigue Scale for Motor and Cognitive Functions. Univariate and multivariate regression models were built to determine which variables were associated with the PGA. RESULTS A total of 350 patients (89% female; median age: 42 years, IQR: 34-52) were included. The median Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) score was 4 (IQR: 2-6). Of these 350 patients, 257 (73%) reported significant fatigue. The PGA (p=0.004) but not the SELENA-SLEDAI (p=0.43) was significantly associated with fatigue. Both fatigue and SELENA-SLEDAI were independently associated with the PGA in two different multivariate models. CONCLUSION Fatigue is independently associated with disease activity assessed using the PGA but not the SLEDAI. These findings highlight the fact that the PGA should capture only objectively active disease manifestations in order to improve its reliability.
Collapse
Affiliation(s)
- Philippe Mertz
- Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, 1 Avenue Molière BP 83049, 67098 Strasbourg Cedex, France,Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA
| | - Matteo Piga
- Rheumatology Unit, AOU University Clinic and University of Cagliari, 09042 Cagliari, Italy
| | - Elisabetta Chessa
- Rheumatology Unit, AOU University Clinic and University of Cagliari, 09042 Cagliari, Italy
| | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, Centre national de Référence Lupus et SAPL, Assistance Publique–Hôpitaux de Paris (APHP), Groupement Hospitalier Pitié–Salpêtrière, Paris, France
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Schwarting
- Division of Rheumatology and Clinical Immunology, I.st Department of Internal Medicine Universitätsmedizin Mainz Langenbeckstr, 1 55131 Mainz, Germany
| | - Francois Maurier
- Internal Medicine Unit, Hôpitaux Privés de Metz Site Belle Isle 2 rue Belle Isle, 57045 Metz, France
| | - Gilles Blaison
- Service de médecine interne - Centre de compétence en maladies auto-immunes et systémiques rares, Hôpitaux Civils de Colmar, 39 avenue de la Liberté 68000 Colmar, France
| | - Bernard Bonnotte
- Service de médecine interne et immunologie clinique, CHU Dijon Bourgogne, 2, boulevard Mal-de-Lattre-de-Tassigny, 21000 Dijon, France
| | - Vincent Poindron
- Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA,Service d’immunologie clinique Nouvel hôpital civil, 1 place de l’hôpital, 67091 Strasbourg Cedex, France
| | - Christoph Fiehn
- ACURA Centre for Rheumatic Diseases, Rotenbachtalstr, 5 Baden-Baden, DE 76530, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology. Dept. of Medicine V University Hospital Heidelberg, Center for Rheumatic Diseases Baden-Baden, INF 410 69120 Heidelberg, Germany
| | - Anne-Sophie Korganow
- Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA,Service d’immunologie clinique Nouvel hôpital civil, 1 place de l’hôpital, 67091 Strasbourg Cedex, France
| | - Jean Sibilia
- Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, 1 Avenue Molière BP 83049, 67098 Strasbourg Cedex, France,Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA
| | - Thierry Martin
- Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA,Service d’immunologie clinique Nouvel hôpital civil, 1 place de l’hôpital, 67091 Strasbourg Cedex, France
| | - Laurent Arnaud
- Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, 1 Avenue Molière BP 83049, 67098 Strasbourg Cedex, France,Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA
| |
Collapse
|
5
|
Kósa F, Kunovszki P, Gimesi-Országh J, Kedves M, Szabó M, Karyekar CS, Nagy G. High risk of depression, anxiety, and an unfavorable complex comorbidity profile is associated with SLE: a nationwide patient-level study. Arthritis Res Ther 2022; 24:116. [PMID: 35590393 PMCID: PMC9118724 DOI: 10.1186/s13075-022-02799-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this national population-based, retrospective database study is to compare the comorbidity profiles of systemic lupus erythematosus (SLE) patients and general population controls matched for age, gender, and region and assess the risk of depression or anxiety when controlled for age, gender and adjusted for the Charlson Comorbidity Index (CCI). Methods Claims data of 1051 patients diagnosed with SLE (full population between January 01, 2011, and December 31, 2014) from the Hungarian National Health Insurance Fund have been analyzed against matched controls (1:5 ratio) with a follow-up of 30 months. The first record of SLE diagnosis was considered the diagnosis date. The odds ratio (OR) and 99.9% confidence interval (CI) of having depression or anxiety among patients with SLE vs. controls have been assessed using logistic regression models. Results SLE patients report more comorbidities than the matched general population both in pre- and post-index periods (mean CCI 1.79 vs. 1.15 and 2.78 vs. 1.22 [both p<0.001], respectively). Both SLE patients and controls diagnosed with depression or anxiety had significantly higher CCI than those without comorbid depression or anxiety (p<0.001). However, SLE patients had a twofold higher risk of depression or anxiety than matched controls when controlled for age, gender, and adjusted for CCI. Conclusion Our analysis indicates the enormity of comorbidity burden in SLE, especially that of anxiety and depression. The size and complexity of the comorbidity burden emphasizes the importance of early diagnosis and intervention with comprehensive modalities incorporating attention to comorbidities in SLE patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02799-6.
