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Mena-Vázquez N, Ortiz-Márquez F, Ramírez-García T, Cabezudo-García P, García-Studer A, Mucientes-Ruiz A, Lisbona-Montañez JM, Borregón-Garrido P, Ruiz-Limón P, Redondo-Rodríguez R, Manrique-Arija S, Cano-García L, Serrano-Castro PJ, Fernández-Nebro A. Impact of inflammation on cognitive function in patients with highly inflammatory rheumatoid arthritis. RMD Open 2024; 10:e004422. [PMID: 39043441 DOI: 10.1136/rmdopen-2024-004422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 06/07/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To evaluate cognitive function in patients with rheumatoid arthritis (RA) and inflammatory activity. PATIENTS AND METHODS We performed a cross-sectional study of a cohort of patients with RA initiating their first biological treatment due to moderate-to-high inflammation and a healthy control group (no inflammatory diseases) matched for age, sex and educational level. All participants underwent a comprehensive neuropsychological assessment, with cognitive impairment defined as a Montreal Cognitive Assessment (MoCA) score<26. Additional assessments included various cognitive tests (STROOP, forward and backward digit spans), anxiety and depression scales (Hospital Anxiety and Depression Scale), quality of life measures (Quality of Life-Rheumatoid Arthritis) and average inflammatory activity according to the 28-joint Disease Activity Score (DAS28)-C-reactive protein (CRP) into high activity (DAS28≥3.2) and low activity (DAS28<3.2) groups, also CRP levels and interleukin 6 (IL-6) levels were measured using an ELISA. RESULTS The study population comprised 140 participants, 70 patients with RA and 70 controls. Patients more frequently experienced cognitive impairment than controls (60% vs 40%; p=0.019) and had lower mean (SD) values in the MoCA (23.6 (3.9) vs 25.1 (3.4); p=0.019. As for subtests of the MoCA, involvement was more marked in patients than in controls for the visuospatial-executive (p=0.030), memory (p=0.026) and abstraction (p=0.039) domains. Additionally, patients scored lower on executive function, as assessed by the backward digit span test (4.0 (1.7) vs 4.7 (1.9); p=0.039). Cognitive impairment is associated with age and a lower educational level in the general population, and among patients with RA with educational level, obesity and average inflammatory activity (DAS28, CRP, and IL-6). CONCLUSIONS Patients with RA with high inflammatory activity are more susceptible to cognitive impairment, which specifically affects the domains of visuospatial, memory, abstraction and executive function.
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Affiliation(s)
- Natalia Mena-Vázquez
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Fernando Ortiz-Márquez
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Málaga, Spain
| | - Teresa Ramírez-García
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Pablo Cabezudo-García
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Aimara García-Studer
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Málaga, Spain
| | - Arkaitz Mucientes-Ruiz
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jose Manuel Lisbona-Montañez
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Málaga, Spain
| | - Paula Borregón-Garrido
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Patricia Ruiz-Limón
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Endocrinología y Nutrición, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Rocío Redondo-Rodríguez
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara Manrique-Arija
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Málaga, Spain
| | - Laura Cano-García
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Pedro J Serrano-Castro
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Antonio Fernández-Nebro
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Málaga, Spain
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2
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Barraclough M, Howe A, Soberanis A, Kakvan M, Chattu V, Bani‐Fatemi A, Engel L, Vitti M, Nalder E, Goverover Y, Gignac M, Bonilla D, Nielsen W, Anderson N, Tartaglia C, Nowrouzi‐Kia B, Touma Z. The Effects of Systemic Lupus-Related Cognitive Impairments on Activities of Daily Living and Life Role Participation: A Qualitative Framework Study. ACR Open Rheumatol 2024; 6:21-30. [PMID: 37964675 PMCID: PMC10789303 DOI: 10.1002/acr2.11624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/30/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Cognitive impairment (CI) in systemic lupus erythematosus (SLE) negatively impacts health-related quality of life leading to activity limitations. This qualitative study aimed to (1) explore the effect of SLE-related CI on activities of daily living and life role participation and (2) describe factors influencing activity restriction and life role participation. METHODS Semistructured, in-depth interviews of lived experience of CI in SLE were conducted with 24 participants with SLE. Sociodemographic and clinical data, and objective and subjective cognitive function, were collected to characterize participants. A qualitative thematic content analysis was undertaken guided by a framework analytical approach. RESULTS Participants reported problems in multiple cognitive domains, with multiple perceived causes. CI was felt to impact work, social, domestic, and family life, health, and independence. Five overarching themes were represented in the data: (1) characterization of SLE-reported CI, (2) perceived cause of CI, (3) perceived impact of CI on activities of daily living and life role participation, (4) adaptations for managing CI, and (5) influence of CI adaptations on activities of daily living and life role participation. CONCLUSION This study provides a better understanding of the patient experience of CI in SLE, how it impacts their lives, and what coping strategies they employ. It highlights the long-term challenges those with CI in SLE undergo and provides evidence for the urgent need to implement multidisciplinary treatment options. When managing CI, it may be beneficial to evaluate and understand available psychosocial support resources to help identify and reinforce relevant adaptations to improve health-related quality of life.
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Affiliation(s)
- Michelle Barraclough
- University Health Network, Toronto, Ontario, Canada, and The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, and Manchester Academic Health Science CentreManchesterUK
| | - Aaron Howe
- University of TorontoTorontoOntarioCanada
| | | | - Mahta Kakvan
- University Health Network, and University of Toronto Lupus Clinic, Toronto Western HospitalTorontoOntarioCanada
| | | | | | - Lisa Engel
- University of Manitoba, Winnipeg, Manitoba, and Institute for Work and HealthTorontoOntarioCanada
| | - Michelle Vitti
- University Health Network, and University of Toronto Lupus Clinic, Toronto Western HospitalTorontoOntarioCanada
| | | | | | - Monique Gignac
- University Health Network, University of Toronto, and Institute for Work and HealthTorontoOntarioCanada
| | - Dennisse Bonilla
- University Health Network, and University of Toronto Lupus Clinic, Toronto Western HospitalTorontoOntarioCanada
| | - Wils Nielsen
- University of Toronto Lupus Clinic and Western HospitalTorontoOntarioCanada
| | - Nicole Anderson
- University Health Network, and University of Toronto Lupus Clinic, Toronto Western HospitalTorontoOntarioCanada
| | | | | | - Zahi Touma
- University Health Network, and University of Toronto Lupus Clinic, Toronto Western HospitalTorontoOntarioCanada
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3
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Shumilova A, Vital EM. Musculoskeletal manifestations of systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2023; 37:101859. [PMID: 37620235 DOI: 10.1016/j.berh.2023.101859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
MSK is the most common and impactful symptom of lupus at a population level. It has a variety of different presentations, but joint swelling is often not present despite imaging-proven synovitis. Imaging with US and MRI has been shown to improve detection of inflammation and identify treatment-responsive patients. In contrast, the SLEDAI shows poor sensitivity, specificity, and responsiveness. While BILAG and SLE-DAS are superior, they are still less accurate than imaging. These issues may explain why the evidence for conventional and biologic therapies for MSK lupus is complex. In clinical practice, physicians must take care not to underestimate MSK inflammation and consider using imaging. Future research should investigate new therapeutic targets specifically for synovitis and more sensitive outcome measures and trials to evaluate them.
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Affiliation(s)
- Anastasiia Shumilova
- University of Leeds, Leeds, United Kingdom; V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
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4
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Treatment Patterns and Clinical Characteristics of Patients with Systemic Lupus Erythematosus and Musculoskeletal Symptoms: A Retrospective, Observational Study. Adv Ther 2022; 39:3131-3145. [PMID: 35534786 PMCID: PMC9239948 DOI: 10.1007/s12325-022-02148-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/25/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Musculoskeletal (MSK) symptoms, including arthritis and arthralgia, are common manifestations of systemic lupus erythematosus (SLE); definitions of activity patterns in SLE differ across studies. This study described clinical characteristics and treatment patterns of patients with SLE-MSK over time and by disease activity patterns from a real-world setting. METHODS This retrospective descriptive analysis includes a subset of patients with SLE from the Hopkins Lupus Cohort with identified MSK involvement by scores on the arthritis domain of the Safety of Estrogens in Systemic Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) or Lupus Activity Index. Clinical characteristics and treatment patterns were described for patients with at least two visits over the observation period (2010-2019) for the SLE-MSK population based on three disease activity patterns: chronically active (MSK-CA), relapsing-remitting (MSK-RR), and long quiescence (MSK-LQ). RESULTS The SLE-MSK subpopulation included 664 patients (4069 person-years). The most frequently used medications over the observation period were antimalarials (95%), corticosteroids (92%), immunosuppressants (58%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (48%); 7% of patients used biologics. The highest use of corticosteroids was in the MSK-CA group (90.5% of follow-up time), followed by MSK- RR (83.9%), and MSK-LQ (46.5%). Mean prednisone dose was significantly higher in MSK-RR (8.5 mg) compared to MSK-CA (6.5 mg). CONCLUSIONS This descriptive analysis highlights the impact of prevalent manifestations such as arthritis on the chronic use of corticosteroids, immunosuppressants, and NSAIDs to manage disease activity in patients with SLE, suggesting there is a need for new therapeutic options that enable a lower use of medication when treating lupus.
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5
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Cardwell FS, Dixon J, Clarke AE, Elliott SJ. Canadian workplace experiences of systemic lupus erythematosus (SLE). Lupus Sci Med 2021; 8:8/1/e000536. [PMID: 34548374 PMCID: PMC8458365 DOI: 10.1136/lupus-2021-000536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/08/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Francesca S Cardwell
- Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Jenna Dixon
- Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan J Elliott
- Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
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Ubhi M, Dubey S, Gordon C, Adizie T, Sheeran T, Allen K, Jordan R, Sadhra S, Adams J, Daji R, Reynolds JA, Kumar K. Understanding the impact of systemic lupus erythematosus on work amongst South Asian people in the UK: An explorative qualitative study. Lupus 2021; 30:1492-1501. [PMID: 34092136 PMCID: PMC8283190 DOI: 10.1177/09612033211022816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SLE has a range of fluctuating symptoms affecting individuals and their ability to work. Although South Asian (SA) patients are at increased risk of developing SLE there is limited knowledge of the impact on employment for these patients in the UK. Understanding ethnicity and disease-specific issues are important to ensure patients are adequately supported at work. Semi-structured interviews were conducted with patients of SA origin to explore how SLE impacted on their employment. Thematic analysis was used to analyse the data which are reported following COREQ guidelines. Ten patients (8 female; 2 male) were recruited from three rheumatology centres in the UK and interviewed between November 2019 and March 2020. Patients were from Indian (n = 8) or Pakistani (n = 2) origin and worked in a range of employment sectors. Four themes emerged from the data: (1) Disease related factors; (2) Employment related factors; (3) Cultural and interpersonal factors impacting on work ability; (4) Recommendations for improvement. Patients’ ability to work was affected by variable work-related support from their hospital clinicians, low awareness of SLE and variable support from their employers, and cultural barriers in their communities that could affect levels of family support received. These findings highlight the need for additional support for SA patients with SLE in the workplace.
