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Azizoddin DR, Olmstead R, Anderson KA, Hirz AE, Irwin MR, Gholizadeh S, Weisman M, Ishimori M, Wallace D, Nicassio P. Socioeconomic status, reserve capacity, and depressive symptoms predict pain in Rheumatoid Arthritis: an examination of the reserve capacity model. BMC Rheumatol 2024; 8:46. [PMID: 39304956 PMCID: PMC11414099 DOI: 10.1186/s41927-024-00416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Guided by the reserve capacity model, we evaluated the unique relationships between socioeconomic status (SES), reserve capacity (helplessness, self-efficacy, social support), and negative emotions on pain in patients with Rheumatoid Arthritis (RA). METHODS The secondary analysis used baseline, cross-sectional data from 106 adults in a clinical trial comparing behavioral treatments for RA. Patients were eligible if they were ≥ 18 years old, met the ACR criteria for RA (determined by study rheumatologist), had stable disease and drug regimens for 3 months, and did not have a significant comorbid condition. Structural equation modeling evaluated the direct effects of SES, reserve capacity (helplessness- Arthritis Helplessness Index, self-efficacy -Personal Mastery Scale, social support- Social Provisions Scale) and negative emotions (stress and depressive symptoms- Perceived Stress Scale and Hamilton Depression Rating Scale) on pain (Rapid Assessment of Disease Activity in Rheumatology-RADAR & visual analog scale-VAS), and the indirect effects of SES as mediated by reserve capacity and negative emotions. The SEM model was evaluated using multiple fit criteria: χ2 goodness-of-fit statistic, the comparative fit index (CFI), the standardized root mean square residual (SRMR), and the root mean square error of approximation (RMSEA). RESULTS Participants were mostly female (85%), 55.45 years old on average, self-identified as white (61%), Hispanic (16%), black (13%), and other (10%), and had RA for an average of 10.63 years. Results showed that low SES contributed to worse pain, through lower reserve capacity and higher negative emotions. Mediational analyses showed that reserve capacity and negative emotions partially mediated the effect of SES on pain. The final model explained 39% of the variance in pain. CONCLUSIONS The findings indicate that lower SES was related to worse clinical pain outcomes and negative emotions and reserve capacity (helplessness, social support, and self-efficacy) mediated the effect of SES on pain. A primary limitation is the small sample size; future studies should evaluate this model further in larger, longitudinal approaches. Interventions that target negative emotions in patients with low SES may facilitate better pain control with RA. TRIAL REGISTRATION clinicaltrials.gov NCT00072657 01/02/2004 20/03/2009.
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Affiliation(s)
- Desiree R Azizoddin
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway Suite 4000, Oklahoma City, OK, 73104, USA.
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kris-Ann Anderson
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway Suite 4000, Oklahoma City, OK, 73104, USA
| | - Alanna E Hirz
- Department of Community Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Shadi Gholizadeh
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Michael Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mariko Ishimori
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Wallace
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Perry Nicassio
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Roveta A, Parodi EL, Brezzi B, Tunesi F, Zanetti V, Merlotti G, Francese A, Maconi AG, Quaglia M. Lupus Nephritis from Pathogenesis to New Therapies: An Update. Int J Mol Sci 2024; 25:8981. [PMID: 39201667 PMCID: PMC11354900 DOI: 10.3390/ijms25168981] [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: 07/11/2024] [Revised: 08/03/2024] [Accepted: 08/15/2024] [Indexed: 09/03/2024] Open
Abstract
Lupus Nephritis (LN) still represents one of the most severe complications of Systemic Lupus Erythematosus (SLE) and a major risk factor for morbidity and mortality. However, over the last few years, several studies have paved the way for a deeper understanding of its pathogenetic mechanisms and more targeted treatments. This review aims to provide a comprehensive update on progress on several key aspects in this setting: pathogenetic mechanisms of LN, including new insight into the role of autoantibodies, complement, vitamin D deficiency, and interaction between infiltrating immune cells and kidney resident ones; the evolving role of renal biopsy and biomarkers, which may integrate information from renal histology; newly approved drugs such as voclosporin (VOC) and belimumab (BEL), allowing a more articulate strategy for induction therapy, and other promising phase III-immunosuppressive (IS) agents in the pipeline. Several adjunctive treatments aimed at reducing cardiovascular risk and progression of chronic renal damage, such as antiproteinuric agents, represent an important complement to IS therapy. Furthermore, non-pharmacological measures concerning general lifestyle and diet should also be adopted when managing LN. Integrating these therapeutic areas requires an effort towards a holistic and multidisciplinary approach. At the same time, the availability of an increasingly wider armamentarium may translate into improvements in patient's renal outcomes over the next decades.