Collapse
Affiliation(s)
| | | | | | - Melinda Kedves
- Department of Rheumatology, Hospital of Bács-Kiskun County, Kecskemét, Hungary
| | - Melinda Szabó
- New Saint John Hospital and Outpatient Clinic, Budapest, Hungary
| | | | - György Nagy
- Department of Rheumatology and Clinical Immunology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary.,Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| |
Collapse
|
6
|
Dietz B, Katz P, Dall'Era M, Murphy LB, Lanata C, Trupin L, Criswell LA, Yazdany J. Major Depression and Adverse Patient-Reported Outcomes in Systemic Lupus Erythematosus: Results From a Prospective Longitudinal Cohort. Arthritis Care Res (Hoboken) 2021; 73:48-54. [PMID: 32741124 PMCID: PMC7775294 DOI: 10.1002/acr.24398] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/15/2020] [Accepted: 07/21/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) is reduced in systemic lupus erythematosus (SLE), partly driven by comorbid depression. Among patients with SLE, the association between major depression and HRQoL, measured using the NIH's Patient-Reported Outcomes Measurement Information System (PROMIS), is not well characterized. The objective was to determine an association between major depression and HRQoL as measured by PROMIS. METHODS Cross-sectional data were obtained from the California Lupus Epidemiology Study, a cohort of adults in the San Francisco Bay Area with SLE. We studied the association between major depression (score ≥10 on the Patient Health Questionnaire 8 depression scale) and T scores (scaled to population mean ± SD of 50 ± 10) on 12 PROMIS domains representing physical, mental, and social health. Mean T scores in depressed and nondepressed individuals were compared using multiple linear regression models adjusting for age, sex, race/ethnicity, disease activity, damage, body mass index, and household income. RESULTS Mean age of the 326 participants was 45 years; ~89% were women, 29% White, 23% Hispanic, 10% African American, and 36% Asian. One-fourth met the criteria for major depression. In multivariable analyses, major depression was independently associated with worse T scores on all 12 PROMIS domains (P < 0.001); compared with those without major depression, depressed individuals scored >10 points (1 SD) worse on fatigue, sleep impairment, negative psychosocial impact of illness, satisfaction in discretionary social activities, and satisfaction in social roles. CONCLUSION In individuals with SLE, major depression is associated with markedly worse PROMIS scores in physical, mental, and social domains. Diagnosing and treating depression may help improve HRQoL in individuals with SLE.
Collapse
Affiliation(s)
| | | | | | - Louise B Murphy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | |
Collapse
|
7
|
Mertz P, Schlencker A, Schneider M, Gavand PE, Martin T, Arnaud L. Towards a practical management of fatigue in systemic lupus erythematosus. Lupus Sci Med 2020; 7:7/1/e000441. [PMID: 33214160 PMCID: PMC7678390 DOI: 10.1136/lupus-2020-000441] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 12/13/2022]
Abstract
Significant fatigue is reported by two-thirds of patients with SLE and severe fatigue by one-third. The assessment and treatment of fatigue remains a major challenge in SLE, especially in patients with no disease activity. Here, we suggest a practical algorithm for the management of fatigue in SLE. First, common but non–SLE-related causes of fatigue should be ruled out based on medical history, clinical and laboratory examinations. Then, presence of SLE-related disease activity or organ damage should be assessed. In patients with active disease, remission is the most appropriate therapeutic target while symptomatic support is needed in case of damage. Both anxiety and depression are major independent predictors of fatigue in SLE and require dedicated assessment and care with psychological counselling and pharmacological intervention if needed. This practical algorithm will help in improving the management of one the most common and complex patient complaints in SLE.
Collapse
Affiliation(s)
- Philippe Mertz
- Department of Rheumatology, Hôpitaux universitaires de Strasbourg, Strasbourg, France.,Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Est Sud-Ouest (RESO), Strasbourg, France, France
| | - Aurélien Schlencker
- Department of Rheumatology, Hôpitaux universitaires de Strasbourg, Strasbourg, France.,Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Est Sud-Ouest (RESO), Strasbourg, France, France
| | - Matthias Schneider
- Policlinic for Rheumatology & Hiller Research Centre for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Pierre-Edouard Gavand
- Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Est Sud-Ouest (RESO), Strasbourg, France, France.,Service d'immunologie clinique, Hopitaux universitaires de Strasbourg, Strasbourg, France
| | - Thierry Martin
- Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Est Sud-Ouest (RESO), Strasbourg, France, France.,Service d'immunologie clinique, Hopitaux universitaires de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- Department of Rheumatology, Hôpitaux universitaires de Strasbourg, Strasbourg, France .,Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Est Sud-Ouest (RESO), Strasbourg, France, France
| |
Collapse
|
8
|
Azizoddin DR, Jolly M, Arora S, Yelin E, Katz P. Longitudinal Study of Fatigue, Stress, and Depression: Role of Reduction in Stress Toward Improvement in Fatigue. Arthritis Care Res (Hoboken) 2020; 72:1440-1448. [PMID: 31421030 PMCID: PMC7024647 DOI: 10.1002/acr.24052] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/13/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Fatigue is common among individuals with systemic lupus erythematosus (SLE), but the causes are not well understood. Our objective was to examine perceived stress and depressive symptoms as predictors of fatigue in SLE. METHODS Data from 2 years of the Lupus Outcomes Study (n = 650 patients), obtained through annual structured interviews, were used. Fatigue was measured with the Short Form 36 (SF-36) vitality scale along with a variety of self-report measures of disease, depression, and stress. Multivariate linear regression models examined predictors of changes in fatigue. Model 1 tested the association of time 1 (T1) depression with time 2 (T2) fatigue; model 2 added T1 perceived stress to model 1, and final models added T1-to-T2 decrease in stress. All analyses controlled for T1 fatigue, age, sex, self-report of fibromyalgia, pain, and SLE duration, activity, and damage. RESULTS Mean ± SD age was 51 ± 12 years, 92% of participants were women, and 68% were white. The mean ± SD SF-36 fatigue score was 55 ± 24. T1 depression significantly predicted T2 fatigue. When T1 stress was added, stress (β = 1.7 [95% confidence interval (95% CI) 1.1, 2.2]; P < 0.0001) significantly predicted T2 fatigue, but depression was no longer significant. The addition of T1-to-T2 decrease in stress was associated with a clinically meaningful decline in fatigue (β = -11.8 [95% CI -15.6, -8.9]; P < 0.0001). CONCLUSION While depressive symptoms initially predicted subsequent fatigue, the effects were mediated by stress. A decrease in stress, in addition, was associated with a clinically meaningful decrease in fatigue. These results suggest that perceived stress plays an important role in SLE fatigue and may be an important focus of interventions for fatigue.