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Affiliation(s)
- Mandeep Ubhi
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Shirish Dubey
- University Hospitals Coventry, Coventry, UK.,Warwickshire NHS Trust, Warwick, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | | | - Tom Sheeran
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Kerry Allen
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Rachel Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Steven Sadhra
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
| | - Jo Adams
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | | | - John A Reynolds
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Booth S, Price E, Walker E. 'When I asked for help and support it was not there': current NHS employment practice and its impact on people with systemic lupus erythematosus. Rheumatol Adv Pract 2021; 5:rkab019. [PMID: 33928213 PMCID: PMC8058394 DOI: 10.1093/rap/rkab019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/11/2021] [Indexed: 01/26/2023] Open
Abstract
Objectives The aim was to investigate whether National Health Service (NHS) employees with SLE, for whom work disability and early retirement are high, are supported effectively in at work. Methods An online survey of 393 people with lupus was completed through the LUPUS UK website, investigating participants’ experiences in maintaining employment. Quantitative and qualitative data were collected. Disease fluctuation, invisibility and fatigue were identified as having substantial negative impacts on employment. This study examined data from a large subgroup (n = 72, 18.74%) of current/previous NHS employees. Descriptive statistics and thematic analysis were used to explore and characterize the demography and experiences of participants. Results The NHS subgroup (n = 72) represented 18.74% of the whole cohort; 100% were female and of working age (18–64 years). Fifty-one were currently (70.8%) and 21 previously (29.2%) NHS employees. Forty-nine (60%) were clinicians. Twenty-one (29.16%) of this working-age subgroup had left any employment. Negative effects of SLE on employment were universal (including an impact on career choices, work disability, enforced part-time working, lower income and early retirement). NHS support for participants to maintain employment was inconsistent, with more negative experiences than positive. The impact of SLE on employment seemed to be poorly understood. Conclusion A punitive approach to NHS employees with SLE was more common than a proactive, flexible, problem-solving one despite inclusive rhetoric, resulting in the loss of skills and experience to the service. Characterizing conditions such as SLE and long coronavirus disease 2019 as fluctuating, invisible conditions with constitutional symptoms highlights features with negative employment impact, potentially facilitating much-needed change in NHS organizations, with greater use of occupational health, vocational rehabilitation, redeployment and retraining opportunities, highlighting the need for evidence-based employment interventions and improved management of fatigue.
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Affiliation(s)
- Sara Booth
- Cambridge Breathlessness Intervention Service, University of Cambridge, Cambridge
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8
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Gergianaki I, Garantziotis P, Adamichou C, Saridakis I, Spyrou G, Sidiropoulos P, Bertsias G. High Comorbidity Burden in Patients with SLE: Data from the Community-Based Lupus Registry of Crete. J Clin Med 2021; 10:jcm10050998. [PMID: 33801229 PMCID: PMC7957898 DOI: 10.3390/jcm10050998] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/28/2021] [Accepted: 02/22/2021] [Indexed: 01/14/2023] Open
Abstract
Comorbidities and multimorbidity, often complicating the disease course of patients with chronic inflammatory rheumatic diseases, may be influenced by disease-intrinsic and extrinsic determinants including regional and social factors. We analyzed the frequency and co-segregation of self-reported comorbid diseases in a community-based Mediterranean registry of patients (n = 399) with systemic lupus erythematosus (SLE). Predictors for multimorbidity were identified by multivariable logistic regression, strongly-associated pairs of comorbidities by the Cramer's V-statistic, and comorbidities clusters by hierarchical agglomerative clustering. Among the most prevalent comorbidities were thyroid (45.6%) and metabolic disorders (hypertension: 24.6%, dyslipidemia: 33.3%, obesity: 35.3%), followed by osteoporosis (22.3%), cardiovascular (20.8%), and allergic (20.6%) disorders. Mental comorbidities were also common, particularly depression (26.7%) and generalized anxiety disorder (10.7%). Notably, 51.0% of patients had ≥3 physical and 33.1% had ≥2 mental comorbidities, with a large fraction (n = 86) displaying multimorbidity from both domains. Sociodemographic (education level, marital status) and clinical (disease severity, neurological involvement) were independently associated with physical or mental comorbidity. Patients were grouped into five distinct clusters of variably prevalent comorbid diseases from different organs and domains, which correlated with SLE severity patterns. Conclusively, our results suggest a high multimorbidity burden in patients with SLE at the community, advocating for integrated care to optimize outcomes.
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Affiliation(s)
- Irini Gergianaki
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece
| | - Panagiotis Garantziotis
- Laboratory of Immune Regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece;
- Division of Immunology and Rheumatology, Hannover Medical University, 30625 Hannover, Germany
| | - Christina Adamichou
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Ioannis Saridakis
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Georgios Spyrou
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Prodromos Sidiropoulos
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece
| | - George Bertsias
- Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece; (I.G.); (C.A.); (I.S.); (G.S.); (P.S.)
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece
- Correspondence: ; Tel.: +30-2810-394635
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9
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Fung W, Lim LSH, Tomlinson G, Engel L, Su J, Diaz-Martinez JP, Touma Z. Joint trajectories of disease activity, and physical and mental health-related quality of life in an inception lupus cohort. Rheumatology (Oxford) 2021; 59:3032-3041. [PMID: 32191334 DOI: 10.1093/rheumatology/keaa091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/31/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To examine for latent patterns of SLE disease activity trajectories that associate with specific latent patterns of health-related quality of life (HRQoL; Medical Outcomes Study Short Form-36), and to determine baseline predictors of class membership. METHODS In this retrospective longitudinal inception cohort of 222 SLE adults over 10 years, trajectories of three outcomes were studied jointly: Short Form-36 physical (PCS) and mental (MCS) component summaries and adjusted mean SLEDAI-2000 (AMS). Group-based joint trajectory modelling was used to model latent classes; univariable and multivariable analyses were used to identify predictors of class membership. RESULTS Four latent classes were identified: Class 1 (C1) (24%) had moderate AMS, and persistently low PCS and MCS; C2 (26%) had low AMS, moderate PCS and improved then worsened MCS; C3 (38%) had moderate AMS, and persistently high PCS and MCS; and C4 (11%) had high AMS, moderate-low PCS and improving MCS. Baseline older age was associated with lower HRQoL trajectories. Higher AMS trajectories did not associate with a particular pattern of HRQoL trajectory. A higher prevalence of fibromyalgia (44% in C1) was associated with worse HRQoL trajectories. Disease manifestations, organ damage and cumulative glucocorticoid were not differentially distributed across the latent classes. CONCLUSION High disease activity did not necessarily associate with low HRQoL. More patients with worse HRQoL trajectories had fibromyalgia. Older age at diagnosis increased the probability of belonging to a class with low HRQoL trajectories. The care of SLE patients may be improved through addressing fibromyalgia in addition to disease activity.
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Affiliation(s)
- William Fung
- Department of Rheumatology, University of Toronto, Toronto, Ontario
| | - Lily Siok Hoon Lim
- Max Rady Faculty of Health Sciences, Children's Hospital Research Institute of Manitoba, University of Manitoba, Manitoba
| | - George Tomlinson
- Institute of Health Policy, University of Toronto, Toronto, Ontario
| | - Lisa Engel
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Manitoba
| | - Jiandong Su
- Department of Rheumatology, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, Toronto, Ontario, Canada
| | | | - Zahi Touma
- Institute of Health Policy, University of Toronto, Toronto, Ontario.,Department of Rheumatology, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, Toronto, Ontario, Canada
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10
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Kernder A, Elefante E, Chehab G, Tani C, Mosca M, Schneider M. The patient's perspective: are quality of life and disease burden a possible treatment target in systemic lupus erythematosus? Rheumatology (Oxford) 2020; 59:v63-v68. [PMID: 33280017 PMCID: PMC7719037 DOI: 10.1093/rheumatology/keaa427] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
A few decades ago, the therapy goal of patients with systemic lupus erythematosus (SLE) was survival and the prevention of organ failure. Today, clinical remission and low disease activity are believed to be the optimal therapeutic targets. These aims are difficult to reach for many patients, but they still do not address the health-related quality of life (QoL) that is significantly impaired in SLE patients. Even in the state of remission, QoL and fatigue are insufficient controlled. Thus, patient-oriented research is essential to design new strategies for the management of lupus patients. The INTEGRATE project analyses the patients' and physicians' perspectives to pave the way to design an innovative therapeutic strategy for lupus and focuses on the multifaceted dimensions of the disease burden. Shared decision making (SDM) could include the patient's perspective of SLE to treatment strategy and consider QoL and the burden of lupus into the process of therapy decision.
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Affiliation(s)
- Anna Kernder
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gamal Chehab
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matthias Schneider
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
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Berkovic D, Briggs AM, Ayton D, Parker C, Ackerman I. Arthritis-related work outcomes experienced by younger to middle-aged adults: a systematic review. Occup Environ Med 2020; 78:225-236. [PMID: 32847992 DOI: 10.1136/oemed-2020-106640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aim of this review was to systematically identify, appraise and synthesise evidence on work-related outcomes experienced by younger to middle-aged adults (aged 16-50 years) with arthritis. METHODS Eligible studies were identified in Medline, PsycINFO, Embase and CINAHL in January 2020. Quantitative and qualitative studies containing self-reported data on work-related outcomes on younger/middle-aged adults with arthritis were included. Quality assessment was undertaken using validated quality appraisal tools from the Joanna Briggs Institute. RESULTS Thirty-four studies were identified for inclusion. Work outcomes were organised around five themes: (1) arthritis-related work productivity outcomes, (2) arthritis-related work participation outcomes, (3) other arthritis-related workplace outcomes, (4) barriers to work participation associated with arthritis and (5) enablers to work participation associated with arthritis. Arthritis was associated with work limitations on the Workplace Activity Limitations Scale (average scores ranging from 5.9 (indicating moderate workplace difficulty) to 9.8 (considerable workplace difficulty)), and higher work disability prevalence rates (range: 6%-80%) relative to healthy populations. Arthritis was not associated with decreased absenteeism on the Work Productivity and Activity Impairment Questionnaire (mean (SD) 7.9% (14.0%)), indicating low levels of absenteeism, similar to healthy populations. As work outcomes were commonly binary, person-centred (qualitative) perspectives on barriers and enablers augmented the quantitative findings. CONCLUSION Arthritis is commonly associated with poorer work outcomes for younger/middle-aged adults relative to healthy populations. Additional research focusing solely on the workplace needs of younger/middle-aged population groups is required to inform tailored interventions and workplace support initiatives to maximise productive working years.
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Affiliation(s)
- Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catriona Parker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ilana Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Hoge C, Bowling CB, Lim SS, Drenkard C, Plantinga LC. Association of Poverty Income Ratio with Physical Functioning in a Cohort of Patients with Systemic Lupus Erythematosus. J Rheumatol 2020; 47:983-990. [PMID: 32115428 DOI: 10.3899/jrheum.190991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the association of income relative to the poverty threshold [poverty income ratio (PIR)] with self-reported physical functioning (PF) in a cohort of patients with systemic lupus erythematosus. METHODS We used cross-sectional data on 744 participants from Georgians Organized Against Lupus (GOAL), and secondary analyses used data on 56 participants from a nested pilot study. Primary analyses used multivariable linear regression to estimate the association between PIR (categorized as < 1.00, 1.00-1.99, 2.00-3.99, and ≥ 4.00; lower PIR indicate higher poverty) and PF (scaled subscore from the Medical Outcomes Study Short Form-12 survey; range 0-100, higher scores indicate better functioning). Secondary analyses summarized complementary measures of PF as means or percentages by PIR (categorized as < 1.00, 1.00-1.99, and ≥ 2.00). RESULTS The mean age of participants was 48.0 years; 6.7% were male; 80.9% were black; and 37.5%, 21.0%, 29.6%, and 12.0% had PIR of < 1.00, 1.00-1.99, 2.00-3.99, and ≥ 4.00, respectively. The overall mean PF score was 45.8 (36.2, 40.7, 55.5, and 61.2 for PIR of < 1.00, 1.00-1.99, 2.00-3.99, and ≥ 4.00). With adjustment, higher PIR remained associated with higher PF scores [2.00-3.99 vs 1.00-1.99: β = 10.9 (95% CI 3.3-18.6); ≥ 4.00 vs 1.00-1.99: β = 16.2 (95% CI 6.4-26.0)]. In secondary analyses, higher PIR was also associated with higher scores for objective physical performance. CONCLUSION Our results show that higher income relative to the poverty threshold is associated with better PF across multiple domains, warranting further research into multicomponent functional assessments to develop individual treatment plans and potentially improve socioeconomic disparities in outcomes.
