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Dixon J, Cardwell FS, Clarke AE, Elliott SJ. Choices are inevitable: A qualitative exploration of the lifecosts of systemic lupus erythematosus. Chronic Illn 2022; 18:125-139. [PMID: 32183564 DOI: 10.1177/1742395320910490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Individuals with systemic lupus erythematosus experience considerable economic challenges. The aim of this research is to qualitatively investigate experiences of the lifecosts (direct and indirect economic costs and beyond) to those with systemic lupus erythematosus in Canada. METHODS Using a biopsychosocial conceptual framework and integrated knowledge translation approach, qualitative semi-structured interviews were conducted with 3 physicians, 5 representatives from systemic lupus erythematosus advocacy groups, and 29 adult systemic lupus erythematosus patients. Themes emerged deductively and inductively, and the theme code set was used to code all transcripts. RESULTS Three dominant themes emerged: (1) impacts of systemic lupus erythematosus on quality of life, relationships, and health; (2) costs linked to healthcare; and (3) impacts of living with systemic lupus erythematosus on employment/economic standing. DISCUSSION Whereas previous work has focused almost exclusively on the direct, individual costs of systemic lupus erythematosus, the biopsychosocial approach taken here emphasizes not only the individual and intermediate factors (such as the workplace and family), but also the system-level factors (i.e. system-level policies) that influence quality of life, healthcare, and employment/economic experiences of those with systemic lupus erythematosus. Results indicate a need to target interventions beyond the individual and their immediate context, and recognize that lifecosts are shaped significantly by systems-level action.
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Affiliation(s)
- J Dixon
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - F S Cardwell
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, Canada
| | - Ann E Clarke
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - S J Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, Canada
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Said JT, Elman SA, Merola JF. Evaluating safety and compatibility of anti-tumor necrosis factor therapy in patients with connective tissue disorders. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:430. [PMID: 33842651 PMCID: PMC8033307 DOI: 10.21037/atm-20-5552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Inhibition of the proinflammatory cytokine tumor necrosis factor alpha (TNFα) has been utilized as a treatment strategy for a variety of immune-mediated inflammatory disorders (IMID), including rheumatoid arthritis, Crohn’s disease and psoriasis. A wide array of biologic therapies targeting the TNFα molecule, including etanercept, infliximab, certolizumab, golimumab and adalimumab, are routinely used in the care of patients with these conditions. In addition to their therapeutic potential, anti-TNFα agents commonly induce the formation of autoantibodies such as anti-nuclear antibodies and anti-double stranded DNA antibodies; however, the vast majority of these are of IgM isotype and of unclear clinical significance, uncommonly leading to drug-induced autoimmune disease. For these reasons, TNFα inhibition has been a controversial strategy in the treatment of primary connective tissue disorders (CTDs). However, as new therapeutics continue to be developed for the management of CTDs, the potential utility for anti-TNFα agents has become of great interest, demonstrated in several recent case series and small open-label trials. We review the safety and compatibility of anti-TNFα therapy in the management of systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE), two well-studied example CTDs, as well as summarize the risks of autoantibody generation, infection, malignancy, and iatrogenic lupus flares as side effects of blocking TNFα in patients with these conditions.