Collapse
Affiliation(s)
| | | | | | - Edward Yelin
- Russell/Engleman Research Center in Arthritis and Philip R Lee Institute for Health Policy Studies, University of San Francisco California, San Francisco, CA
| | - Patricia Katz
- Russell/Engleman Research Center in Arthritis and Philip R Lee Institute for Health Policy Studies, University of San Francisco California, San Francisco, CA
| |
Collapse
|
9
|
Arnaud L, Gavand PE, Voll R, Schwarting A, Maurier F, Blaison G, Magy-Bertrand N, Pennaforte JL, Peter HH, Kieffer P, Bonnotte B, Poindron V, Fiehn C, Lorenz H, Amoura Z, Sibilia J, Martin T. Predictors of fatigue and severe fatigue in a large international cohort of patients with systemic lupus erythematosus and a systematic review of the literature. Rheumatology (Oxford) 2020; 58:987-996. [PMID: 30597077 DOI: 10.1093/rheumatology/key398] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/01/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Fatigue is reported in up to 90% of patients with SLE. This study was conducted to identify the determinants associated with fatigue in a large cohort of patients with SLE, as well as to provide a systematic review of the literature. METHODS Patients from the Lupus BioBank of the upper Rhein, a large German-French cohort of SLE patients, were included in the FATILUP study if they fulfilled the 1997 ACR criteria for SLE and had Fatigue Scale for Motor and Cognitive Functions scores collected. Multivariate logistic regression analyses were performed to assess the determinants of fatigue and severe fatigue. RESULTS A total of 570 patients were included (89.1% female). The median age was 42 years (interquartile range 25-75: 34-52). The median value of the SAfety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI was 2 (0-4). Fatigue was reported by 386 patients (67.7%) and severe fatigue by 209 (36.7%). In multivariate analyses, fatigue was associated with depression [odds ratio (OR): 4.72 (95% CI: 1.39-16.05), P = 0.01], anxiety [OR: 4.49 (95% CI: 2.60-7.77), P < 0.0001], glucocorticoid treatment [OR: 1.59 (95% CI 1.05-2.41), P = 0.04], SELENA-SLEDAI scores [OR: 1.05 (95% CI: 1.00-1.12) per 1 point increase, P = 0.043] and age at sampling [OR: 1.01 (95% CI: 1.00-1.03) per 1 year increase, P = 0.03]. Severe fatigue was independently associated with anxiety (P < 0.0001), depression (P < 0.0001), glucocorticoid treatment (P = 0.047) and age at sampling (P = 0.03). CONCLUSION Both fatigue and severe fatigue are common symptoms in SLE, and are strongly associated with depression and anxiety. Disease activity and the use of glucocorticoids were also independently associated with fatigue, although more weakly.
Collapse
Affiliation(s)
- Laurent Arnaud
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS
| | - Pierre Edouard Gavand
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service d'immunologie clinique Nouvel hôpital civil, Strasbourg, France
| | - Rheinardt Voll
- Klinik für Rheumatologie und Klinische Immunologie & Center of Chronic Immunodeficiency (CCI) Universitätsklinikum, Freiburg
| | - Andreas Schwarting
- I.st Department of Internal Medicine, Universitätsmedizin, Mainz, Germany
| | | | - Gilles Blaison
- Service de médecine interne - Centre de compétence en maladies auto-immunes et systémiques rares, Hôpitaux Civils de COLMAR, Colmar
| | | | | | - Hans-Harmut Peter
- Freiburg University Hospital, Uniklinikum Medizinische Klinik Abt, Rheumatologie and Klinische Immunologie, Freiburg, Germany
| | - Pierre Kieffer
- Centre de compétence des maladies autoimmunes et systemiques rares, Service de médecine interne et soins continus du, centre hospitalier de Mulhouse, Mulhouse
| | - Bernard Bonnotte
- CHU Dijon Bourgogne, Service de médecine interne et immunologie clinique, France
| | - Vincent Poindron
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service d'immunologie clinique Nouvel hôpital civil, Strasbourg, France
| | | | - Hannes Lorenz
- Department of Medicine V, University Hospital Heidelberg, Center for Rheumatic Diseases Baden-Baden, Heidelberg, Germany
| | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, Assistance Publique-Hôpitaux de Paris (APHP), Groupement Hospitalier Pitié-Salpêtrière, Paris
| | - Jean Sibilia
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, Strasbourg, France
| | - Thierry Martin
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service d'immunologie clinique Nouvel hôpital civil, Strasbourg, France
| |
Collapse
|
10
|
Petrongolo JL, Zelikovsky N, Keegan RM, Furth SL, Knight A. Examining Uncertainty in Illness in Parents and Children With Chronic Kidney Disease and Systemic Lupus Erythematosus: A Mediational Model of Internalizing Symptoms and Health-Related Quality of Life. J Clin Psychol Med Settings 2019; 27:31-40. [PMID: 30989366 DOI: 10.1007/s10880-019-09617-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To examine if parent illness uncertainty is indirectly associated with child depression, anxiety, and HRQOL in the CKD/SLE population. Parent-child dyads (N = 31) from outpatient rheumatology and nephrology clinics included children (ages 9-18) diagnosed with CKD (Stage 1, 2, or nephrotic syndrome) or SLE. Parents completed demographic and uncertainty measures and children completed uncertainty, depression, anxiety, and HRQOL measures. This cross-sectional study examined mediational models using the percentile bootstrapping method. Parent uncertainty had an indirect effect on child depression, anxiety, and HRQOL through the mediator, child uncertainty. In other words, parents' illness uncertainty regarding their child's condition correlates to the child's illness uncertainty, which then is associated with the child's mental health and wellbeing. Reverse mediations illustrated that parent uncertainty did not mediate child uncertainty and outcome variables. Results extend previous research by examining parent and child illness uncertainty in understudied conditions (CKD/SLE) and the relationship to outcome variables commonly related to depression (e.g., anxiety and HRQOL). Findings allow health psychologists and medical personnel to understand the impact of uncertainty on the child's wellbeing and HRQOL. Clinical implications, including using specialized interventions to address illness uncertainty, are discussed.