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Affiliation(s)
- Courtney Hoge
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - C Barrett Bowling
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - S Sam Lim
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - Cristina Drenkard
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - Laura C Plantinga
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA. .,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University.
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Katz P, Nelson WW, Daly RP, Topf L, Connolly-Strong E, Reed ML. Patient-Reported Lupus Flare Symptoms Are Associated with Worsened Patient Outcomes and Increased Economic Burden. J Manag Care Spec Pharm 2020; 26:275-283. [PMID: 32105178 PMCID: PMC10390967 DOI: 10.18553/jmcp.2020.26.3.275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lupus flares significantly contribute to health resource utilization and hospitalizations. Identification of flare activity may be hindered since validated assessment scales are rarely used in clinical practice and flare severity may fall below clinician-assessed thresholds. Therefore, patient-reported outcomes of lupus flare frequency are important assessment tools for lupus management. OBJECTIVE To better understand the relationship between lupus flares as reported by persons with lupus and specific direct and indirect costs, including hospital admission, unplanned urgent care (UC)/emergency department (ED) visits, work productivity loss, and nonwork activity impairment. METHODS In this cross-sectional analysis, persons with lupus were drawn from 2 enriched sampling sources. Data were collected via an online survey and included individuals with self-reported physician's diagnosis of systemic lupus erythematosus, skin or discoid lupus, or lupus nephritis. Respondents were asked the total number of hospitalizations and ED/UC visits for any reason and for lupus-related hospitalizations and ED/UC visits. Work productivity loss and nonwork activity impairment were measured via the Work Productivity and Activity Impairment - General Health scale. The sample was stratified into those with 0 flares, 1-3 flares, 4-6 flares, and 7 or more flares, with 0 flares used as the reference. Chi-square tests for trend and analyses of variance were used to evaluate differences among flare frequency groups. Multivariable regression modeling was conducted to evaluate the independent relationship of flare frequency to health care use and productivity loss. RESULTS We studied 1,288 survey respondents with known flare frequency in the past 12 months. Flare frequency increased with duration of illness. The mean number of lupus-related hospital admissions was significantly associated with increasing flare frequency for the total sample (F = 3.9; P < 0.009). Compared to patients with no flare, those who reported flare activities had 1.72-3.13 times higher rates of hospitalizations. The mean number of lupus-related ED/UC visits were also found to be significantly associated with increasing flare frequency for the total sample (F = 23.4; P < 0.001), and rates were increased by 6.98- to 16.12-fold for unplanned ED/UC visits depending on flare frequency. Rates of employment were significantly related to increasing flare frequency. With respect to work-related impairment, absenteeism increased with greater lupus flare frequency (F = 6.2; P < 0.001), as did presenteeism (F = 31.5; P < 0.001) and the combined value of total work productivity loss (F = 30.4; P < 0.001). Mean work-related activity impairment was 12%-32% more among patients who reported flare activities compared to those who reported no flares. CONCLUSIONS Increased lupus-related flare frequency is associated with worsened patient outcomes as measured by increased hospitalizations, visits to the ED/UC, work productivity loss, and activity impairment. This association may be an important indicator of disease severity and resource burden and therefore suggests an unmet need among patients experiencing lupus-related flares. DISCLOSURES This study was sponsored by Mallinckrodt Pharmaceuticals via grants to Vedanta Research and The Lupus Foundation of America. Katz received consulting fees from Vedanta Research, which received grant support from Mallinckrodt Pharmaceuticals to support data collection and analysis. Nelson and Connolly-Strong are employees of Mallinckrodt Pharmaceuticals and are stockholders in the company. Reed is an employee of Vedanta Research. Daly and Topf are employees of the Lupus Foundation of America, which received grant funding to support data collection. This study was a podium presentation at The American College of Rheumatology (ACR) Annual Meeting 2018; October 19-24, 2018; Chicago, IL.
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Loftus J, Camacho-Hubner C, Hey-Hadavi J, Goodrich K. Targeted literature review of the humanistic and economic burden of adult growth hormone deficiency. Curr Med Res Opin 2019; 35:963-973. [PMID: 30411985 DOI: 10.1080/03007995.2018.1546682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Quality of life (QoL) and health economic data are becoming increasingly important factors in healthcare decision making. While there is a wealth of information establishing the benefit of growth hormone (GH) replacement therapy in adults with growth hormone deficiency (aGHD), recent reviews on the QoL and health economic impact of aGHD and the effect of treatment on these factors is limited. OBJECTIVE The aim of this article is to summarize the impact of early and sustained treatment on the QoL and economic burden of aGHD by conducting a targeted literature review. METHODS Standard electronic databases, including PubMed and the Cochrane collaboration website, were searched for publications between January 2006 and July 2016 for evidence of the humanistic and economic burden of aGHD. Search terms included growth hormone deficiency, health-related quality of life, HRQoL, patient-reported outcomes, outcome assessment, well-being and adherence. RESULTS The literature search identified 732 initial hits and a final 14 publications were included. The analysis showed that the economic burden of aGHD is largely driven by the productivity losses associated with the disease. This is because most patients with aGHD are of working age and the QoL domains (memory & concentration and energy & vitality) most commonly affected by aGHD severely impair a person's ability to work and may limit their contribution to society. CONCLUSION Untreated aGHD can seriously affect patients' functioning. Early and continued treatment with GH replacement therapy could potentially improve the QoL and reduce the economic burden associated with aGHD. This review has limitations: only English language articles published since January 2006 were included and many of the studies were conducted in the Nordic countries; it is unclear how representative these studies are of the population as a whole. This was a literature review and not a systematic review, as it was thought to be unlikely that, in this rare disease, any additional publications would have been identified. Overall, this review reveals a paucity of data in this underserved population and points to research gaps which could be addressed with new studies.
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Booth S, Price E, Walker E. Fluctuation, invisibility, fatigue - the barriers to maintaining employment with systemic lupus erythematosus: results of an online survey. Lupus 2019; 27:2284-2291. [PMID: 30451638 PMCID: PMC6247450 DOI: 10.1177/0961203318808593] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objectives Systemic lupus erythematosus (SLE) is associated with high levels of workplace disability and unemployment. The objective of this study was to understand the reasons for this and to describe the barriers and facilitators of employment identified by people with SLE to develop appropriate solutions. Unemployment, as well as unsuitable work, has adverse health outcomes. Methods Adults with SLE completed a UK-specific online survey, through the LUPUS UK website, designed to find out more about the difficulties and successes that people with SLE have in maintaining employment. The survey was predominantly qualitative, to understand participants’ employment experiences to generate possible solutions. Results Three hundred and ninety-three people gave detailed responses to the survey within eight weeks. Every respondent reported a detrimental effect of SLE on their ability to work: 40.45% had left employment because of it. The themes of concern to respondents were unambiguous: (i) the difficulties of working (and career damage) with SLE, (ii) fear and anxiety overshadowing work/family life, (iii) the greater potential to remain in some employment or stay in full employment when modifications of work pattern and support from management and colleagues were available. SLE-related fatigue, its invisibility and fluctuating nature were felt to be the main barriers to maintaining employment. Numerous respondents could work only part-time and anxiety was high regarding their future ability to continue working. Many had taken substantial pay reductions and refused offered promotions to preserve their health. Distress due to loss of work and the benefits it brings were reported by every respondent who had left work. Conclusion SLE presents specific difficulties for maintaining employment – fatigue, fluctuation and invisibility – not addressed by current anti-discrimination legislation or currently available ‘reasonable adjustments’. This study demonstrates that (i) employment is an important area of concern for people with SLE, (ii) SLE has significant detrimental effects on individuals’ ability to participate and progress in employment, (iii) legislators and employers need information about SLE as invisibility and fluctuation cause hidden problems, and (iv) more data is needed to inform workplace adjustments if individual distress and societal loss of skills are to be addressed.
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Affiliation(s)
- S Booth
- 1 Cambridge Breathlessness Intervention Service, University of Cambridge, Cambridge, UK
| | - E Price
- 2 Faculty of Health Sciences, University of Hull, Hull, UK
| | - E Walker
- 2 Faculty of Health Sciences, University of Hull, Hull, UK
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16
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Guffroy A, Martin T, Korganow AS. Adolescents and young adults (AYAs) affected by chronic immunological disease: A tool-box for success during the transition to adult care. Clin Immunol 2018; 197:198-204. [PMID: 30347239 DOI: 10.1016/j.clim.2018.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/17/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022]
Abstract
Adolescence is a time of physical, psychological and social changes between childhood and adulthood. All adolescents and young adults (AYAs) are in transition and experience key underlying processes that will influence their later life. It is a critical period, particularly for AYAs with a chronic medical condition. Diseases can start at any point during adolescence. The transition of care will concern health care providers, as well as more unexpected actors such as social workers, teachers, business managers and the family. In this review, we focus on transition in primary immunodeficiencies (PIDs) and autoimmune diseases (AIDs). We describe the challenges and needs of transition in the field. Questions that AYAs with PID and/or AID must face during transition in their familial, professional and personal life are discussed. We expose a practical, AYA centered approach to help physicians in their daily practice, and we propose a position for the future.
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Affiliation(s)
- Aurélien Guffroy
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Autoimmune Diseases (RESO), Referral Centre for Primary Immunodeficiencies, Strasbourg University Hospital, 67091 Strasbourg, France; CNRS UPR 3572, Immunopathology and Therapeutic Chemistry, Strasbourg University, 67000 Strasbourg, France; UFR Médecine, Université de Strasbourg, 67000 Strasbourg, France.
| | - Thierry Martin
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Autoimmune Diseases (RESO), Referral Centre for Primary Immunodeficiencies, Strasbourg University Hospital, 67091 Strasbourg, France.
| | - Anne-Sophie Korganow
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Autoimmune Diseases (RESO), Referral Centre for Primary Immunodeficiencies, Strasbourg University Hospital, 67091 Strasbourg, France; CNRS UPR 3572, Immunopathology and Therapeutic Chemistry, Strasbourg University, 67000 Strasbourg, France; UFR Médecine, Université de Strasbourg, 67000 Strasbourg, France.