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Affiliation(s)
- Annalisa Roveta
- Research and Innovation Department (DAIRI), “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (A.R.); (A.F.); (A.G.M.)
| | - Emanuele Luigi Parodi
- Nephrology and Dialysis Unit, “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (E.L.P.); (B.B.)
| | - Brigida Brezzi
- Nephrology and Dialysis Unit, “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (E.L.P.); (B.B.)
| | - Francesca Tunesi
- Nephrology and Dialysis Unit, IRCCS “San Raffaele” Scientific Institute, 20132 Milan, Italy;
| | - Valentina Zanetti
- Department of Internal Medicine, University of Genova, 16126 Genoa, Italy;
| | - Guido Merlotti
- Department of Primary Care, Azienda Socio Sanitaria Territoriale (ASST) of Pavia, 27100 Pavia, Italy;
| | - Alessia Francese
- Research and Innovation Department (DAIRI), “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (A.R.); (A.F.); (A.G.M.)
| | - Antonio G. Maconi
- Research and Innovation Department (DAIRI), “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (A.R.); (A.F.); (A.G.M.)
| | - Marco Quaglia
- Nephrology and Dialysis Unit, “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (E.L.P.); (B.B.)
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100 Novara, Italy
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Azizoddin D, Olmstead R, Anderson KA, Hirz AE, Irwin MR, Gholizadeh S, Weisman M, Ishimori M, Wallace D, Nicassio P. Socioeconomic Status, Reserve Capacity, and Depressive Symptoms Predict Pain in Rheumatoid Arthritis: An Examination of the Reserve Capacity Model. RESEARCH SQUARE 2023:rs.3.rs-2758092. [PMID: 37066198 PMCID: PMC10104260 DOI: 10.21203/rs.3.rs-2758092/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Guided by the reserve capacity model, we examined the roles of socioeconomic status (SES), reserve capacity, and negative emotions as determinants of pain in patients with Rheumatoid Arthritis (RA). Methods The study used cross-sectional baseline data from 106 adults in a clinical trial comparing behavioral treatments for RA. Structural equation modeling evaluated the direct effects of SES, reserve capacity (helplessness, self-efficacy, social support) and negative emotions (stress and depressive symptoms) on pain, and the indirect effects of SES as mediated by reserve capacity and negative emotions. Results Results showed that low SES contributed to greater pain, through lower reserve capacity and higher negative emotions. Mediational analyses showed that reserve capacity and negative emotions partially mediated the effect of SES on pain. Conclusions The findings indicate that interventions that target negative emotions in patients with low SES may facilitate better pain control with RA. Trial registration clinicaltrials.gov NCT00072657; 02/2004.
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Thurner C, Stengel A. Long-COVID syndrome: physical-mental interplay in the spotlight. Inflammopharmacology 2023; 31:559-564. [PMID: 36892678 PMCID: PMC9996557 DOI: 10.1007/s10787-023-01174-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/10/2023]
Abstract
Patients suffering from Long-COVID syndrome experience a variety of different symptoms on a physical, but also on a psychological and social level. Previous psychiatric conditions such as depression and anxiety have been identified as separate risk factors for developing Long-COVID syndrome. This suggests a complex interplay of different physical and mental factors rather than a simple cause-effect relationship of a specific biological pathogenic process. The biopsychosocial model provides a foundation for understanding these interactions and integrating them into a broader perspective of the patient suffering from the disease instead of the individual symptoms, pointing towards the need of treatment options on a psychological as well as social level besides biological targets. This leads to our conclusion, that the biopsychosocial model should be the underlying philosophy of understanding, diagnosing and treating patients suffering from Long-COVID syndrome, moving away from the strictly biomedical understanding suspected by many patients, treaters and the media while also reducing the stigma still associated with the suggestion of a physical-mental interplay.
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Affiliation(s)
- Carolin Thurner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
- Charité Center for Internal Medicine and Dermatology, Medical Clinic for Psychosomatic Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Berlin, Germany.
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Castellano-Rioja E, Giménez-Espert MDC, Soto-Rubio A. Lupus Erythematosus Quality of Life Questionnaire (LEQoL): Development and Psychometric Properties. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8642. [PMID: 33233805 PMCID: PMC7699946 DOI: 10.3390/ijerph17228642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023]
Abstract
Lupus erythematosus (LE) affects patients' quality of life. Nevertheless, no instrument has been developed to assess the quality of life in systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE) patients. This study aims to develop and psychometrically test the "Quality of Life of Patients with Lupus Erythematosus Instrument" (LEQoL) and study the quality of life of these patients. Finally, percentiles for interpreting scores of LEQoL in patients with LE are provided. This study is cross-sectional, with a sample of 158 patients recruited from a lupus association for the psychometric evaluation of the final version of LEQoL. The scale's reliability was assessed by Cronbach's alpha, composite reliability (CR), and average variance extracted (AVE). Validity was examined through exploratory factorial analyses (EFA) and confirmatory factorial analyses (CFA). The definitive model, composed of 21 items grouped into five factors, presented good psychometric properties. Mean levels of quality of life were observed in patients with systemic LE, with higher values in patients with cutaneous LE. The LEQoL instrument is a useful tool for assessing the quality of life of patients with LE, allowing the evaluation of current clinical practices, the identification of educational needs, and the assessment of the effectiveness of interventions intended to improve the quality of life of patients with LE, SLE, and CLE.