Collapse
Affiliation(s)
- Jennifer L Petrongolo
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA.
| | - Nataliya Zelikovsky
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Rachel M Keegan
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Andrea Knight
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| |
Collapse
|
11
|
Wang Y, Zhao R, Gu C, Gu Z, Li L, Li Z, Dong C, Zhu J, Fu T, Gao J. The impact of systemic lupus erythematosus on health-related quality of life assessed using the SF-36: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2019; 24:978-991. [PMID: 30943791 DOI: 10.1080/13548506.2019.1587479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Yilin Wang
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China
| | - Rui Zhao
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China
| | - Chaoyu Gu
- School of Medicine, Nantong University, Nantong, China
| | - Zhifeng Gu
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Liren Li
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhenyu Li
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China
| | - Chen Dong
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China
| | - Jinjin Zhu
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Ting Fu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Jianlin Gao
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China
| |
Collapse
|
12
|
Yilmaz-Oner S, Ilhan B, Can M, Alibaz-Oner F, Polat-Korkmaz O, Ozen G, Mumcu G, Kremers HM, Tuglular S, Direskeneli H. Fatigue in systemic lupus erythematosus : Association with disease activity, quality of life and psychosocial factors. Z Rheumatol 2019; 76:913-919. [PMID: 27600110 DOI: 10.1007/s00393-016-0185-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of the study was to determine which disease-related factors and non-disease features can explain the presence of systemic lupus erythematosus (SLE)-related fatigue in Turkish patients. METHODS This cross-sectional study was carried out with 99 SLE patients and 71 healthy controls. To assess fatigue and health-related quality of life (HRQoL) the participants were asked to complete two questionnaires: the short form-36 health survey (SF-36) and the multidimensional assessment of fatigue (MAF) scale. Anxiety and depression of participants were assessed by the hospital anxiety and depression scale (HADS). RESULTS A total of 99 patients (female/male 95/4) and 71 controls (female/male 40/31) were studied. The mean age and standard deviation (±SD) of patients and controls were 43.3 ± 12.2 years and 43.2 ± 12.1 years, respectively. The mean (SD) disease duration was 7.8 ± 5.3 years and median SLE disease activity index (SLEDAI) score was 0 (range = 0-16). The level of fatigue was higher in patients compared to controls with mean MAF scores of 24.7 ± 12.2 and 12.8 ± 9.9 (p < 0.001), respectively. The HADS-D and HADS-A scores were also significantly higher in SLE patients (6.6 ± 4.3 vs. 3.6 ± 2.9, p < 0.001 and 7.2 ± 4 vs. 4.9 ± 4, p = 0.007, respectively). There were no significant associations between the MAF and SLEDAI scores (r = 0.05, p = 0.63) but MAF scores positively correlated with age, HADS-A and HADS-D scores and negatively correlated with physical component summary (PCS), mental component summary (MCS) and each domain of SF-36 except role emotional in SLE patients. CONCLUSION Fatigue is an important factor influencing patient daily life independent from disease activity in our study. The SLE patients with severe fatigue should also be assessed for other possible underlying causes such as anxiety, depression and poor quality of life.
Collapse
Affiliation(s)
- S Yilmaz-Oner
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey.
| | - B Ilhan
- School of Medicine, Marmara University, Istanbul, Turkey
| | - M Can
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
| | - F Alibaz-Oner
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
| | | | - G Ozen
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
| | - G Mumcu
- Faculty of Health Sciences, Department of Health Management, Marmara University, Istanbul, Turkey
| | - H M Kremers
- College of Medicine, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - S Tuglular
- School of Medicine, Department of Nephrology, Marmara University, Istanbul, Turkey
| | - H Direskeneli
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
| |
Collapse
|
13
|
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease with a prevalence of approximately 1 in 1000. Over the last 30 years, advances in treatment such as use of corticosteroids and immunosuppressants have improved life expectancy and quality of life for patients with lupus and the key unmet needs have therefore changed. With the reduced mortality from disease activity, development of cardiovascular disease (CVD) has become an increasingly important cause of death in patients with SLE. The increased CVD risk in these patients is partly, but not fully explained by standard risk factors, and abnormalities in the immune response to lipids may play a role. Invariant natural killer T cells, which are triggered specifically by lipid antigens, may protect against progression of subclinical atherosclerosis. However, currently our recommendation is that clinicians should focus on optimal management of standard CVD risk factors such as smoking, blood pressure and lipid levels. Fatigue is one of the most common and most limiting symptoms suffered by patients with SLE. The cause of fatigue is multifactorial and disease activity does not explain this symptom. Consequently, therapies directed towards reducing inflammation and disease activity do not reliably reduce fatigue and new approaches are needed. Currently, we recommend asking about sleep pattern, optimising pain relief and excluding other causes of fatigue such as anaemia and metabolic disturbances. For the subgroup of patients whose disease activity is not fully controlled by standard treatment regimes, a range of different biologic agents have been proposed and subjected to clinical trials. Many of these trials have given disappointing results, though belimumab, which targets B lymphocytes, did meet its primary endpoint. New biologics targeting B cells, T cells or cytokines (especially interferon) are still going through trials raising the hope that novel therapies for patients with refractory SLE may be available soon.