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Elera-Fitzcarrald C, Fuentes A, González LA, Burgos PI, Alarcón GS, Ugarte-Gil MF. Factors affecting quality of life in patients with systemic lupus erythematosus: important considerations and potential interventions. Expert Rev Clin Immunol 2018; 14:915-931. [DOI: 10.1080/1744666x.2018.1529566] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Claudia Elera-Fitzcarrald
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
| | - Alejandro Fuentes
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Alonso González
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Paula I. Burgos
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Graciela S. Alarcón
- The University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Manuel F. Ugarte-Gil
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
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Self-care model application to improve self-care agency, self-care activities, and quality of life in patients with systemic lupus erythematosus. J Taibah Univ Med Sci 2018; 13:472-478. [PMID: 31435364 PMCID: PMC6695026 DOI: 10.1016/j.jtumed.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 11/24/2022] Open
Abstract
Objectives This study aimed to examine the effect of the application of a self-care model to improve self-care agency (SCA), self-care operation, and quality of life (QoL) in patients with systemic lupus erythematosus (SLE). Methods This study employed a pre-experimental design with one pretest-posttest group. Thirty-six respondents were selected through total sampling. The experimental group was provided self-care management training, followed by four weekly home visits. Self-care agency was measured with the self-care agency scale, the other variables through self-rated abilities on the health practices scale and Lupus quality inventory. Data were analysed using paired t-tests with α < 0.05. Results SLE was common in actively working married women of childbearing age, most of whom had had SLE for 1–2 years (33.3%), with arthritis being the most common symptom (reported by 61.1%). The major flare trigger factor was physical stress (66.7%), resulting in fatigue. On average, the self-care model was able to improve SCA by 19.93%, self-care operation by 17.53%, and QoL by 12.19%. It was significantly effective in enhancing SCA, self-care operation, and QoL in patients with SLE (p < 0.001). Conclusions The application of Orem's self-care model is effective in improving SCA, self-care, and QoL, and this study provides evidence of the benefits of its use in the nursing care of patients with SLE in a community setting. Health care providers should incorporate Orem's self-care model in nursing care to enhance SCA, self-care, and QoL in patients with SLE.
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Gergianaki I, Bertsias G. Systemic Lupus Erythematosus in Primary Care: An Update and Practical Messages for the General Practitioner. Front Med (Lausanne) 2018; 5:161. [PMID: 29896474 PMCID: PMC5986957 DOI: 10.3389/fmed.2018.00161] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/08/2018] [Indexed: 12/29/2022] Open
Abstract
Systemic Lupus Erythematosus (SLE) is a complex chronic autoimmune disease that manifests a wide range of organ involvement. Traditionally, the diagnosis and management of SLE is provided at secondary and tertiary centers to ensure prompt initiation of treatment, adequate control of flares and prevention of irreversible organ damage. Notwithstanding, the role of primary care in SLE is also emerging as there are still significant unmet needs such as the diagnostic delay at the community level and the high burden of therapy- and disease-related comorbidities. In the present review, we summarize practical messages for primary care physicians and general practitioners (GPs) concerning early diagnosis and proper referral of patients with SLE. In addition, we discuss the main comorbidities complicating the disease course and the recommended preventative measures, and we also provide an update on the role and current educational needs of GPs regarding the disease.
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Affiliation(s)
- Irini Gergianaki
- Rheumatology, Clinical Immunology and Allergy, University of Crete Faculty of Medicine, Iraklio, Greece
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University of Crete Faculty of Medicine, Iraklio, Greece
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Pisoni CN, Muñoz SA, Tamborenea MN, García M, Curti A, Cappuccio A, Rillo O, Imamura PM, Schneeberger E, Ballent M, Cousseau ML, Velasco Zamora J, Saurit V, Toloza S, Danielsen MC, Bellomio VI, Graf C, Paira S, Cavallasca J, Pons Estel B, Moreno JLC, Díaz M, Alba P, Verando M, Tate G, Mysler E, Sarano J, Civit EE, Risueño F, Álvarez Sepúlveda P, Larroude MS, Méndez MF, Conforti A, Sohn D. Work disability in Argentinian patients with systemic lupus erythematosus is prevalent and it is due to ethnic, socioeconomic and disease-related factors. Int J Rheum Dis 2018; 21:2019-2027. [PMID: 29611343 DOI: 10.1111/1756-185x.13269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the prevalence and the associated factors of work disability (WD) in systemic lupus erythematosus (SLE) patients. METHODS A sample of 419 SLE patients from an observational cross-sectional multicenter study was included. Sociodemographic features, disease characteristics, comorbidities, quality of life, unhealthy behaviors, and work-related factors were measured in a standardized interview. Work disability was defined by patient self-report of not being able to work because of SLE. To identify variables associated with work disability, two different multivariate regression models using a stepwise backward method were performed. RESULTS Prevalence of WD due to SLE was 24.3%. Eighty-nine percent were female and 51% were Caucasians. Mean disease duration was 8.9 ± 7.2 years, and median System Lupus International Collaborating Clinics/American College of Rheumatology damage index SLICC-SDI was 1.5 (range 0-17). In stepwise multivariate logistic regression, living below the poverty line (odds ratio [OR] = 4.65), less than 12 years of education (OR = 2.84), Mestizo ethnicity (OR = 1.94) and SLICC-SDI (OR = 1.25) were predictors of WD. A second model was performed including patient-derived measures; in this model sedentary lifestyle (OR = 2.69) and lower emotional health domain score of the Lupus Quality of Life (LupusQoL) questionnaire (OR = 1.03) were found to be associated to WD and a higher score in LupusQoL physical health domain (OR = 0.93) was protective. CONCLUSION The prevalence of WD in Argentinian SLE patients was 24.3%. WD was associated with ethnic (Mestizo), socioeconomic (poverty) and disease-related factors. Patient-related outcomes such us sedentary lifestyle and poor emotional quality of life were also associated with WD.
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Affiliation(s)
- Cecilia N Pisoni
- Immunology and Rheumatology Section, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Ciudad Autónoma de, Buenos Aires, Argentina
| | - Sebastián A Muñoz
- Hospital General de Agudos Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - María N Tamborenea
- Organización Médica de Investigaciones (OMI), Ciudad Autónoma de Buenos Aires, Argentina
| | - Mercedes García
- Hospital Interzonal General de Agudos "General José de San Martín", Ciudad Autónoma de Buenos Aires, Argentina, Ciudad de La Plata, Argentina
| | - Ana Curti
- Hospital de Clínicas "José de San Martín", Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Cappuccio
- Hospital Cesar Milstein, Ciudad Autónoma de Buenos Aires, Argentina
| | - Oscar Rillo
- Hospital General de Agudos "Dr. Ignacio Pirovano", Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Emilce Schneeberger
- Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | - Verónica Saurit
- Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina
| | - Sergio Toloza
- Hospital Interzonal San Juan Bautista, Fernando del Valle de Catamarca, Argentina
| | | | | | - Cesar Graf
- Centro Médico Mitre, Ciudad de Paraná, Argentina
| | - Sergio Paira
- Hospital José Maria Cullen, Ciudad de Santa Fé, Argentina
| | - Javier Cavallasca
- Hospital José Bernardo Iturraspe, Ciudad de San Francisco, Argentina
| | | | | | - Mónica Díaz
- Centro Traumatológico Bariloche, Ciudad de San Carlos de Bariloche, Argentina
| | - Paula Alba
- Hospital de Córdoba, Ciudad de Córdoba, Argentina
| | - Marcela Verando
- Hospital General de Agudos Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires, Argentina
| | - Guillermo Tate
- Organización Médica de Investigaciones (OMI), Ciudad Autónoma de Buenos Aires, Argentina
| | - Eduardo Mysler
- Organización Médica de Investigaciones (OMI), Ciudad Autónoma de Buenos Aires, Argentina
| | - Judith Sarano
- Instituto de Investigaciones Médicas "Dr. Alfredo Lanari", Ciudad Autónoma de Buenos Aires, Argentina
| | - Emma E Civit
- Hospital del Carmen, Ciudad de Godoy Cruz, Argentina
| | | | | | - María S Larroude
- Hospital Cesar Milstein, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | - Débora Sohn
- Instituto de Diagnóstico Roche, Ciudad de Escobar, Argentina
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Merrill JT, Manzi S, Aranow C, Askanase A, Bruce I, Chakravarty E, Chong B, Costenbader K, Dall'Era M, Ginzler E, Hanrahan L, Kalunian K, Merola J, Raymond S, Rovin B, Saxena A, Werth VP. Lupus community panel proposals for optimising clinical trials: 2018. Lupus Sci Med 2018; 5:e000258. [PMID: 29657738 PMCID: PMC5894527 DOI: 10.1136/lupus-2018-000258] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/06/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022]
Abstract
Formidable impediments stand in the way of treatment development for lupus. These include the unwieldy size of current trials, international competition for scarce patients, complex outcome measures and a poor understanding of these outcomes in the world at large. The heterogeneity of the disease itself coupled to superimposition of variegated background polypharmacy has created enough immunological noise to virtually ensure the failure of lupus treatment trials, leaving an understandable suspicion that at least some of the results in testing failed drugs over the years may not have been negative, but merely uninterpretable. The authors have consulted with many clinical trial investigators, biopharmaceutical developers and stakeholders from government and voluntary sectors. This paper examines the available evidence that supports workable trial designs and proposes approaches to improve the odds of completing interpretable treatment development programs for lupus.
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Affiliation(s)
- Joan T Merrill
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Susan Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Cynthia Aranow
- Autoimmune and Musculoskeletal Disease, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Anca Askanase
- Columbia University Medical Center, New York City, New York, USA
| | - Ian Bruce
- University of Manchester, Manchester, England, UK
| | - Eliza Chakravarty
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Ben Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karen Costenbader
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Ellen Ginzler
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Leslie Hanrahan
- Research and Education, Lupus Foundation of America, Washington, District of Columbia, USA
| | - Ken Kalunian
- Rheumatology, University of California, San Diego, San Diego, USA
| | - Joseph Merola
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sandra Raymond
- Lupus Foundation of America, Washington, District of Columbia, USA
| | - Brad Rovin
- Internal Medicine/Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amit Saxena
- Rheumatology, New York University, New York City, New York, USA
| | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Elfving P, Puolakka K, Rantalaiho V, Kautiainen H, Virta LJ, Kaipiainen-Seppänen O. Impact of early systemic lupus erythematosus on work disability-results from the Finnish nationwide register 2000-2007. Clin Rheumatol 2018. [PMID: 29541950 DOI: 10.1007/s10067-018-4066-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives of this study were to examine work disability (WD) and its leading causes in incident SLE patients. Data were derived from the Finnish nationwide registries to identify all non-retired, 18 to 64-year-old incident SLE patients between 2000 and 2007. Sick benefits and WD pensions and the causes for them were monitored until the end of 2008. A total of 446 working-aged, incident SLE patients available for work force (mean age 42 ± 13 years, 89% females) were found. During the follow-up (median 5.3 years), WD pension was granted to 27 patients. The most common cause was SLE itself (14 patients, 52%), with cumulative incidence of 3.4% (95% CI 1.9 to 5.8) in 5 years and 5.0% (95% CI 3.0 to 8.5) in 8 years, followed by musculoskeletal and psychiatric causes. The age- and sex- adjusted incidence ratio for WD pension in SLE patients due to any cause was 5.4 (95% CI 3.7 to 7.9) compared to the Finnish population. The mean number of WD days was 32 (95% CI 28 to 35) per patient-year among all SLE patients during the follow-up. The study concludes that SLE patients have an increased risk for WD already in early course of the disease.