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Affiliation(s)
- Elena Castellano-Rioja
- Department of Nursing, Faculty of Nursing, Catholic University of Valencia, 46001 Valencia, Spain;
| | | | - Ana Soto-Rubio
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, University of Valencia, 46010 Valencia, Spain;
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Chae DH, Martz CD, Fuller-Rowell TE, Spears EC, Smith TTG, Hunter EA, Drenkard C, Lim SS. Racial Discrimination, Disease Activity, and Organ Damage: The Black Women's Experiences Living With Lupus (BeWELL) Study. Am J Epidemiol 2019; 188:1434-1443. [PMID: 31062841 DOI: 10.1093/aje/kwz105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 12/21/2022] Open
Abstract
Black women are disproportionately affected by systemic lupus erythematosus (SLE), a chronic, potentially debilitating autoimmune disease, and they also experience more rapid progression and worse outcomes compared with other groups. We examined if racial discrimination is associated with disease outcomes among 427 black women with a validated diagnosis of SLE, who live in the Atlanta, Georgia, metropolitan area, and were recruited to the Black Women's Experiences Living with Lupus Study (2015-2017). Frequency of self-reported experiences of racial discrimination in domains such as employment, housing, and medical settings was assessed using the Experiences of Discrimination measure. SLE activity in the previous 3 months, including symptoms of fatigue, fever, skin rashes, and ulcers, was measured using the Systemic Lupus Activity Questionnaire; irreversible damage to an organ or system was measured using the Brief Index of Lupus Damage. Results of multivariable linear regression analyses examining the Systemic Lupus Activity Questionnaire and log-transformed Brief Index of Lupus Damage scores indicated that increasing frequency of racial discrimination was associated with greater SLE activity (b = 2.00, 95% confidence interval: 1.32, 2.68) and organ damage (b = 0.08, 95% confidence interval: 0.02, 0.13). Comprehensive efforts to address disparities in SLE severity should include policies that address issues of racial discrimination.
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Affiliation(s)
- David H Chae
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, Alabama
| | - Connor D Martz
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, Alabama
| | - Thomas E Fuller-Rowell
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, Alabama
| | - Erica C Spears
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, Alabama
| | - Tianqi Tenchi Gao Smith
- Department of Industrial and Systems Engineering, Samuel Ginn College of Engineering, Auburn University, Auburn, Alabama
| | - Evelyn A Hunter
- Department of Special Education, Rehabilitation and Counseling, College of Education, Auburn University, Auburn, Alabama
| | - Cristina Drenkard
- Department of Medicine, Division of Rheumatology, School of Medicine, Emory University, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, School of Medicine, Emory University, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Martz CD, Allen AM, Fuller-Rowell TE, Spears EC, Lim SS, Drenkard C, Chung K, Hunter EA, Chae DH. Vicarious Racism Stress and Disease Activity: the Black Women's Experiences Living with Lupus (BeWELL) Study. J Racial Ethn Health Disparities 2019; 6:1044-1051. [PMID: 31215018 DOI: 10.1007/s40615-019-00606-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Indirect or vicarious exposure to racism (e.g., hearing about or observing acts of racism or discrimination) is a salient source of stress for African Americans. Emerging research suggests that these "secondhand" experiences of racism may contribute to racial health inequities through stress-mediated pathways. Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease that disproportionately impacts African American women and is characterized by racial disparities in severity. Health outcomes in this population may be susceptible to vicarious racism given that SLE is shown to be sensitive to psychosocial stress. METHODS Data are from 431 African American women with SLE living in Atlanta, Georgia in the Black Women's Experiences Living with Lupus (BeWELL) Study (2015-2017). Vicarious racism stress was measured with four items assessing distress from (1) hearing about racism in the news; (2) experiences of racism among friends or family; (3) witnessing racism in public; and (4) racism depicted in movies and television shows. Multivariable linear regression was used to examine associations with disease activity measured using the Systemic Lupus Activity Questionnaire. RESULTS Adjusting for sociodemographic and health-related covariates, vicarious racism stress was associated with greater disease activity (b = 2.15; 95% CI = 1.04-3.27). This association persisted even after adjustment for personal experiences of racial discrimination (b = 1.80; 95% CI = 0.67-2.92). CONCLUSIONS Vicarious racism may result in heightened disease activity and contribute to racial disparities in SLE. Our findings suggest that acts of racism committed against members of one's racial group may have distinct health consequences beyond the immediate victim or target.