Collapse
|
14
|
Winthrop KL, Weinblatt ME, Crow MK, Burmester GR, Mease PJ, So AK, Bykerk V, Van Vollenhoven RF, Dougados M, Kay J, Mariette X, Sieper J, Melchers F, Cronstein BN, Shevach E, Breedfeld FC, Kalden J, Smolen JS, Furst DE. Unmet need in rheumatology: reports from the Targeted Therapies meeting 2018. Ann Rheum Dis 2019; 78:872-878. [PMID: 30712015 DOI: 10.1136/annrheumdis-2018-214280] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/16/2018] [Accepted: 01/19/2019] [Indexed: 12/13/2022]
Abstract
To develop a comprehensive listing of the greatest unmet scientific and clinical needs in rheumatology. The 20th annual international Targeted Therapies meeting brought more than 100 leading basic scientists and clinical researchers in rheumatology, immunology, epidemiology, molecular biology and other specialties. During the meeting, breakout sessions were convened, consisting of five disease-specific groups with 20-30 experts assigned to each group based on expertise. Specific groups included rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematosus, connective tissue diseases and a basic science immunology group spanning all of these clinical domains. In each group, experts were asked to consider recent accomplishments within their clinical domain in the last year and update the unmet needs in three categorical areas: basic/translational science, clinical science and therapeutic development, and clinical care. While progress was noted among some of previously identified needs, both new needs were identified and themes from prior meetings were re-iterated: the need for better understanding the heterogeneity within each disease, and for identifying preclinical states of disease allowing treatment and prevention of disease in those at risk, and the elusive ability to cure disease. Within the clinical care realm, improved comorbidity management and patient-centred care continue to be unmet needs, and the need for new and affordable therapeutics was highlighted. Unmet needs for new and accessible targeted therapies, disease prevention and ultimately cure remain a priority in rheumatology.
Collapse
Affiliation(s)
| | | | - Mary K Crow
- Hospital for Special Surgery, New York City, New York, USA
| | | | - Philip J Mease
- Swedish Medical Center, University of Washington, Seattle, Washington, USA
| | | | - Vivian Bykerk
- Hospital for Special Surgery, New York City, New York, USA
| | | | | | - Jonathan Kay
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany
| | - Fritz Melchers
- Max Planck Institute for Infection Biology, Berlin, Germany.,Deutsches Rheumaforschungszentrum, Berlin, Germany
| | | | - Ethan Shevach
- National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Daniel E Furst
- Swedish Medical Center, University of Washington, Seattle, Washington, USA.,Los Angeles Medical Center, University of California, Los Angeles, California, USA.,University of Florence, Florence, Italy
| |
Collapse
|
15
|
Dima A, Caraiola S, Delcea C, Ionescu RA, Jurcut C, Badea C. Self-reported disease severity in women with systemic lupus erythematosus. Rheumatol Int 2018; 39:533-539. [PMID: 30415452 DOI: 10.1007/s00296-018-4203-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/06/2018] [Indexed: 01/08/2023]
Abstract
Systemic lupus erythematosus (SLE), pathology with net feminine predominance, is one of the most complex autoimmune diseases and has major impact on patients' life. The aim is to identify patient and disease-related factors associated with self-perceived disease severity in female SLE patients. This cross-sectional study enrolled 73 women fulfilling the 2012 Systemic Lupus International Collaborating Clinic (SLICC) criteria. SLE disease activity was assessed by the Systemic Lupus Activity Measure (SLAM) score and overall damage by the SLICC/American College of Rheumatology (ACR) index. Patients' general characteristics, associated conditions as well as SLE specific clinical involvements and therapeutic principles were also noted. Fatigue was assessed by FACIT-fatigue scale. Self-perceived disease severity was assessed using numerical rating scales (1-10 NRSs), to evaluate the disease severity at inclusion (1-10 NRS now) and worst severity anytime during disease history (1-10 NRS worst ever). In regard to worst ever lupus severity, 54.8% of patients responded with 9 or 10, while none with 1 or 2 even if only 22.9% of the patients responded with 7 or more for disease severity at inclusion (1-10 NRS now). Women with higher 1-10 NRS now answers had also higher 1-10 NRS worst ever, SLAM, SLICC, and FACIT-fatigue scores. They associated more frequently anxiety/depression diagnosis, antiphospholipid syndrome, joint involvement as well as treatments with corticosteroids. Self-reported disease severity worst ever, anxiety/depression diagnosis, fatigue, and the daily dose of corticosteroids were independently associated with patients' perception on lupus severity at inclusion: OR (95% CI), 2.13 (1.15-3.94) p = 0.017, 6.67 (1.11-39.97) p = 0.038, 1.10 (1.02-1.19) p = 0.018, and 1.11 (1.02-1.21) p = 0.020, respectively. The vast majority of patients identified severe and very severe events during their disease history, results that raise awareness of burden concerning lupus occurrence in women's life. Self-perceived lupus severity is multifactorial, influenced also by factors less considered in the SLE management like fatigue and the depression/anxiety disorders, but also by the previous patient's experience.