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Affiliation(s)
- Pia Elfving
- Department of Medicine, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Kuopio, Finland.
| | - Kari Puolakka
- Department of Medicine, South Karelia Central Hospital, Valto Käkelän katu 1, 53130, Lappeenranta, Finland
| | - Vappu Rantalaiho
- Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Teiskontie 35, 33521, Tampere, Finland
- School of Medicine, University of Tampere, Kalevantie 4, 33100, Tampere, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Helsinki University Central Hospital, P.O. Box 100, 00029 HUS, Helsinki, Finland
- Department of General Practice, University of Helsinki, Helsingin yliopisto, P.O. Box 3, 00014, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Kuopio, Finland
| | - Lauri J Virta
- Research Department, Social Insurance Institution, Peltolantie 3, 20720, Turku, Finland
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23
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Buji RI, Abdul Murad NA, Chan LF, Maniam T, Mohd Shahrir MS, Rozita M, Shamsul AS, Mohamad Hussain R, Abdullah N, Jamal R, Nik Jaafar NR. Suicidal ideation in systemic lupus erythematosus: NR2A gene polymorphism, clinical and psychosocial factors. Lupus 2017; 27:744-752. [PMID: 29161964 DOI: 10.1177/0961203317742711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Systemic lupus erythematosus (SLE) patients are a high-risk population for suicide. Glutamatergic neurosystem genes have been implicated in the neurobiology of depression in SLE and suicidal behaviour in general. However, the role of glutamate receptor gene polymorphisms in suicidal behaviour among SLE patients remains unclear in the context of established clinical and psychosocial factors. We aimed to investigate the association of NR2A gene polymorphism with suicidal ideation in SLE while accounting for the interaction between clinical and psychosocial factors. Methods A total of 130 SLE patients were assessed for mood disorders (MINI International Neuropsychiatric Interview), severity of depression (Patient Health Questionnaire-9), suicidal behaviour (Columbia-Suicide Severity Rating Scale), socio-occupational functioning (Work and Social Adjustment Scale), recent life events (Social Readjustment Rating Scale) and lupus disease activity (SELENA-SLE Disease Activity Index). Eighty-six out of the 130 study participants consented for NR2A genotyping. Results Multivariable logistic regression showed nominal significance for the interaction effect between the NR2A rs2072450 AC genotype and higher severity of socio-occupational impairment with lifetime suicidal ideation in SLE patients ( p = 0.038, odds ratio = 1.364, 95% confidence interval = 1.018-1.827). However, only the association between lifetime mood disorder and lifetime suicidal ideation remained significant after Bonferroni correction ( p < 0.001, odds ratio = 33.834, 95% confidence interval = 7.624-150.138). Conclusions Lifetime mood disorder emerged as a more significant factor for suicidal ideation in SLE compared with NR2A gene polymorphism main and interaction effects. Clinical implications include identification and treatment of mood disorders as an early intervention for suicidal behaviour in SLE. More adequately-powered gene-environment interaction studies are required in the future to clarify the role of glutamate receptor gene polymorphisms in the risk stratification of suicidal behaviour among SLE patients.
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Affiliation(s)
- R I Buji
- 1 Hospital Mesra Bukit Padang, Kota Kinabalu, Sabah, Malaysia
| | - N A Abdul Murad
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia
| | - L F Chan
- 3 Department of Psychiatry, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - T Maniam
- 3 Department of Psychiatry, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.,7 Mind Faculty, Mont Kiara, Kuala Lumpur, Malaysia
| | - M S Mohd Shahrir
- 4 Department of Medicine, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - M Rozita
- 4 Department of Medicine, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - A S Shamsul
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia.,5 Department of Community Health, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - R Mohamad Hussain
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia
| | - N Abdullah
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia
| | - R Jamal
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia.,6 Department of Pediatrics, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - N R Nik Jaafar
- 3 Department of Psychiatry, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
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25
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McCormick N, Reimer K, Famouri A, Marra CA, Aviña-Zubieta JA. Filling the gaps in SARDs research: collection and linkage of administrative health data and self-reported survey data for a general population-based cohort of individuals with and without diagnoses of systemic autoimmune rheumatic disease (SARDs) from British Columbia, Canada. BMJ Open 2017; 7:e013977. [PMID: 28637725 PMCID: PMC5541381 DOI: 10.1136/bmjopen-2016-013977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Systemic autoimmune rheumatic diseases (SARDs) are a group of debilitating autoimmune diseases, including systemic lupus erythematosus and related disorders. Assessing the healthcare and economic burden of SARDs has been challenging: while administrative databases can be used to determine healthcare utilisation and costs with minimal selection and recall bias, other health, sociodemographic and economic data have typically been sourced from highly selected, clinic-based cohorts. To address these gaps, we are collecting self-reported survey data from a general population-based cohort of individuals with and without SARDs and linking it to their longitudinal administrative health data. PARTICIPANTS Using administrative data from the province of British Columbia (BC), Canada, we established a population-based cohort of all BC adults receiving care for SARDs during 1996-2010 (n=20 729) and non-SARD individuals randomly selected from the general population. BC Ministry of Health granted us contact information for 12 000 SARD and non-SARD individuals, who were recruited to complete the surveys by mail or online. FINDINGS TO DATE Four hundred individuals were initially invited to participate, with 135 (34%) consenting and 127 (94%) submitting the first survey (72% completed online). Sixty-three (49.6%) reported ≥1 SARD diagnosis. The non-SARDs group (n=64) was 92% female with mean age 57.0±11.6 years. The SARDs group (n=63) was 94% female with mean age 56.5±13.1 years. Forty-eight per cent of those with SARDs were current-or-former smokers (mean 10.6±16.2 pack-years), and 33% were overweight or obese (mean body mass index of 24.4±5.3). FUTURE PLANS Health and productivity data collected from the surveys will be linked to participants' administrative health data from the years 1990-2013, allowing us to determine the healthcare and lost productivity costs of SARDs, and assess the impact of patient-reported variables on utilisation, costs, disability and clinical outcomes. Findings will be disseminated through scientific conferences and peer-reviewed journals.
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Affiliation(s)
- Natalie McCormick
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Richmond, Canada
| | - Kathryn Reimer
- Arthritis Research Canada, Richmond, Canada
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | | | - Carlo A Marra
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Richmond, Canada
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - J. Antonio Aviña-Zubieta
- Arthritis Research Canada, Richmond, Canada
- Division of Rheumatology, Department of Medicine, The University of British Columbia, Vancouver, Canada
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26
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Affiliation(s)
- Luis Alonso González
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Graciela S. Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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27
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Devilliers H, Vernier N, Muller G, Turcu A, Samson M, Bielefeld P, Besancenot JF. [Quality of life measures in SLE: An update]. Rev Med Interne 2017; 39:107-116. [PMID: 28457682 DOI: 10.1016/j.revmed.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 02/28/2017] [Accepted: 03/04/2017] [Indexed: 12/20/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic disease that considerably hampers patient's daily living. Qualitative studies with patients' interviews have been conducted to describe the experiences and perspectives of adults living with SLE. Among existing generic and disease-specific quality of life (QOL) questionnaires, none succeeded to exhaustively measure patient's preoccupations. However, these tools are useful to quantify the burden of the disease. Social precariousness, socioeconomic status and education level are intimately correlated to QOL measures, either generic or disease-specific. Musculoskeletal disease activity is also associated with a lower QOL. Using disease-specific tools may be useful because of a better aptitude to record an improvement in health status. Moreover, using generic and disease-specific questionnaires together may help to identify factors associated with a lower quality of life but not related to SLE from the patient's perspective (such as smoking or obesity). Developing new ways of recording QOL data in the future may help to evaluate the real benefit of using QOL scales in daily practice.
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Affiliation(s)
- H Devilliers
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France.
| | - N Vernier
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - G Muller
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - A Turcu
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - M Samson
- Service de médecine interne et immunologie clinique (médecine interne 1), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon, France
| | - P Bielefeld
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - J-F Besancenot
- Service de médecine interne et maladies systémiques (médecine interne 2), hôpital François-Mitterrand, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
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28
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Kent T, Davidson A, Newman D, Buck G, D'Cruz D. Burden of illness in systemic lupus erythematosus: results from a UK patient and carer online survey. Lupus 2017; 26:1095-1100. [PMID: 28406053 DOI: 10.1177/0961203317698594] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The objective of this study was to assess the impact of systemic lupus erythematosus (SLE) on patients and carers. Methods Adults with SLE and carers of SLE patients completed a UK-specific online survey covering many aspects of the disease. Surveys were developed in collaboration with an NHS lupus unit and a lupus patient organization. Results A total of 121 patients and 31 carers completed the surveys. Of the 70% of patients initially misdiagnosed with another condition, 59% received treatment for the misdiagnosis. Fatigue was the most debilitating symptom, experienced daily by 79% of patients. The proportion of patients not reporting flares to healthcare providers varied with flare severity: mild flares (43%), moderate flares (15%) and severe flares (5%). Most patients (89%) reported reduced ability to socialize, and 76% had changed employment; of these, 52% stopped working completely. Over one-half (52%) of carers in paid employment missed time from work, and 55% of carers reported a worsened financial status. Most carers (87%) experienced interference with social activities. Conclusion SLE is commonly misdiagnosed and has a considerable impact on the physical, social and financial status of patients and carers. Increased awareness of the disease among healthcare providers and employers of patients and their carers is needed.
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Affiliation(s)
- T Kent
- 1 Eli Lilly and Company, UK
| | - A Davidson
- 2 St Thomas' Lupus Trust, Guy's Hospital, UK
| | | | - G Buck
- 1 Eli Lilly and Company, UK.,3 Cello Health Insight, UK
| | - D D'Cruz
- 4 Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, UK
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29
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Xie X, Wu D, Chen H. Prevalence and risk factors of anxiety and depression in patients with systemic lupus erythematosus in Southwest China. Rheumatol Int 2016; 36:1705-1710. [PMID: 27580610 DOI: 10.1007/s00296-016-3559-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/25/2016] [Indexed: 02/05/2023]
Abstract
Systemic lupus erythematosus (SLE) patients have high risk for anxiety and depression. We aimed to investigate the prevalence and risk factors of anxiety and depression in SLE patients in Southwest China. Participants were recruited by convenience sampling from Rheumatic Outpatient Clinic of West China Hospital Sichuan University between August and October 2014. The prevalence of anxiety and depression was evaluated using Hospital Anxiety and Depression Scale (HADS). Risk factors were explored by multiple logistic regression analyses. A total of 352 participants were enrolled, of who 64 (18.2 %) met the HADS criteria for anxiety and 82 (23.3 %) for depression. In multivariable analysis, higher levels of pain (OR = 1.17, P = 0.02) and fatigue (OR = 1.19, P < 0.01) predicted a higher risk of anxiety. Similarly, a higher level of fatigue (OR = 1.2, P < 0.01) was associated with a higher risk of depression. The results suggest that anxiety and depression are common in patients with SLE in Southwest China. Health care providers and SLE patients should take some measures to cope with them as early as possible. Strengthening management of pain and fatigue may be useful. But further studies are needed to verify these findings.
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Affiliation(s)
- Xia Xie
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Dongmei Wu
- Pain Management Ward of West China Hospital, Sichuan University, Chengdu, China
| | - Hong Chen
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China.
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30
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Carter EE, Barr SG, Clarke AE. The global burden of SLE: prevalence, health disparities and socioeconomic impact. Nat Rev Rheumatol 2016; 12:605-20. [PMID: 27558659 DOI: 10.1038/nrrheum.2016.137] [Citation(s) in RCA: 290] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can potentially lead to serious organ complications and even death. Its global burden - in terms of incidence and prevalence, differential impact on populations, economic costs and capacity to compromise health-related quality of life - remains incompletely understood. The reported worldwide incidence and prevalence of SLE vary considerably; this variation is probably attributable to a variety of factors, including ethnic and geographic differences in the populations being studied, the definition of SLE applied, and the methods of case identification. Despite the heterogeneous nature of the disease, distinct patterns of disease presentation, severity and course can often be related to differences in ethnicity, income level, education, health insurance status, level of social support and medication compliance, as well as environmental and occupational factors. Given the potential for the disease to cause such severe and widespread organ damage, not only are the attendant direct costs high, but these costs are sometimes exceeded by indirect costs owing to loss of economic productivity. As an intangible cost, patients with SLE are, not surprisingly, likely to endure considerably reduced health-related quality of life.