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Affiliation(s)
- Jordan T Said
- Department of Dermatology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Scott A Elman
- Department of Dermatology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
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Khanom S, McDonagh JE, Briggs M, Bakir E, McBeth J. Adolescents' experiences of fluctuating pain in musculoskeletal disorders: a qualitative systematic review and thematic synthesis. BMC Musculoskelet Disord 2020; 21:645. [PMID: 33008357 PMCID: PMC7532580 DOI: 10.1186/s12891-020-03627-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Adolescents with chronic musculoskeletal pain experience daily fluctuations in pain. Although not all fluctuations are bothersome, pain flares are a distinct type of symptom fluctuation with greater impact. Since literature on the experience of pain flares is non-existent, the aim of this review was to (i) synthesise the qualitative literature on adolescents' experiences of fluctuating pain in musculoskeletal disorders in order to (ii) identify knowledge gaps to inform future research on pain flares. METHODS Electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO), grey literature and reference lists were searched from inception to June 2018 for qualitative studies reporting adolescents' experiences of pain. Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research. Studies were analysed using thematic synthesis. RESULTS Of the 3787 records identified, 32 studies (n = 536) were included. Principal findings were synthesised under three key themes: 1) symptom experience, 2) disruption and loss, and 3) regaining control. The first theme (symptom experience) describes adolescent's perception and interpretation of pain fluctuations. The second theme (disruption and loss) describes the physical, social and emotional constraints faced as a result of changes in pain. The third theme (regaining control) describes coping strategies used to resist and accommodate unpredictable phases of pain. Each theme was experienced differently depending on adolescents' characteristics such as their developmental status, pain condition, and the duration of the pain experience. CONCLUSIONS Adolescents with chronic musculoskeletal pain live with a daily background level of symptoms which frequently fluctuate and are associated with functional and emotional difficulties. It was not clear whether these symptoms and challenges were experienced as part of 'typical' fluctuations in pain, or whether they reflect symptom exacerbations classified as 'flares'. Further research is needed to explore the frequency and characteristics of pain flares, and how they differ from their typical fluctuations in pain. The review also highlights areas relating to the pain experience, symptom management and health service provision that require further exploration to support more personalised, tailored care for adolescents with chronic musculoskeletal pain.
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Affiliation(s)
- Sonia Khanom
- Centre for Epidemiology Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 2.706 Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 2.706 Stopford Building, Oxford Road, Manchester, M13 9PT, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ebru Bakir
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 2.706 Stopford Building, Oxford Road, Manchester, M13 9PT, UK
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Katz P, Wan GJ, Daly P, Topf L, Connolly-Strong E, Bostic R, Reed ML. Patient-reported flare frequency is associated with diminished quality of life and family role functioning in systemic lupus erythematosus. Qual Life Res 2020; 29:3251-3261. [PMID: 32683643 DOI: 10.1007/s11136-020-02572-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To understand the influence of the systemic lupus erythematosus (SLE)-related flares on patient's health-related quality of life (HRQoL). METHODS An online survey included individuals with self-reported physician's diagnosis of SLE or lupus nephritis (LN). Lupus impact tracker (LIT) assessed lupus symptoms and HRQoL, SLE-Family questionnaire measured family role functioning, and Healthy Days Core Module (HDCM) measured overall mental and physical health. Chi-square and analysis of variance evaluated differences by flare frequency. Multivariable linear regression and generalized linear models evaluated the independent relationships of flare frequency to HRQoL. RESULTS 1066 respondents with SLE or LN completed the survey. Mean (SD) duration of illness was 12.4 (10.1) years. 93.4% (n = 996) were women, 82.3% (n = 830) were White, and 49.7% (n = 530) were employed or students. More frequent flares were associated with significantly worse scores on all HRQoL measures: LIT (adjusted means: 0 flares, 31.8; 1-3 flares, 47.0; 4-6 flares, 56.1; ≥ 7 flares, 63.6; P < 0.001); SLE-Family (adjusted means: 0 flares, 3.1; 1-3 flares 3.8; 4-6 flares, 4.3; ≥ 7 flares, 4.6, P < 0.001); HDCM unhealthy days (0 flares, 8.7; 1-3 flares, 17.4; 4-6 flares, 21.5; ≥ 7 flares, 26.2 days, P < 0.001). CONCLUSION Lupus flares contributed to impaired functional and psychological well-being, family functioning, and number of monthly healthy days. Better understanding of the burden of flare activity from the patient's perspective will support a holistic approach to lupus management.
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Affiliation(s)
- Patricia Katz
- School of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Arthritis Research Group, University of California San Francisco, 3333 California Street, San Francisco, CA, 94143-0936, USA.