Collapse
Affiliation(s)
- A Dima
- Internal Medicine Department, Carol Davila UMF, Dionisie Lupu Street 37, 020022, Bucharest S2, Romania.
- Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania.
| | - S Caraiola
- Internal Medicine Department, Carol Davila UMF, Dionisie Lupu Street 37, 020022, Bucharest S2, Romania
- Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
| | - C Delcea
- Internal Medicine Department, Carol Davila UMF, Dionisie Lupu Street 37, 020022, Bucharest S2, Romania
- Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
| | - R A Ionescu
- Internal Medicine Department, Carol Davila UMF, Dionisie Lupu Street 37, 020022, Bucharest S2, Romania
- Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
| | - C Jurcut
- Dr Carol Davila Central University Emergency Military Hospital, Bucharest, Romania
| | - C Badea
- Internal Medicine Department, Carol Davila UMF, Dionisie Lupu Street 37, 020022, Bucharest S2, Romania
- Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
| |
Collapse
|
16
|
Åkesson K, Pettersson S, Ståhl S, Surowiec I, Hedenström M, Eketjäll S, Trygg J, Jakobsson PJ, Gunnarsson I, Svenungsson E, Idborg H. Kynurenine pathway is altered in patients with SLE and associated with severe fatigue. Lupus Sci Med 2018; 5:e000254. [PMID: 29868176 PMCID: PMC5976103 DOI: 10.1136/lupus-2017-000254] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/08/2018] [Accepted: 04/16/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Fatigue has been reported as the most disturbing symptom in a majority of patients with SLE. Depression is common and often severe. Together these symptoms cause significant morbidity and affect patients with otherwise relatively mild disease. Tryptophan and its metabolites in the kynurenine pathway are known to be important in several psychiatric conditions, for example, depression, which are often also associated with fatigue. We therefore investigated the kynurenine pathway in patients with SLE and controls. METHODS In a cross-sectional design plasma samples from 132 well-characterised patients with SLE and 30 age-matched and gender-matched population-based controls were analysed by liquid chromatography tandem mass spectrometry to measure the levels of tryptophan and its metabolites kynurenine and quinolinic acid. Fatigue was measured with Fatigue Severity Scale and depression with Hospital Anxiety and Depression Scale. SLE disease activity was assessed with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). RESULTS The kynurenine/tryptophan ratio, as a measure of indoleamine 2,3-dioxygenase (IDO) activity, was increased in patients with SLE. Patients with active disease (SLEDAI ≥6) showed lower tryptophan levels compared with controls (54 µM, SD=19 vs 62 µM, SD=14, p=0.03), although patients with SLE overall did not differ compared with controls. Patients with SLE had higher levels of tryptophan metabolites kynurenine (966 nM, SD=530) and quinolinic acid (546 nM, SD=480) compared with controls (kynurenine: 712 nM, SD=230, p=0.0001; quinolinic acid: 380 nM, SD=150, p=0.001). Kynurenine, quinolinic acid and the kynurenine/tryptophan ratio correlated weakly with severe fatigue (rs =0.34, rs =0.28 and rs =0.24, respectively) but not with depression. CONCLUSIONS Metabolites in the kynurenine pathway are altered in patients with SLE compared with controls. Interestingly, fatigue correlated weakly with measures of enhanced tryptophan metabolism, while depression did not. Drugs targeting enzymes in the kynurenine pathway, for example, IDO inhibitors or niacin (B12) supplementation, which suppresses IDO activity, merit further investigation as treatments in SLE.
Collapse
Affiliation(s)
- Karolina Åkesson
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Pettersson
- Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sara Ståhl
- Personalized Healthcare and Biomarkers Laboratories, Innovative Medicines, Science for Life Laboratory, Translational Science Centre, AstraZeneca, Stockholm, Sweden
| | - Izabella Surowiec
- Department of Chemistry, Computational Life Science Cluster, Umeå University, Umeå, Sweden
| | - Mattias Hedenström
- Department of Chemistry, Computational Life Science Cluster, Umeå University, Umeå, Sweden
| | - Susanna Eketjäll
- Cardiovascular and Metabolic Diseases, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Integrated Cardio Metabolic Centre (ICMC), Karolinska Institutet, Huddinge, Sweden
| | - Johan Trygg
- Department of Chemistry, Computational Life Science Cluster, Umeå University, Umeå, Sweden
| | - Per-Johan Jakobsson
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Iva Gunnarsson
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabet Svenungsson
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Idborg
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
17
|
Figueiredo-Braga M, Cornaby C, Bernardes M, Figueiredo M, Mesquita CDS, Costa L, Poole BD. Correlation between physical markers and psychiatric health in a Portuguese systemic lupus erythematosus cohort: The role of suffering in chronic autoimmune disease. PLoS One 2018; 13:e0195579. [PMID: 29659589 PMCID: PMC5901990 DOI: 10.1371/journal.pone.0195579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 03/26/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects a large number of people throughout the world. Anxiety, depression and fatigue are common symptoms of SLE that substantially contribute to decreased quality of life. This study investigates the interplay between physical and psychiatric manifestations of lupus. To this end, an SLE patient cohort was examined for correlations between clinical presentation, laboratory tests, and psychological indicators. METHODS Seventy-two lupus patients were evaluated for psychological status using a battery of instruments, including assessments for fatigue (CFS & FSS), depression (HADS), anxiety (HADS), overall health (SF-36 & PSQI) and intimate relationship satisfaction (RAS & CSI). Scores from these assessments were correlated with lupus clinical profiles and laboratory test values. RESULTS The prevalence of depression in the SLE patient cohort was 41.7%, as measured by the hospital depression and anxiety scale. The study identified that pain (p = 0.001), body mass index (p = 0.026), Chalder's fatigue scale (p < 0.001), fatigue severity scale (p < 0.001), and anxiety (p = 0.001) are all positively correlated with depression in SLE patients. Total complement (CH50) (p = 0.032), and SF-36 physical and mental characteristic assessments are negatively correlated with depression. Longitudinal analysis indicated that the disease related complaint alopecia (p = 0.008) and relationship assessment scale scores (p = 0.004) may also be correlated to depression in SLE patients. Multivariant scrutiny of the clinical and psychosocial characteristics identified the fatigue severity scale (p = 0.026), SF-36 physical function (p = 0.040), physical role function (0.030), and mental health (p = 0.002) as the best indicators directly correlated with depression for the SLE cohort. CONCLUSION These results reveal the influence of physical manifestations of lupus including fatigue, pain, body mass index and anxiety, as well as decreased physical and mental function, on depression. Fatigue is the strongest factor correlated with depression in SLE patients in the cohort. Both physical and social/psychological aspects likely contribute to the depression and anxiety in lupus.