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Affiliation(s)
- Erin E Carter
- University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road S.W., Calgary, Alberta T2T 5C7, Canada
| | - Susan G Barr
- University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road S.W., Calgary, Alberta T2T 5C7, Canada
| | - Ann E Clarke
- University of Calgary, Health Research Innovation Centre, 3280 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada
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31
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Al Dhanhani AM, Gignac MAM, Beaton DE, Su J, Fortin PR. Job Accommodations Availability and Utilization Among People With Lupus: An Examination of Workplace Activity Limitations and Work Context Factors. Arthritis Care Res (Hoboken) 2016. [PMID: 26214148 DOI: 10.1002/acr.22662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to examine the availability of diverse job accommodations (or flexible working arrangements) and to describe their use among people with systemic lupus erythematosus (lupus), as well as to examine factors associated with the use of job accommodations. METHODS A mail survey was sent to adult lupus patients receiving care from a lupus clinic based in Toronto, Canada. The survey assessed demographic information, self-reported disease activity, work history, workplace activity limitations, job strain, and the availability and use of job accommodations. Standard multivariable linear regression analysis was used to examine factors associated with the use of job accommodations. RESULTS We received 362 responses of 604 mailed surveys (60% response rate). Participants who were employed within the last 5 years, but who were not currently working, were less likely than currently employed participants to report having had job accommodations available to them at their last place of employment. The use of job accommodations was reported by 70% of currently employed respondents and by 72% of those not currently employed. The most common job accommodation used was sick leave days. Factors positively associated with the use of job accommodations among those who were employed included higher levels of education, being diagnosed with fibromyalgia, at least 1 episode of short-term work disability, not belonging to a union, greater workplace activity limitations, and greater job strain. CONCLUSION The use of job accommodations among people with lupus is common. Work context factors, such as workplace activity limitations and job strain, are the main factors associated with the use of job accommodations.
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Affiliation(s)
- Ali M Al Dhanhani
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Monique A M Gignac
- Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada
| | - Dorcas E Beaton
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Jiandong Su
- Toronto Western Research Institute and University Health Network, Toronto, Ontario, Canada
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Felsenstein S, Reiff AO, Ramanathan A. Transition of Care and Health-Related Outcomes in Pediatric-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2015; 67:1521-8. [DOI: 10.1002/acr.22611] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | - Andreas O. Reiff
- Children's Hospital Los Angeles and the Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Anusha Ramanathan
- Children's Hospital Los Angeles and the Keck School of Medicine of the University of Southern California; Los Angeles California
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33
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Schneider M, Haupt M. [Overcoming disease in systemic lupus erythematosus]. Z Rheumatol 2015; 74:591-6. [PMID: 26286190 DOI: 10.1007/s00393-014-1556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease affecting a broad range of different organ systems and, hence, presenting with multiple symptomatic domains, which considerably reduces the quality of life of patients. Within the last decade the prognosis of the disease has been significantly improved by novel therapies and intensive monitoring; however, non-pharmaceutical strategies for symptom control, self-efficacy and coping abilities for those affected are still insufficiently established. OBJECTIVE This article describes the possibilities and limitations of non-pharmaceutical strategies and makes suggestions for future treatment and research. RESULTS Preliminary interventional studies using psychoeducational, psychosocial and behavioral psychotherapeutic approaches, have consistently shown that the needs and expectations of patients related to help and support by doctors and professional care can be adequately and sustainably met. In addition, coping abilities and the quality of life can be increased.
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Affiliation(s)
- M Schneider
- Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland,
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Furukawa M, Kiyohara C, Horiuchi T, Tsukamoto H, Mitoma H, Kimoto Y, Uchino A, Nakagawa M, Oryoji K, Shimoda T, Akashi K. Quality of life in Japanese female patients with systemic lupus erythematosus: Evaluation using the Short Form 36 Health Survey. Mod Rheumatol 2015; 26:240-7. [PMID: 26054420 DOI: 10.3109/14397595.2015.1060668] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/08/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Aspects of health-related quality of life (HRQoL) are important for assessing perceived health status and treatment burden. We evaluated HRQoL using Short Form 36 Health Survey (SF-36) and factors associated with HRQoL. METHODS We collected basic and lifestyle-related, clinical, and treatment characteristics among 119 female Japanese patients with systemic lupus erythematosus (SLE). Odds ratios (ORs) and their 95% confidence intervals were assessed for associations between HRQoL and selected factors. RESULTS Irregularity of sleep was significantly associated with risk of lower role physical (RP) (OR = 8.27), vitality (VT) (OR = 8.45), and role emotional (OR = 10.7) domains. Compared with clerical work, non-clerical work was significantly associated with risk of lower RP (OR = 7.39), and unemployment was significantly associated with risk of lower VT (OR = 41.0). Daily soybean intake was associated with improved General Health or GH (OR = 0.17). Compared with Systemic Lupus Collaborative Clinics Damage Index (SDI) = 0, SDI > 2 was associated with risk of lower PF (OR = 7.88), RP (OR = 4.29), and bodily pain (OR = 3.06) domains. CONCLUSION Reduced HRQoL was observed in our SLE patients. Interventions addressing sleep and work disturbances, as well as daily soybean consumption, could alter the HRQoL of SLE patients.
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Affiliation(s)
- Makio Furukawa
- a Department of Medicine and Biosystemic Science , Kyushu University , Fukuoka , Japan
| | - Chikako Kiyohara
- b Department of Preventive Medicine , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Takahiko Horiuchi
- c Department of Internal Medicine , Kyushu University Beppu Hospital , Oita , Japan 4 Department of Clinical Reserch , Fukuoka National Hospital , Fukuoka , Japan
| | - Hiroshi Tsukamoto
- a Department of Medicine and Biosystemic Science , Kyushu University , Fukuoka , Japan
| | - Hiroki Mitoma
- a Department of Medicine and Biosystemic Science , Kyushu University , Fukuoka , Japan
| | - Yasutaka Kimoto
- a Department of Medicine and Biosystemic Science , Kyushu University , Fukuoka , Japan
| | - Ayumi Uchino
- a Department of Medicine and Biosystemic Science , Kyushu University , Fukuoka , Japan
| | - Misato Nakagawa
- a Department of Medicine and Biosystemic Science , Kyushu University , Fukuoka , Japan
| | - Kensuke Oryoji
- a Department of Medicine and Biosystemic Science , Kyushu University , Fukuoka , Japan
| | - Terufumi Shimoda
- c Department of Internal Medicine , Kyushu University Beppu Hospital , Oita , Japan 4 Department of Clinical Reserch , Fukuoka National Hospital , Fukuoka , Japan
| | - Koichi Akashi
- a Department of Medicine and Biosystemic Science , Kyushu University , Fukuoka , Japan
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Utset TO, Baskaran A, Segal BM, Trupin L, Ogale S, Herberich E, Kalunian K. Work disability, lost productivity and associated risk factors in patients diagnosed with systemic lupus erythematosus. Lupus Sci Med 2015; 2:e000058. [PMID: 25632349 PMCID: PMC4305073 DOI: 10.1136/lupus-2014-000058] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/14/2014] [Accepted: 12/10/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess prevalence and correlates of work presenteeism, absenteeism and work disability (WD) in patients with systemic lupus erythematous (SLE) and matched controls. METHODS Patients with SLE from six medical centres were recruited to complete a questionnaire consisting of several prevalidated survey instruments. The subject's rheumatologist completed medical history. Subjects recruited two non-SLE 'best friend' controls with matching demographics to complete a control survey. Analyses employed Student's t tests, χ(2) tests and logistic regression models. RESULTS 344 subjects with SLE and 322 controls submitted completed questionnaires. Mean pain, fatigue, Brief Cognitive Symptoms Index (BCSI) scores and depressive symptoms were worse in patients with SLE with WD (all p<0.01). WD was associated with African-American race, older age (51-65 years) and less than 4-year college education (all p<0.01). High presenteeism was associated with low pain and fatigue levels, higher BCSI scores and negatively correlated with depressive symptoms (all p<0.05). Increased pain and fatigue were associated with elevated absenteeism (p<0.05). Subjects with physically and cognitively demanding work reported worse presenteeism compared with controls with similar jobs (77% vs 85%, p<0.05 and 75% vs 85%, p<0.001), respectively. Patients with most cognitively demanding jobs reported greater weekly absenteeism (mean, 5.9 h) compared with controls (mean, 6.9 overtime hours, p<0.05). CONCLUSIONS The questionnaire demonstrated increased WD in SLE. Highly physical and highly cognitive jobs are challenging to patients with SLE and had increased absenteeism compared with controls. Depressive symptoms were correlated with better presenteeism without major socio-demographic determinants. Employability may be enhanced by improving treatment of depressive symptoms in patients with SLE.
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Affiliation(s)
- Tammy O Utset
- Department of Medicine/Rheumatology, University of Chicago, Chicago, Illinois, USA
| | - Amrutha Baskaran
- Department of Medicine/Rheumatology, University of California San Diego, La Jolla, California, USA
| | - Barbara M Segal
- Department of Medicine/Rheumatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura Trupin
- Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Sarika Ogale
- Department of Medicine/Rheumatology, Genentech, South San Francisco, California, USA
| | | | - Kenneth Kalunian
- Department of Medicine/Rheumatology, University of California San Diego, La Jolla, California, USA
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Albrecht K, Huscher D, Richter J, Backhaus M, Bischoff S, Kötter I, Thiele K, Zink A. Changes in referral, treatment and outcomes in patients with systemic lupus erythematosus in Germany in the 1990s and the 2000s. Lupus Sci Med 2014; 1:e000059. [PMID: 25553251 PMCID: PMC4271412 DOI: 10.1136/lupus-2014-000059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/22/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Abstract
Objective To evaluate trends in the referral, treatment and outcome of patients with systemic lupus erythematosus (SLE) in Germany over two decades. Methods From 1993 to 2012, ∼1200 patients with SLE were recorded annually in the national database of the German Collaborative Arthritis Centres. Treatment patterns, healthcare use and outcomes, such as disease activity, function and work participation, were evaluated over time. Furthermore, two distinct cohorts of patients (enrolment 1994–1998, n=467; and 2004–2008, n=376) observed over 5 years were assessed for changes in outcomes. Results The mean disease duration at the first visit to a rheumatologist decreased from 2.6 (1994) to 1.5 (2012) years. Glucocorticoids (69%), antimalarials (56%), azathioprine (22%), non-steroidal anti-inflammatory drugs (23%) and mycophenolate mofetil (15%) were the most frequently used treatments in 2012. A significant increase was observed in the use of antimalarials and mycophenolate mofetil. The use of glucocorticoids at >7.5 mg/day decreased from 27% (1994) to 10% (2012). The average length of sick leave taken due to SLE declined from 9 weeks (1997) to 6 weeks (2012). When comparing the two longitudinal cohorts, in the cohort from the 2000s, the intraindividual decline of disease activity was significantly stronger (p<0.001), and fewer patients retired early (36% vs 46%). Conclusions The disease activity and resource use declined considerably over the observation period, and more patients remained in the labour force. Earlier treatment onset, faster modification of the treatment regimen and more intensive use of anti-inflammatory therapy may account for the improved outcomes in patients with SLE across the years.