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Affiliation(s)
- Connor D Martz
- Department of Human Development and Family Studies, Auburn University, College of Human Sciences, Auburn, AL, USA.
| | - Amani M Allen
- Divisions of Community Health Sciences and Epidemiology, University of California - Berkeley, School of Public Health, Berkeley, CA, USA
| | - Thomas E Fuller-Rowell
- Department of Human Development and Family Studies, Auburn University, College of Human Sciences, Auburn, AL, USA
| | - Erica C Spears
- Department of Health Behavior and Health Systems, University of North Texas Health Sciences Center, School of Public Health, Fort Worth, TX, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University, School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University, School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Kara Chung
- Department of Human Development and Family Studies, Auburn University, College of Human Sciences, Auburn, AL, USA
| | - Evelyn A Hunter
- Department of Special Education, Rehabilitation and Counseling, Auburn University, College of Education, Auburn, AL, USA
| | - David H Chae
- Department of Human Development and Family Studies, Auburn University, College of Human Sciences, Auburn, AL, USA
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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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Pilch M, Scharf SN, Lukanz M, Wutte NJ, Fink-Puches R, Glawischnig-Goschnik M, Unterrainer HF, Aberer E. Spiritual well-being and coping in scleroderma, lupus erythematosus, and melanoma. J Dtsch Dermatol Ges 2018; 14:717-28. [PMID: 27373247 DOI: 10.1111/ddg.12715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Religious/spiritual (R-S) well-being is associated with greater vitality and lower depression scores. In this study, we investigated strategies for coping with disease and the role of religiosity/spirituality with respect to improving subjective well-being. PATIENTS AND METHODS One hundred and forty-nine patients (107 women), 44 of whom with systemic sclerosis (SSc), 48 with lupus erythematosus (LE), and 57 with stage I or II malignant melanoma (MM) were surveyed using a self-designed questionnaire, which addressed subjective well-being and disease-related circumstances, as well as the Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSWB). RESULTS At the time of diagnosis, disease burden is greater in LE patients than in patients with SSc and MM. Only after several years are SSc and LE patients able to accept their disease. Compared with healthy individuals, the overall score of R-S well-being is significantly lower in LE patients. In LE, photosensitivity and joint pain are inversely correlated with the ability to forgive. SSc patients with facial lesions and pulmonary involvement show greater religiosity. MM patients display significantly higher values for transcendental hope. CONCLUSION Talks about the disease and psychological support are the most important needs of patients with SSc, LE, and MM. At present, programs aimed at improving R-S coping skills do not seem to play a significant role, but could be an important resource that should be addressed in the future.
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Affiliation(s)
- Michaela Pilch
- Department of Dermatology, Medical University Graz, Austria
| | | | - Martin Lukanz
- Department of Psychology, Karl-Franzens University Graz, Austria
| | | | | | | | - Human-Friedrich Unterrainer
- Department of Psychology, Karl-Franzens University Graz, Austria.,Center for Integrative Addiction Research (Grüner Kreis), Vienna, Austria
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Plantinga L, Lim SS, Bowling CB, Drenkard C. Perceived stress and reported cognitive symptoms among Georgia patients with systemic lupus erythematosus. Lupus 2017; 26:1064-1071. [PMID: 28420055 PMCID: PMC5494014 DOI: 10.1177/0961203317693095] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To examine associations of perceived stress with cognitive symptoms among adults with systemic lupus erythematosus (SLE). Methods Among 777 adult (≥18 years) SLE patients, the association of Perceived Stress Scale (PSS) scores with two self-reported cognitive symptoms was examined: forgetfulness (severe/moderate vs. mild/none; from the Systemic Lupus Activity Questionnaire) and difficulty concentrating (all/most vs. some/little/none of the time; from the Lupus Impact Tracker). The study used multivariable logistic regression to estimate the odds ratios (ORs) per minimal important difference (MID = 0.5*SD) of PSS score and cognitive symptoms. Results Forgetfulness and difficulty concentrating were reported by 41.7% and 29.5%, respectively. Women and those with less education and high disease activity had higher PSS scores and were more likely to report cognitive symptoms than their counterparts. With adjustment for age, race, sex, education, and disease activity, each MID increase in PSS score was associated with higher prevalence of forgetfulness (OR = 1.43, 95% CI 1.29-1.47) and difficulty concentrating (OR = 2.19, 95% CI 1.90-2.52). No substantial differences in this association by age, race, sex, or disease activity were noted. Conclusions SLE patients, particularly those with high disease activity, report a high burden of cognitive symptoms, for which stress may be a modifiable risk factor.