Collapse
Affiliation(s)
- Margarida Figueiredo-Braga
- Medical Psychology Unit, Dep. Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Caleb Cornaby
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah, United States of America
| | - Miguel Bernardes
- Rheumatology Department, Hospital of São João EPE, Porto, Portugal
| | - Marta Figueiredo
- Medical Psychology Unit, Dep. Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Lúcia Costa
- Rheumatology Department, Hospital of São João EPE, Porto, Portugal
| | - Brian D. Poole
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah, United States of America
| |
Collapse
|
18
|
Mahieu MA, Ahn GE, Chmiel JS, Dunlop DD, Helenowski IB, Semanik P, Song J, Yount S, Chang RW, Ramsey-Goldman R. Serum adipokine levels and associations with patient-reported fatigue in systemic lupus erythematosus. Rheumatol Int 2018; 38:1053-1061. [PMID: 29302804 DOI: 10.1007/s00296-017-3924-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 12/29/2017] [Indexed: 01/03/2023]
Abstract
Physical activity ameliorates fatigue in systemic lupus erythematosus (SLE) patients by an unknown mechanism. Adipokines, which are influenced by adiposity and physical activity, may be associated with patient-reported fatigue. We describe cross-sectional associations between adipokines and fatigue, physical activity, and SLE disease activity. We measured adipokines, self-reported fatigue, and objective physical activity in 129 SLE patients. Fatigue was assessed with the Fatigue Severity Scale (FSS) and Patient Reported Outcomes Measurement Information System® (PROMIS®) Fatigue score. Disease activity was measured with the Safety of Estrogens in Systemic Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI). Participants wore an accelerometer for 7 days to measure physical activity. Leptin, adiponectin, and resistin were measured in stored serum with a Luminex bead-based assay. Multivariable regression models assessed relationships between fatigue and adipokines, and Spearman correlation coefficients summarized associations between adipokines, physical activity, and SELENA-SLEDAI. Median adipokine levels were: leptin 30.5 ng/ml (Interquartile Range 14.0, 56.6), adiponectin 11.6 μg/ml (7.2, 16.8) and resistin 1.4 ng/ml (1.0, 2.2). Associations between adipokines and FSS or PROMIS fatigue were not significant. Body mass index (BMI) ≥ 30 kg/m2 was associated with FSS and PROMIS fatigue in regression analyses (p < 0.05). Weak correlations between leptin, adiponectin, leptin/adiponectin (L/A) ratio, and physical activity and between adiponectin and SELENA-SLEDAI score were not significant after adjusting for BMI. Adipokines were not associated with fatigue in SLE. Adipokines were correlated with physical activity (leptin, adiponectin, L/A ratio) and SLE disease activity (adiponectin), but most of these associations were explained by BMI.
Collapse
Affiliation(s)
- Mary A Mahieu
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 East Huron Street M-300, Chicago, IL, 60611, USA.
| | - Grace E Ahn
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 East Huron Street M-300, Chicago, IL, 60611, USA.,Arthritis and Rheumatism Associates, Wheaton, MD, USA
| | - Joan S Chmiel
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dorothy D Dunlop
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 East Huron Street M-300, Chicago, IL, 60611, USA.,Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Irene B Helenowski
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pamela Semanik
- Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, IL, USA
| | - Jing Song
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susan Yount
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rowland W Chang
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 East Huron Street M-300, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 East Huron Street M-300, Chicago, IL, 60611, USA
| |
Collapse
|
19
|
Abstract
CONCEPT Fatigue is a major concern for patients with multiple sclerosis (MS). A clear definition of MS-related fatigue is a prerequisite for appropriate instruments for fatigue assessment. In turn, accurate assessment of fatigue in MS will enhance exploration of plausible mechanisms underlying this common and distressing symptom. Content/Objectives: To provide an integrative review of the current literature on theoretical models used to study fatigue in MS, instruments used to assess fatigue and other factors that impact fatigue during the various phases of MS. DATA SOURCES PUBMED, OVID, Ovid Health Star, Ovid MEDINE, CINAHL, Health and Psychosocial Instruments (HaPI), and PsycINFO. Seventeen articles fit the inclusion criteria and were included in the review. RESULTS Definitions of MS-related fatigue are reviewed. Several studies found a link with neurotransmitter dysfunction, circadian rhythm, and the timing of fatigue. Central fatigue in MS is associated with neurotransmitters disruptions as well as circadian rhythm disorders, but the evidence is not strong. Perceptions of fatigue or fatigability may arise as either a primary or secondary manifestation of disease. Based on findings from the literature review, a theoretical model of fatigue in MS is proposed. CONCLUSION Future research on MS-related fatigue may consider a longitudinal design with a carefully selected self-report instrument to advance understanding of the underlying pathological mechanisms.