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Affiliation(s)
- Katinka Albrecht
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute, Berlin , Germany
| | - Dörte Huscher
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute, Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital , Berlin , Germany
| | - Jutta Richter
- Department of Rheumatology , Heinrich-Heine-University Duesseldorf , Duesseldorf , Germany
| | - Marina Backhaus
- Department of Rheumatology and Clinical Immunology , Charité University Hospital , Berlin , Germany
| | - Sascha Bischoff
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute, Berlin , Germany
| | - Ina Kötter
- Department of Rheumatology , Robert-Bosch Hospital , Stuttgart , Germany
| | - Katja Thiele
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute, Berlin , Germany
| | - Angela Zink
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute, Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital , Berlin , Germany
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Jugrin AV, Sun Y, Cox F. The Economic Burden of Systemic Lupus Erythematosus: A Structured Literature Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A529. [PMID: 27201677 DOI: 10.1016/j.jval.2014.08.1675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A V Jugrin
- IMS Health RWE Solutions and HEOR, Vilvoorde, Belgium
| | - Y Sun
- UCB Pharma, Brussels, Belgium
| | - F Cox
- UCB Pharma, Smyrna, GA, USA
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Huang X, Magder LS, Petri M. Predictors of incident depression in systemic lupus erythematosus. J Rheumatol 2014; 41:1823-33. [PMID: 25128512 DOI: 10.3899/jrheum.140111] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Findings from previous studies of predictors of depression among patients with systemic lupus erythematosus (SLE) have been inconsistent. The aim of our study was to identify risk factors that preceded incident depression based on a large, closely followed longitudinal cohort. METHODS Data regarding 1609 patients with SLE in the Hopkins Lupus Cohort who had no history of depression prior to cohort entry were analyzed. Demographic variables, SLE manifestations, laboratory tests, physician's global assessment, Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI), cumulative organ damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), and onset of depression were recorded at enrollment and each quarterly visit. Rates of incident depression were calculated overall, and in subgroups defined by demographic and clinical variables. Adjusted estimates of association were derived using pooled logistic regression. RESULTS The incidence of depression was 29.7 episodes per 1000 person-years. In the multivariable analysis, these variables remained as independent predictors of incident depression: recent SLE diagnosis, non-Asian ethnicity, disability, cutaneous activity, longitudinal myelitis, and current prednisone use of 20 mg/day or higher. Global disease activity (SELENA-SLEDAI) was not a significant predictor after controlling for prednisone use. CONCLUSION Depression in SLE is multifactorial. Higher-dose prednisone (≥ 20 mg daily) is 1 important independent risk factor. Global disease activity is not a risk factor, but cutaneous activity and certain types of neurologic activity (myelitis) are predictive of depression. The independent effect of prednisone provides clinicians with an additional incentive to avoid and reduce high-dose prednisone exposure in SLE.
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Affiliation(s)
- Xiangyang Huang
- From the Sichuan University School of Medicine, West China Hospital, Chengdu, Sichuan, China; Department of Rheumatology, Johns Hopkins University School of Medicine; University of Maryland, Baltimore, Maryland, USA.X. Huang, MD, PhD, Associate Professor, Division of Rheumatology, Johns Hopkins University School of Medicine, and the Department of Rheumatology, Sichuan University School of Medicine, West China Hospital; L.S. Magder, MPH, PhD, Professor of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, MD, MPH, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Laurence S Magder
- From the Sichuan University School of Medicine, West China Hospital, Chengdu, Sichuan, China; Department of Rheumatology, Johns Hopkins University School of Medicine; University of Maryland, Baltimore, Maryland, USA.X. Huang, MD, PhD, Associate Professor, Division of Rheumatology, Johns Hopkins University School of Medicine, and the Department of Rheumatology, Sichuan University School of Medicine, West China Hospital; L.S. Magder, MPH, PhD, Professor of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, MD, MPH, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Michelle Petri
- From the Sichuan University School of Medicine, West China Hospital, Chengdu, Sichuan, China; Department of Rheumatology, Johns Hopkins University School of Medicine; University of Maryland, Baltimore, Maryland, USA.X. Huang, MD, PhD, Associate Professor, Division of Rheumatology, Johns Hopkins University School of Medicine, and the Department of Rheumatology, Sichuan University School of Medicine, West China Hospital; L.S. Magder, MPH, PhD, Professor of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, MD, MPH, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine.
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Drenkard C, Bao G, Dennis G, Kan HJ, Jhingran PM, Molta CT, Lim SS. Burden of systemic lupus erythematosus on employment and work productivity: data from a large cohort in the southeastern United States. Arthritis Care Res (Hoboken) 2014; 66:878-87. [PMID: 24339382 DOI: 10.1002/acr.22245] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 11/26/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To examine the burden of systemic lupus erythematosus (SLE) on work loss, unemployment, and work productivity impairment in an SLE cohort from the southeastern US. METHODS We examined 689 SLE patients ages 18-64 years from the Georgians Organized Against Lupus (GOAL) cohort. GOAL is a longitudinal cohort predominantly derived from the Georgia Lupus Registry, a population-based registry established in metropolitan Atlanta. We used the Kaplan-Meier method to assess the proportion of patients who self-reported work loss since diagnosis. We compared unemployment between SLE patients and the general population from the same geographic area, calculating the standardized unemployment ratio (SUR) within demographic and disease strata. We also calculated the percentage of work productivity impairment by disease outcomes. RESULTS Of 511 patients employed at diagnosis, 249 (49%) experienced work loss within an average disease duration of 13 years. The proportion of patients who lost their jobs since diagnosis was almost twice for African Americans than for whites. However, the SURs were similar across demographic characteristics, including race. Patients with severe disease activity and severe organ damage had the highest SUR at 4.4 and 5.6, respectively. Among those that remained employed, patients with severe fatigue, neurocognitive symptoms, and musculoskeletal symptoms had the highest impairment of work productivity. CONCLUSION SLE imposes a substantial toll on individuals and burden on society. Major factors that negatively impact work outcomes are fatigue, disease activity, and organ damage. More effective treatments along with coping strategies at the workplace are needed to reduce the burden of SLE on work outcomes.
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Drenkard C, Yazdany J, Trupin L, Katz PP, Dunlop-Thomas C, Bao G, Lim SS. Validity of a self-administered version of the brief index of lupus damage in a predominantly African American systemic lupus erythematosus cohort. Arthritis Care Res (Hoboken) 2014; 66:888-96. [PMID: 24249662 DOI: 10.1002/acr.22231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/05/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the reliability and criterion and construct validity of the self-administered Brief Index of Lupus Damage (SA-BILD), a patient-reported measure of organ damage in systemic lupus erythematosus (SLE). METHODS The validity of the SA-BILD was assessed using data from the Georgians Organized Against Lupus (GOAL) survey. GOAL is a longitudinal cohort of SLE patients predominantly derived from the Georgia Lupus Registry, a population-based registry established in Atlanta, Georgia. In total, 711 participants with documented SLE completed the SA-BILD. To test reliability, the SA-BILD was readministered to 32 patients. Criterion validity was examined in 150 respondents for whom the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) was also completed. Construct validity was assessed among 711 GOAL participants by dividing the SA-BILD scores into quartiles and examining the association with demographics, health status, and health care utilization. RESULTS The test-retest correlation score was 0.93 (P < 0.0001), the item-by-item agreement with the SDI was >80% for most SA-BILD items, and the Spearman's rho correlation coefficient for the SDI and SA-BILD was moderately high (ρ = 0.59, P < 0.0001). SA-BILD scores showed significant associations in the expected directions with age, disease duration, disease activity, overall health, comorbidity index, and physician visits. CONCLUSION The SA-BILD was reliable and had very good or good criterion validity compared with the SDI when tested in a predominantly African American cohort of US SLE patients. Associations of SA-BILD scores with sociodemographics and health status were consistent with previous studies. These findings support the use of the SA-BILD as a valid measure of patient-reported damage in SLE.
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Connolly D, McNally A, Moran D, Ryan M. Fatigue in Systemic Lupus Erythematosus: Impact on Occupational Participation and Reported Management Strategies. Br J Occup Ther 2014. [DOI: 10.4276/030802214x14044755581862] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Deirdre Connolly
- Lecturer, Trinity College Dublin, Occupational Therapy, St James' Hospital, Dublin, Ireland
| | - Aine McNally
- Occupational Therapist, St James' Hospital, Dublin, Ireland
| | - Deirdre Moran
- Occupational Therapist, Our Lady's Hospice and Care Services, Occupational Therapy, Dublin, Ireland
| | - Margaret Ryan
- Occupational Therapist, Enable Ireland, Co. Meath, Ireland
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Al Dhanhani AM, Gignac MAM, Beaton DE, Su J, Fortin PR. Work factors are associated with workplace activity limitations in systemic lupus erythematosus. Rheumatology (Oxford) 2014; 53:2044-52. [PMID: 24917563 DOI: 10.1093/rheumatology/keu242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine the extent of workplace activity limitations among persons with lupus and to identify factors associated with activity limitations among those employed. METHODS We conducted a cross-sectional study using a mailed survey and clinical data of persons with lupus who attended a large lupus outpatient clinic. Data were collected on demographics, health, work factors and psychosocial measures. The workplace activity limitations scale (WALS) was used to measure difficulty related to different activities at work. Multivariable analysis examined the association of health, work context, psychosocial and demographic variables with workplace activity limitations. RESULTS We received 362 responses from 604 (60%) mailed surveys. Among those not employed, 52% reported not working because of lupus. A range of physical and mental tasks were reported as difficult. Each of the physical, cognitive and energy work activities was cited as difficult by more than one-third of participants. Among employed participants, 40% had medium to high WALS difficulty scores. In the multivariable analysis, factors significantly associated with workplace activity limitations were older age, greater disease activity, fatigue, poorer health status measured by the 36-item Short Form Health Survey, lower job control, greater job strain and working more than 40 h/week. CONCLUSION People with lupus experience limitations and difficulty at work. Determinants of workplace activity limitations are mainly those related to workplace and health factors.