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Affiliation(s)
- Laura Plantinga
- Division of Renal Medicine, Department of Medicine, Emory University
- Division of Geriatrics and General Medicine, Department of Medicine, Emory University
| | - S. Sam Lim
- Division of Rheumatology, Department of Medicine, Emory University
| | - C. Barrett Bowling
- Division of Geriatrics and General Medicine, Department of Medicine, Emory University
- Birmingham/Atlanta VA Geriatrics Research and Clinical Center, Atlanta, Georgia, United States
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Agarwal N, Kumar V. Burden of lupus on work: Issues in the employment of individuals with lupus. Work 2017; 55:429-439. [PMID: 27689581 DOI: 10.3233/wor-162398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) or Lupus is one of the leading causes of work disability in the United States, accounting for about 20% of the more than estimated 1.5 million Americans with a work disability. The symptoms of lupus can have a profound impact on the person's employment. Impacts of lupus are more pronounced among young and middle-adulthood. Studies have shown that loss in work hours cost the nation nearly $13 billion annually. The loss also impacts the individual's work, quality of life, self-management, and self-efficacy. OBJECTIVE In this article, the author describes the financial burden of lupus. The article also describes the substantial impact of lupus on employment outcomes for individuals living with the condition. The author also reviews major signs and symptoms of disease and their impact on employment. RESULTS Findings from this research can be used to identify various accommodations and strategies for individuals to prevent flare-ups. CONCLUSIONS The paper presents innovative strategies that include early interventions and how employers andco-workers can provide helpful support that includes job accommodations to individuals with lupus.
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Affiliation(s)
- Neelam Agarwal
- Center for Accommodations and Support Services (CASS), University of Texas at El Paso, El Paso, TX, USA
| | - Vinod Kumar
- Department of Mechanical Engineering, University of Texas at El Paso, El Paso, TX, USA
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Agarwal N, Kumar V. An invisible student population: Accommodating and serving college students with lupus. Work 2017; 56:165-173. [DOI: 10.3233/wor-162477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Neelam Agarwal
- Center for Accommodations and Support Services (CASS), The University of Texas at El Paso, TX, USA
| | - Vinod Kumar
- Department of Mechanical Engineering, University of Texas at El Paso, TX, USA
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Pilch M, Scharf SN, Lukanz M, Wutte NJ, Fink-Puches R, Glawischnig-Goschnik M, Unterrainer HF, Aberer E. Spirituelles Wohlbefinden und Coping bei Sklerodermie, Lupus erythematodes und malignem Melanom. J Dtsch Dermatol Ges 2016; 14:717-29. [PMID: 27373246 DOI: 10.1111/ddg.12715_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HINTERGRUND UND ZIELE Religiös-spirituelles Wohlbefinden ist verbunden mit höherer Vitalität und verminderter Depressionsneigung. In unserer Studie untersuchten wir die Strategien zur Krankheitsbewältigung und die Rolle von Religiosität-Spiritualität (R-S) zur Verbesserung des subjektiven Wohlbefindens. PATIENTEN UND METHODIK 149 Patienten (107 Frauen), 44 mit systemischer Sklerodermie (SKL), 48 mit Lupus erythematodes (LE) und 57 mit malignem Melanom (MM), Stadium I-II, wurden mittels eines selbstentwickelten Fragebogens zum subjektiven Wohlbefinden, zu den mit der Erkrankung einhergehenden Umständen sowie mit dem Multidimensionalen Inventar (MI-RSB) zu R-S befragt. ERGEBNISSE LE-Patienten sind zum Zeitpunkt der Diagnosestellung stärker belastet als SKL- und MM-Patienten. SKL- und LE-Patienten können erst nach Jahren die Erkrankung akzeptieren. Der Gesamtscore des religiös-spirituellen Befindens liegt bei LE-Patienten signifikant unter dem Wert der Normalbevölkerung. Fotosensitivität und Gelenksschmerzen sind bei LE-Patienten negativ assoziiert mit der Fähigkeit Vergeben zu können. SKL-Patienten mit Gesichtsveränderungen und Lungenbeteiligung zeigen höhere allgemeine Religiosität. MM-Patienten haben höhere Werte für transzendente Hoffnung. SCHLUSSFOLGERUNGEN Vorträge über die Krankheit und psychologische Betreuung sind die wichtigsten Bedürfnisse von Patienten mit SKL, LE und MM an ihre Betreuer. Religiös-spirituelle Angebote zur Krankheitsverarbeitung scheinen derzeit eine untergeordnete Rolle zu spielen, könnten aber eine wichtige Ressource sein, der man in Zukunft mehr Aufmerksamkeit schenken sollte.