Collapse
Affiliation(s)
- Pamela Newland
- Office of Nursing Research, Goldfarb School of Nursing at Barnes Jewish College, St. Louis, MO, USA,Correspondence to: Pamela Newland, Goldfarb School of Nursing at Barnes Jewish College, Office of Nursing Research, 4483 Duncan Avenue, St. Louis, USA, MO 63110.
| | - Angela Starkweather
- Center for Advancement of Managing Pain, University of Connecticut School of Nursing, Storrs, CT, USA
| | - Matthew Sorenson
- DePaul University School of Nursing, Chicago, IL, USA,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
20
|
Mahieu MA, Ahn GE, Chmiel JS, Dunlop DD, Helenowski IB, Semanik P, Song J, Yount S, Chang RW, Ramsey-Goldman R. Fatigue, patient reported outcomes, and objective measurement of physical activity in systemic lupus erythematosus. Lupus 2016; 25:1190-9. [PMID: 26869353 DOI: 10.1177/0961203316631632] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/14/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Fatigue is a common symptom in systemic lupus erythematosus (SLE), and engaging in physical activity may reduce fatigue. We aimed to characterize relationships between fatigue, other health status measures assessed with the Patient Reported Outcomes Measurement Information System (PROMIS) instruments, and accelerometer-based physical activity measurements in patients with SLE. The internal consistency of each PROMIS measure in our SLE sample was also evaluated. METHODS This cross-sectional study analyzed 123 adults with SLE. The primary fatigue outcome was Fatigue Severity Scale score. Secondary outcomes were PROMIS standardized T-scores in seven health status domains. Accelerometers were worn for seven days, and mean daily minutes of light, moderate/vigorous, and bouted (10 minutes) moderate/vigorous physical activity were estimated. Cronbach's alpha was determined for each PROMIS measure to assess internal consistency. Relationships between Fatigue Severity Scale, PROMIS, and physical activity were summarized with Spearman partial correlation coefficients (r), adjusted for average daily accelerometer wear time. RESULTS Mean Fatigue Severity Scale score (4.3, SD 1.6) was consistent with clinically relevant levels of fatigue. Greater daily and bouted moderate/vigorous physical activity minutes correlated with lower Mean Fatigue Severity Scale score (r = -0.20, p = 0.03 and r = -0.30, p = 0.0007, respectively). For PROMIS, bouted moderate/vigorous physical activity minutes correlated with less fatigue (r = -0.20, p = 0.03). PROMIS internal consistency was excellent, with Cronbach's alpha > 0.90 for each domain. Mean PROMIS T-scores for fatigue, pain interference, anxiety, sleep disturbance, sleep-related impairment, and physical function were worse than reported for the general US population. More moderate/vigorous physical activity minutes were associated with less pain interference (r = -0.22, p = 0.01). Both light physical activity and moderate/vigorous physical activity minutes correlated with better physical function (r = 0.19, p = 0.04 and r = 0.25, p = 0.006, respectively). CONCLUSION More time spent in moderate/vigorous physical activity was associated with less fatigue (Fatigue Severity Scale and PROMIS), less pain interference, and better physical function (PROMIS). PROMIS had excellent internal consistency in our SLE sample, and six of seven PROMIS measures indicated poorer average health status in SLE patients compared with the general US population.
Collapse
Affiliation(s)
- M A Mahieu
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - G E Ahn
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Arthritis and Rheumatism Associates, Wheaton, MD, USA
| | - J S Chmiel
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D D Dunlop
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - I B Helenowski
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - P Semanik
- Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, IL, USA
| | - J Song
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Yount
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R W Chang
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R Ramsey-Goldman
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
21
|
Tesar V, Hruskova Z. Limitations of standard immunosuppressive treatment in ANCA-associated vasculitis and lupus nephritis. Nephron Clin Pract 2014; 128:205-15. [PMID: 25412878 DOI: 10.1159/000368569] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction of the standard immunosuppressive treatment has dramatically changed the outcome of patients with both ANCA-associated vasculitis and lupus nephritis, transforming them from incurable diseases with very high short-term mortality to chronic debilitating diseases with much lower short-term, but still relatively high long-term, morbidity/mortality. Long-term morbidity with damage accumulating partly due to the adverse events of the available treatment (namely gonadal toxicity, malignancy, bone disease, cataracts, diabetes, and thromboembolic and cardiovascular disease) has become a major concern. Although cyclophosphamide-based regimens have been partly replaced by newer agents in both ANCA-associated vasculitis and lupus nephritis (namely rituximab or mycophenolate, respectively) their short-term and medium-term adverse events may not be significantly less frequent and we can only hope that new treatments will translate into better long-term outcomes including better long-term safety.
Collapse
Affiliation(s)
- Vladimir Tesar
- Department of Nephrology, 1st Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | | |
Collapse
|