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Affiliation(s)
- Ali M Al Dhanhani
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates, Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute for Health Policy, Management & Evaluation, University of Toronto, Centre for Prognostic Studies in the Rheumatic Diseases, Division of Rheumatology, Department of Medicine, University Health Network, Toronto, Centre de recherche du CHU de Québec, Division de Rhumatologie, Département de Médicine and Département de Médecine, Université Laval, Québec, Canada
| | - Monique A M Gignac
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates, Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute for Health Policy, Management & Evaluation, University of Toronto, Centre for Prognostic Studies in the Rheumatic Diseases, Division of Rheumatology, Department of Medicine, University Health Network, Toronto, Centre de recherche du CHU de Québec, Division de Rhumatologie, Département de Médicine and Département de Médecine, Université Laval, Québec, Canada Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates, Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute for Health Policy, Management & Evaluation, University of Toronto, Centre for Prognostic Studies in the Rheumatic Diseases, Division of Rheumatology, Department of Medicine, University Health Network, Toronto, Centre de recherche du CHU de Québec, Division de Rhumatologie, Département de Médicine and Département de Médecine, Université Laval, Québec, Canada Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates, Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute for Health Poli
| | - Dorcas E Beaton
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates, Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute for Health Policy, Management & Evaluation, University of Toronto, Centre for Prognostic Studies in the Rheumatic Diseases, Division of Rheumatology, Department of Medicine, University Health Network, Toronto, Centre de recherche du CHU de Québec, Division de Rhumatologie, Département de Médicine and Département de Médecine, Université Laval, Québec, Canada Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates, Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute for Health Policy, Management & Evaluation, University of Toronto, Centre for Prognostic Studies in the Rheumatic Diseases, Division of Rheumatology, Department of Medicine, University Health Network, Toronto, Centre de recherche du CHU de Québec, Division de Rhumatologie, Département de Médicine and Département de Médecine, Université Laval, Québec, Canada
| | - Jiandong Su
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates, Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute for Health Policy, Management & Evaluation, University of Toronto, Centre for Prognostic Studies in the Rheumatic Diseases, Division of Rheumatology, Department of Medicine, University Health Network, Toronto, Centre de recherche du CHU de Québec, Division de Rhumatologie, Département de Médicine and Département de Médecine, Université Laval, Québec, Canada
| | - Paul R Fortin
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates, Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute for Health Policy, Management & Evaluation, University of Toronto, Centre for Prognostic Studies in the Rheumatic Diseases, Division of Rheumatology, Department of Medicine, University Health Network, Toronto, Centre de recherche du CHU de Québec, Division de Rhumatologie, Département de Médicine and Département de Médecine, Université Laval, Québec, Canada Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates, Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute for Health Policy, Management & Evaluation, University of Toronto, Centre for Prognostic Studies in the Rheumatic Diseases, Division of Rheumatology, Department of Medicine, University Health Network, Toronto, Centre de recherche du CHU de Québec, Division de Rhumatologie, Département de Médicine and Département de Médecine, Université Laval, Québec, Canada Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates, Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Institute for Work and Health, Dalla Lana School of Public Health, University of Toronto, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute for Health Poli
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Impact of race and ethnicity in the course and outcome of systemic lupus erythematosus. Rheum Dis Clin North Am 2014; 40:433-54, vii-viii. [PMID: 25034155 DOI: 10.1016/j.rdc.2014.04.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Genetic factors seem to play a more important role early in the course of systemic lupus erythematosus (SLE), whereas nongenetic factors seem to play a more important role over the course of the disease. SLE is more frequent with less favorable outcomes in nonwhite populations. To overcome these differences and reduce the immediate-term, mediate-term, and long-term impact of SLE among disadvantaged populations, it is essential to increase disease awareness, to improve access to health care and to provide care to these patients in a consistent manner regardless of the severity of their disease.
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Squance ML, Guest M, Reeves G, Attia J, Bridgman H. Exploring lifetime occupational exposure and SLE flare: a patient-focussed pilot study. Lupus Sci Med 2014; 1:e000023. [PMID: 25379190 PMCID: PMC4213832 DOI: 10.1136/lupus-2014-000023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/19/2014] [Accepted: 04/22/2014] [Indexed: 01/02/2023]
Abstract
Introduction Environmental effectors, such as ultraviolet radiation exposure, infection and stress, have been established as having a role in exacerbating lupus symptoms. However, unpredictable patterns of flare events still remain a mystery. Occupational effectors have also been suggested as having a contributing role; however, they are not widely researched. In this paper we report a pilot study designed to generate focus areas for future research regarding occupational exposures and systemic lupus erythematosus (SLE). Methods The study explored potential links between exposures and the occurrence of patient-reported flare events in 80 Australian women with SLE (American College of Rheumatology (ACR) criteria classified). Specifically, the study assessed the hypothesis that occupational exposure is associated with significant changes in the likelihood of lupus flares. Lifetime employment history was analysed with the Finnish Job Exposure Matrix (FINJEM), 40 different semiquantified exposure class estimates for a wide number of occupations based on probability of exposure (p≥5%=exposed) were analysed with the construction of negative binomial regression models to test relationships between occupational agents and flare days. A backward stepwise elimination was used to generate a parsimonious model. Results Significant associations were noted for exposure classes of manual handling burden, (p=0.02, incidence rate ratio (IRR) 1.01), Iron (p=0.00, IRR 1.37), wood dust (p=0.00, IRR 3.34) and asbestos (p=0.03, IRR 2.48). Conclusion Exposure assessment results indicated that occupations, such as nursing, with a high manual handling burden, posed increased risk to patients with SLE, however, the greatest risk was associated with wood dust and iron exposure with teachers and specialist labourers.
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Affiliation(s)
- Marline L Squance
- Faculty of Health and Medicine , University of Newcastle , Callaghan, New South Wales , Australia ; Faculty of Science and Information Technology , University of Newcastle , Callaghan, New South Wales , Australia ; Autoimmune Resource and Research Centre , New Lambton, New South Wales , Australia ; Hunter New England Health District , New Lambton, New South Wales , Australia ; Hunter Medical Research Institute , Newcastle, New South Wales , Australia
| | - Maya Guest
- Faculty of Health and Medicine , University of Newcastle , Callaghan, New South Wales , Australia ; Hunter Medical Research Institute , Newcastle, New South Wales , Australia
| | - Glenn Reeves
- Faculty of Health and Medicine , University of Newcastle , Callaghan, New South Wales , Australia ; Autoimmune Resource and Research Centre , New Lambton, New South Wales , Australia ; Hunter New England Health District , New Lambton, New South Wales , Australia ; Hunter Medical Research Institute , Newcastle, New South Wales , Australia
| | - John Attia
- Faculty of Health and Medicine , University of Newcastle , Callaghan, New South Wales , Australia ; Hunter New England Health District , New Lambton, New South Wales , Australia ; Hunter Medical Research Institute , Newcastle, New South Wales , Australia
| | - Howard Bridgman
- Faculty of Science and Information Technology , University of Newcastle , Callaghan, New South Wales , Australia
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Faria DAP, Revoredo LS, Vilar MJ, Eulália Maria Chaves M. Resilience and treatment adhesion in patients with systemic lupus erythematosus. Open Rheumatol J 2014; 8:1-8. [PMID: 24665352 PMCID: PMC3963129 DOI: 10.2174/1874312920140127001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is a chronic autoimmune, rheumatic inflammatory disease that can cause significant morbidity with evident psychological impacts and obvious harm to quality-of-life that require the patient to adapt treatment. OBJECTIVE Assessment of resilience and the self-reported treatment adhesion behaviors of patients with SLE, investigating which of these factors are associated to resilience. METHOD Cross-sectional study of 40 women with SLE. A questionnaire with social demographic data, health history and the Wagnild Young Resilience Scale were used. RESULTS 62.5% followed the medical treatment properly but 55% found it difficult. 27.5% of the patients presented low resilience, 57.5% medium and 15% high resilience. Resilience was associated in the chi-square test (p-value < 0.05) with the variables work, understanding SLE, trying to find out about SLE, following the treatment correctly, difficulty in following the treatment and stopping some activity because of the disease. In the correlation analysis, resilience was associated with age (-0.3960), number of working hours (0.5533), specialized treatment duration (-0.8103) and disease duration from diagnosis (-0.8014). CONCLUSION Patients with high resilience tended to follow treatment correctly, tried to understand the disease and adhered more to the treatment to avoid risks and promote protection factors. Therefore knowledge of resilience in patients with SLE is necessary. It is important that the state takes necessary actions to facilitate access to treatment, to educational programs and to medical support. Awareness and counselling sessions must be initiated to develop and promote individual capacities to learn how to tackle with the disease for which psychological support of family and doctors can play a significant role.
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Affiliation(s)
- Daniella Antunes Pousa Faria
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal,
Brazil
| | - Luciana Silva Revoredo
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal,
Brazil
| | - Maria José Vilar
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal,
Brazil
| | - Maia Eulália Maria Chaves
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal,
Brazil
- Programa de Pós-Graduação em Psicologia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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Ugarte-Gil MF, Acevedo-Vásquez E, Alarcón GS, Pastor-Asurza CA, Alfaro-Lozano JL, Cucho-Venegas JM, Segami MI, Wojdyla D, Soriano ER, Drenkard C, Brenol JC, de Oliveira e Silva Montandon AC, Costallat LTL, Massardo L, Molina-Restrepo JF, Guibert-Toledano M, Silveira LH, Amigo MC, Barile-Fabris LA, Chacón-Díaz R, Esteva-Spinetti MH, Pons-Estel GJ, McGwin G, Pons-Estel BA. The number of flares patients experience impacts on damage accrual in systemic lupus erythematosus: data from a multiethnic Latin American cohort. Ann Rheum Dis 2014; 74:1019-23. [PMID: 24525909 DOI: 10.1136/annrheumdis-2013-204620] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 01/24/2014] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine the association between the number of flares systemic lupus erythematosus (SLE) patients experience and damage accrual, independently of other known risk factors. METHODS SLE patients (34 centres, nine Latin American countries) with a recent diagnosis (≤2 years) and ≥3 evaluations were studied. Disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and damage with the SLICC/ACR Damage Index (SDI). Flare was defined as an increase ≥4 points in the SLEDAI between two study visits. An ambidirectional case- crossover design was used to determine the association between the number of flares and damage accrual. RESULTS 901 patients were eligible for the study; 500 of them (55.5%) experienced at least one flare, being the mean number of flares 0.9 (SD: 1.0). 574 intervals from 251 patients were included in the case-crossover design since they have case and control intervals, whereas, the remaining patients did not. Their mean age at diagnosis was 27.9 years (SD: 11.1), 213 (84.9%) were women. The mean baseline SDI and SLEDAI were 1.3 (1.3) and 13.6 (8.1), respectively. Other features were comparable to those of the entire sample. After adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (SDI) OR 2.05, 95% CI 1.43 to 2.94, p<0.001 (OR 2.62, 95% CI 1.31 to 5.24, p=0.006 for severe and OR 1.91, 95% CI 1.28 to 2.83, p=0.001 for mild-moderate). CONCLUSIONS The number of flares patients experience, regardless of their severity, increases the risk of damage accrual, independently of other known risk factors.
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Affiliation(s)
- Manuel F Ugarte-Gil
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú. Universidad Científica del Sur, Lima, Perú
| | - Eduardo Acevedo-Vásquez
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú. Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Graciela S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cesar A Pastor-Asurza
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú. Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - José L Alfaro-Lozano
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Jorge M Cucho-Venegas
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Maria I Segami
- Universidad Nacional Mayor de San Marcos, Lima, Perú Servicio de Reumatología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú
| | | | - Enrique R Soriano
- Servicio de Reumatología, Hospital Italiano and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - Cristina Drenkard
- Division of Rheumatology, Emory University School of Medicine, Atlanta, USA
| | - João Carlos Brenol
- Hospital das Clinicas de Porto Alegre, Universidade Federal do, Rio Grande do Sul, Brazil
| | | | - Lilian T Lavras Costallat
- Divisao de Reumatologia, Faculdade de Ciencias Medicas, Universidade Estadual da Campinas, Campinas, Brazil
| | - Loreto Massardo
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Luis H Silveira
- Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, México D.F., México
| | | | - Leonor A Barile-Fabris
- Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico D.F., Mexico
| | - Rosa Chacón-Díaz
- Servicio de Reumatología, Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela
| | | | - Guillermo J Pons-Estel
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Autoimmune Diseases, Institut Clinic de Medicina I Dermatologia, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Gerald McGwin
- Department of Epidemiology, Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Mok CC, Chan KL, Cheung EFC, Yip PSF. Suicidal ideation in patients with systemic lupus erythematosus: incidence and risk factors. Rheumatology (Oxford) 2013; 53:714-21. [DOI: 10.1093/rheumatology/ket404] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Depressive Symptoms and Associated Factors in Systemic Lupus Erythematosus. PSYCHOSOMATICS 2013; 54:443-50. [DOI: 10.1016/j.psym.2012.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 08/22/2012] [Accepted: 08/23/2012] [Indexed: 01/22/2023]
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50
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Fatigue, health-related quality of life and other patient-reported outcomes in systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2013; 27:363-75. [DOI: 10.1016/j.berh.2013.07.009] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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