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Affiliation(s)
- Michaela Pilch
- Universitätsklinik für Dermatologie, Medizinische Universität Graz, Austria
| | | | - Martin Lukanz
- Abteilung für Psychologie, Karl-Franzens-Universität Graz, Austria
| | - Nora Johanna Wutte
- Universitätsklinik für Dermatologie, Medizinische Universität Graz, Austria
| | - Regina Fink-Puches
- Universitätsklinik für Dermatologie, Medizinische Universität Graz, Austria
| | | | - Human-Friedrich Unterrainer
- Abteilung für Psychologie, Karl-Franzens-Universität Graz, Austria.,Center for Integrative Addiction -Research (Grüner Kreis) Wien, Austria
| | - Elisabeth Aberer
- Universitätsklinik für Dermatologie, Medizinische Universität Graz, Austria
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Agarwal N, Yasui NY, Kumar V. Lupus: Vocational aspects and the best rehabilitation practices. JOURNAL OF VOCATIONAL REHABILITATION 2015. [DOI: 10.3233/jvr-150757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Neelam Agarwal
- Center for Accommodations and Support Services (CASS), University of Texas at El Paso, El Paso, TX, USA
| | - Naoko Yura Yasui
- Department of Rehabilitation Studies, Alabama State University, Montgomery, AL, USA
| | - Vinod Kumar
- Department of Mechanical Engineering, University of Texas at El Paso, El Paso, TX, USA
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Prevalence of hyposalivation in patients with systemic lupus erythematosus in a brazilian subpopulation. Int J Rheumatol 2015; 2015:730285. [PMID: 25649631 PMCID: PMC4305611 DOI: 10.1155/2015/730285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/16/2014] [Indexed: 01/08/2023] Open
Abstract
Background. Systemic lupus erythematosus (SLE) is a chronic inflammatory, multisystem, and autoimmune disease. Objective. The aim of this study was to describe the prevalence of hyposalivation in SLE patients and evaluate factors associated. Methods. This is a cross-sectional study developed at the Cuiaba University General Hospital (UNIC-HGU), Mato Grosso, Brazil. The study population consisted of female SLE patients treated at this hospital from 06/2010 to 12/2012. Unstimulated salivary flow rates (SFRs) were measured. Descriptive and inferential analyses were performed in all cases using a significance level P < 0.05. Results. The results showed that 79% of patients with systemic lupus erythematosus suffered from hyposalivation and that the disease activity and age in years were the factors that resulted in statistically significant differences. Conclusion. The activity of the disease, age >27 years, and the drugs used were factors associated with hyposalivation, resulting in a statistically significant decrease in saliva production.
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Holloway L, Humphrey L, Heron L, Pilling C, Kitchen H, Højbjerre L, Strandberg-Larsen M, Hansen BB. Patient-reported outcome measures for systemic lupus erythematosus clinical trials: a review of content validity, face validity and psychometric performance. Health Qual Life Outcomes 2014; 12:116. [PMID: 25048687 PMCID: PMC4223409 DOI: 10.1186/s12955-014-0116-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/08/2014] [Indexed: 01/30/2023] Open
Abstract
Background Despite overall progress in treatment of autoimmune diseases, patients with systemic lupus erythematosus (SLE) experience many inflammatory symptoms representing an unmet medical need. This study aimed to create a conceptual model of the humanistic and economic burden of SLE, and review the patient-reported outcomes (PROs) used to measure such concepts in SLE clinical trials. Methods A conceptual model for SLE was developed from structured review of published articles from 2007 to August 2013 identified from literature databases (MEDLINE, EMBASE, PsycINFO, EconLit) plus other sources (PROLabels, FDA/EMA websites, Clinicaltrials.gov). PROs targeting key symptoms/impacts were identified from the literature. They were reviewed in the context of available guidance and assessed for face and content validity and psychometric properties to determine appropriateness for use in SLE trials. Results The conceptual model identified fatigue, pain, cognition, daily activities, emotional well-being, physical/social functioning and work productivity as key SLE concepts. Of the 68 articles reviewed, 38 reported PRO data. From these and the other sources, 15 PROs were selected for review, including SLE-specific health-related quality of life (HRQoL) measures (n = 5), work productivity (n = 1), and generic measures of fatigue (n = 3), pain (n = 2), depression (n = 2) and HRQoL (n = 2). The Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-Fatigue), Brief Pain Inventory (BPI-SF) and LupusQoL demonstrated the strongest face validity, conceptual coverage and psychometric properties measuring key concepts in the conceptual model. All PROs reviewed, except for three Lupus-specific measures, lacked qualitative SLE patient involvement during development. The Hospital Anxiety and Depression Scale (HADS), Short Form [36 item] Health Survey version 2 (SF-36v2), EuroQoL 5-dimensions (EQ-5D-3L and EQ-5D-5L) and Work Productivity and Activity Impairment Questionnaire: Lupus (WPAI:Lupus) showed suitability for SLE economic models. Conclusions Based on the identification of key symptoms and impacts of SLE using a scientifically sound conceptual model, we conclude that SLE is a condition associated with high unmet need and considerable burden to patients. This review highlights the availability and need for disease-specific and generic patient-reported measures of relevant domains of disease signs and symptoms, HRQoL and work productivity, providing useful insight for SLE clinical trial design.
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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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Abstract
Resilience (RS) concerns human beings' capacity to respond positively to adverse situations they face, enabling individuals to achieve, maintain, or recover physical or emotional health after devastating illness, losses, or other stressful situations. RS can be an important factor in health promotion. The aim of this study was to evaluate RS in patients with systemic lupus erythematosus (SLE). Forty-five SLE patients participated in this study and were evaluated by both Mini International Neuropsychiatric and Wagnild and Young scales. Of these, 8.9% had low RS (score < 121), 71% medium score (between 121 and 146), and 20% high RS (score > 146). Patients over 35 years of age had the highest scores on the RS scale and patients at risk of committing suicide presented the lowest RS scores, possibly due to high level of depression. Identifying risk and protective factors is important for developing psychological support strategies.