| | - George J Wan
- Global Head of Health Economics and Outcomes Research, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
| | - Paola Daly
- The Lupus Foundation of America, Washington, DC, USA
| | - Lauren Topf
- The Lupus Foundation of America, Washington, DC, USA
| | - Erin Connolly-Strong
- Global Head of Health Economics and Outcomes Research, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
- Field Medical Affairs, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
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Khanom S, McDonagh JE, Briggs M, McBeth J. Characterizing pain flares in adolescent inflammatory and non-inflammatory musculoskeletal disorders: A qualitative study using an interpretative phenomenological approach. Eur J Pain 2020; 24:1785-1796. [PMID: 32608154 DOI: 10.1002/ejp.1626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/11/2020] [Accepted: 06/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adolescents with musculoskeletal disorders experience acute exacerbations in pain, colloquially called "pain flares" in adult literature. This study aimed to explore adolescents' lived experience of pain flares, including what pain flares are, why they occur, how they are managed and what lasting effects they have on adolescents. METHODS A sample of 10 adolescents diagnosed with juvenile idiopathic arthritis or chronic idiopathic pain syndrome were recruited from a tertiary hospital in the UK. Data were collected using semi-structured interviews and visual aids, and analysed using interpretative phenomenological analysis. RESULTS Four broad themes were identified which describe as a journey of change from participants: (a) daily life with pain, where adolescents report a level of pain that is "normal" for them which they can tolerate and continue their daily routines around; (b) pre-flare period, where adolescents begin to notice pain increasing beyond normal levels and employ preventative strategies to reduce the risk of symptoms developing into a flare; (c) flare period, where adolescents describe the symptoms, frequency, duration, impact and their attempts to manage flares; to their (d) post-flare period, where symptoms begin to return to baseline levels and adolescents take actions to regain the level of normality experienced in daily life. CONCLUSION This study has identified a number of components of the pain flare experience. Findings show that pain flares are more than an increase in pain intensity; they are multi-layered and require other features to change. These findings help to differentiate pain flares from typical fluctuations in pain.
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Affiliation(s)
- Sonia Khanom
- Centre for Epidemiology Versus Arthritis, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Reynolds AC. Patient partnership in medical research: an important consideration for systemic lupus erythematosus research in Australia: a patient perspective. Lupus 2017; 27:694-695. [PMID: 29105557 DOI: 10.1177/0961203317739130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A C Reynolds
- 6939 Central Queensland University , Wayville, Australia
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Squance ML, Reeves G, Attia J, Bridgman H, Guest M. Self-reported Lupus flare: Association with everyday home and personal product exposure. Toxicol Rep 2015; 2:880-888. [PMID: 28962424 PMCID: PMC5598386 DOI: 10.1016/j.toxrep.2015.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/21/2015] [Accepted: 05/24/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The number of chemicals in household products has driven concern about potential adverse health through their use. Most research concentrates on product chemicals with reproductive and carcinogenic consequences, however some evidence exists that immune effects can lead to exacerbation of autoimmune illnesses such as lupus (SLE). OBJECTIVES This paper examines household and personal product exposure patterns in a pilot case/control study of female Australians. We also examined associations between common product exposure and SLE symptom exacerbation over a year period. METHODS We enrolled 41 control and 80 SLE participants aged 18-80 years. Qualitative techniques of structured interview and thematic analysis retrospectively explored patterns of product use, and flare history data of SLE participants. Negative binomial regression models explored associations between self-reported flare (SRF) days and exposure to 34 common home product groups. RESULTS Mean product counts did not differ between participant groups (mean 33.1: SD 11.8), or flare groups (flare mean 32.6:SD 12, no-flare 31.8:SD 6.6). Products used for personal hygiene and general house cleaning were most frequently used.Significant association with increased SRF day relative risk (IRR) was seen for bath oil use (IRR 1.008, CI 1.00-1.02). Paradoxical "protective" effects, (reduced SRF days) were found for cleansing beauty (IRR 0.999, CI 0.998-0.999), make-up (IRR 0.998, CI 0.997-0.999); adhesives (IRR 0.994, CI 0.991-0.997) and paint (IRR 0.99, CI 0.986-0.995). CONCLUSIONS Everyday product exposures can impact on symptom exacerbation in SLE. Some offering protection and others increased health risk. Identifying environmental associations offer the possibility of life-style interventions to reduce illness impact.
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Affiliation(s)
- Marline L. Squance
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
- Faculty of Science and Information Technology, University of Newcastle, Callaghan, NSW 2308, Australia
- Autoimmune Resource and Research Center, New Lambton Heights, NSW 2305, Australia
- Hunter New England Health District, New Lambton Heights, NSW 2305, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Glenn Reeves
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
- Autoimmune Resource and Research Center, New Lambton Heights, NSW 2305, Australia
- Hunter New England Health District, New Lambton Heights, NSW 2305, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - John Attia
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter New England Health District, New Lambton Heights, NSW 2305, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Howard Bridgman
- Faculty of Science and Information Technology, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Maya Guest
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
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