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Affiliation(s)
- Sílvia Fernanda Cal
- a Rheumatology Ambulatory of the Escola Bahiana de Medicina e Saúde Pública , Salvador , Brazil
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Louthrenoo O, Krairojananan J, Chartapisak W, Opastirakul S. Psychosocial functioning of children with systemic lupus erythematosus. J Paediatr Child Health 2012; 48:1091-4. [PMID: 22735025 DOI: 10.1111/j.1440-1754.2012.02499.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIMS Systemic lupus erythematosus (SLE) is a chronic illness in children. Involvement of multiple systems; the chronicity, as well as the treatment, has had great impact on children and their families. The objective of this study was to assess emotional and behavioural problems in childhood lupus during disease remission. METHODS Children with SLE and healthy controls, aged 8-15 years, were studied. Disease remission was confirmed by using the SLE Disease Activity Index (SLEDAI). The Children's Depression Inventory (CDI) and Multidimensional Anxiety Scale for Children (MASC) were rated by the children themselves. The Child Behaviour Checklist was completed by their parents. RESULTS The sample included 40 children with SLE and 40 controls. Their mean age was 12.9 ± 2.1 and 12.1 ± 1.8 years in the SLE and control groups, respectively. The average duration of the disease was 2.6 years. The SLEDAI in the SLE group ranged from 0-1, indicating inactive disease. The mean CDI scores were 8.9 and 10.9 in lupus children and controls, respectively. The mean MASC score was 44.7 in children with SLE and 48.4 in controls. The internalizing, externalizing and total behavioural scores were not significantly different in both groups (9.0 vs. 10.6; 6.6 vs. 8.1; 27.3 vs. 32.5). Only the social competence score was lower in children with SLE (P= 0.03). CONCLUSIONS SLE is a multi-system involvement disease with wide ranging effects on children's physical and psychosocial functioning. However, children with SLE, during inactive disease, were not found to be at increased risk of psychosocial dysfunctions.
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Affiliation(s)
- Orawan Louthrenoo
- Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Thailand.
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Pike MC, Kelley L. Data quality challenges in systemic lupus erythematosus trials: how can this be optimized? Curr Rheumatol Rep 2012; 14:324-33. [PMID: 22580894 PMCID: PMC3387490 DOI: 10.1007/s11926-012-0261-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Major scientific advances in basic science, pharmacology, and translational medicine have allowed the discovery of new molecular targets whose manipulation by new chemical entities has led to treatments for inflammatory diseases, including rheumatoid arthritis, multiple sclerosis, and inflammatory bowel disease. Development of new agents for systemic lupus erythematosus (SLE) has lagged, however, because the protean manifestations of SLE present challenges for measuring therapeutic effects in a consistent manner. Composite end points combining several Disease Activity Indices (DAIs) are being used in ongoing global studies, but the uniform application of these complex DAIs across large numbers of clinical sites has proven difficult. We describe herein approaches that are being utilized to facilitate collection, review, and analysis of the clinical measures utilizing independent central adjudication committees.
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Affiliation(s)
- Marilyn C Pike
- Division of Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Ghauri AJ, Valenzuela AA, O'Donnell B, Selva D, Madge SN. Periorbital Discoid Lupus Erythematosus. Ophthalmology 2012; 119:2193-2194.e11. [DOI: 10.1016/j.ophtha.2012.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/24/2012] [Indexed: 12/18/2022] Open
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Vasquez R, Wang D, Tran QP, Adams-Huet B, Chren MM, Costner MI, Cohen JB, Werth VP, Chong BF. A multicentre, cross-sectional study on quality of life in patients with cutaneous lupus erythematosus. Br J Dermatol 2012; 168:145-53. [PMID: 22708924 DOI: 10.1111/j.1365-2133.2012.11106.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A study at the University of Pennsylvania (UPenn) Medical Center demonstrated that quality of life in patients with cutaneous lupus erythematosus (CLE) is negatively impacted. Whether patients with CLE in other geographic locations have similar quality of life is unknown. OBJECTIVES We sought to compare quality of life indicators between patients with CLE at the University of Texas Southwestern (UTSW) Medical Center at Dallas and those at UPenn. METHODS Patients with CLE (total n=248) at UTSW (n=91) and UPenn (n=157) completed the Skindex-29 +3 and Short Form-36 (SF-36) surveys related to quality of life. Additional information, including demographics, presence of systemic lupus erythematosus (SLE) and disease severity, was collected from UTSW patients with CLE. RESULTS Most Skindex-29 + 3 and SF-36 subdomain scores between UTSW and UPenn patients with CLE were similar. However, UTSW patients with CLE were significantly more affected in the functioning and lupus-specific Skindex-29 + 3 domains, and physical functioning, role-physical and general health SF-36 subscales than UPenn patients with CLE (P<0·05). Factors related to poor quality of life in UTSW patients with CLE include sex, income, education, presence of SLE, and skin disease activity. CONCLUSIONS Most quality of life indicators were similar between the two CLE populations. Differences in psychosocial behaviour, and a larger proportion of patients with SLE and females in the UTSW group likely attributed to differences in a minority of Skindex-29+3 and SF-36 subdomains. Capturing data from CLE populations in different locations provides a more thorough picture of the quality of life that patients with CLE experience on a daily basis with special attention to quality of life issues in select patients with CLE.
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Affiliation(s)
- R Vasquez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Neeman E, Shaashua L, Benish M, Page GG, Zmora O, Ben-Eliyahu S. Stress and skin leukocyte trafficking as a dual-stage process. Brain Behav Immun 2012; 26:267-76. [PMID: 21963875 PMCID: PMC3253878 DOI: 10.1016/j.bbi.2011.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 09/04/2011] [Accepted: 09/15/2011] [Indexed: 10/17/2022] Open
Abstract
Stress responses are known to modulate leukocyte trafficking. In the skin, stress was reported both to enhance and reduce skin immunity, and the chronicity of stress exposure was suggested as a key determining factor. We here propose a dual-stage hypothesis, suggesting that stress, of any duration, reduces skin immunity during its course, while its cessation is potentially followed by a period of enhanced skin immunity. To start testing this hypothesis, rats were subcutaneously implanted with sterile surgical sponges for four-hours, during or after exposure to one of several acute stress paradigms, or to a chronic stress paradigm. Our findings, in both males and females, indicate that numbers of sponge-infiltrating leukocytes, and their specific subsets, were reduced during acute or chronic stress, and increased after stress cessation. Studying potential mediating mechanisms of the reduction in leukocyte numbers during acute stress, we found that neither adrenalectomy nor the administration of beta-adrenergic or glucocorticoid antagonists prevented this reduction. Additionally, administration of corticosterone or epinephrine to adrenalectomized rats did not impact skin leukocyte numbers, whereas, in the blood, these treatments did affect numbers of leukocytes and their specific subsets, as was also reported previously. Overall, our findings support the proposed dual-stage hypothesis, which can be evolutionally rationalized and accounts for most of the apparent inconsistencies in the literature regarding stress and skin immunity. Other aspects of the hypothesis should be tested, also using additional methodologies, and its predictions may bear clinical significance in treatment of skin disorders related to hyper- or hypo-immune function.
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Affiliation(s)
- Elad Neeman
- Neuroimmunology Research Unit, Department of Psychology, Tel Aviv University, Tel Aviv, Israel
| | - Lee Shaashua
- Neuroimmunology Research Unit, Department of Psychology, Tel Aviv University, Tel Aviv, Israel
| | - Marganit Benish
- Neuroimmunology Research Unit, Department of Psychology, Tel Aviv University, Tel Aviv, Israel
| | - Gayle G. Page
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Oded Zmora
- Department of Surgery and Transplantation, Sheba Medical Center, 52621 Tel Hashomer, Israel
| | - Shamgar Ben-Eliyahu
- Neuroimmunology Research Unit, Department of Psychology, Tel Aviv University, Tel Aviv, Israel
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de Abreu MM, Gafni A, Ferraz MB. The use of a decision board to elicit Brazilian patients' and physicians' preferences for treatment: the case of lupus nephritis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:S141-S146. [PMID: 21839889 DOI: 10.1016/j.jval.2011.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To find preferences for treatment expressed by lupus patients and physicians (who were asked to assume they have lupus) and to explore if certain variables explain these preferences. METHODS One hundred seventy-two patients and 202 physicians were interviewed using a lupus nephritis decision board that describes the treatment options and their potential benefits and risks. Clinical and sociodemographic variables were collected. Participants were asked to indicate their preferred treatment and provide justification for their choice. Descriptive statistics, t tests, and Pearson's chi-square tests were used to determine the significance of differences in the decisions made by the two groups. A logistic regression model determined which factors contributed to treatment decisions. RESULTS The average age of study participants was 34 ± 8 years for patients and 31 ± 7 years for physicians. Sixty-eight percent of patients and 96% of physicians (P < 0.001) selected the oral option. Patients and physicians justified their choice of treatment using different arguments (P < 0.001 in each case). Logistic regression showed that risk potential (P < 0.001) and a history of joint involvement (P = 0.011) were the arguments used most often to explain a patient's decision and the risk of side effects was most relevant among physicians (P < 0.001). CONCLUSIONS Using a decision board, patients and physicians were found to have different preferences for treatment when faced with the same treatment options. Further, the variables that influence their preferences are different.
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