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Jiang TE, Pascual AP, Le N, Nguyen TB, Mackey S, Darnall BD, Simard JF, Falasinnu T. The Problem of Pain in Lupus: Epidemiological Profiles of Patients Attending Multidisciplinary Pain Clinics. Pain Manag Nurs 2024; 25:e209-e213. [PMID: 38494346 PMCID: PMC11144551 DOI: 10.1016/j.pmn.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Patients with systemic lupus erythematosus (SLE) bear a significant burden of pain. We aimed to identify factors that distinguish patients with SLE referred to comprehensive pain clinics and those who are not. Characterizing this patient population will identify unmet needs in SLE management and inform efforts to improve pain care in rheumatology. METHODS Among patients with SLE with ≥2 rheumatology clinic visits in a large hospital system from 1998 to 2023 (n = 1319), we examined factors that distinguished those who had at least one visit to multidisciplinary pain clinics (n = 77, 5.8%) from those who did not have any visits (n = 1242, 94.2%) with a focus on biopsychosocial and socioeconomic characteristics. We extracted demographic data and ICD-9/ICD-10 codes from the EHR. RESULTS Patients with SLE attending the pain clinics exhibited characteristics including average older age (mean age ± SD: 54.1 ± 17.9 vs. 48.4 ± 19.9), a higher likelihood of relying on public health insurance (50.7% vs. 34.2%), and a greater representation of Black patients (9.1% vs. 4.4%) compared to SLE patients not seen in pain clinics. Nearly all patients seen at the pain clinics presented with at least one chronic overlapping pain condition (96.1% vs. 58.6%), demonstrated a higher likelihood of having a mental health diagnosis (76.7% vs. 42.4%), and exhibited a greater number of comorbidities (mean ± SD: 6.0 ± 3.0 vs. 2.9 ± 2.6) compared to those not attending the pain clinic. CONCLUSION We found notable sociodemographic and clinical differences between these patient populations. Patients presenting with multiple comorbidities might benefit from further pain screening and referral to pain clinics to provide comprehensive care, and earlier referral could mitigate the development and progression of multimorbidities.
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Affiliation(s)
- Tiffany E Jiang
- Department of Epidemiology and Population Sciences, Stanford University School of Medicine, Stanford, CA
| | | | - Nathan Le
- University of California, Los Angeles, CA
| | - Thy B Nguyen
- Department of Epidemiology and Population Sciences, Stanford University School of Medicine, Stanford, CA
| | - Sean Mackey
- Departments of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine Stanford, CA; Department of Neurology, Stanford University School of Medicine, Stanford, CA
| | - Beth D Darnall
- Departments of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine Stanford, CA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Julia F Simard
- Department of Epidemiology and Population Sciences, Stanford University School of Medicine, Stanford, CA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA; Departments of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA
| | - Titilola Falasinnu
- Departments of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine Stanford, CA; Departments of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA.
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Tharwat S, Husain SM. Musculoskeletal symptoms in systemic lupus erythematosus patients and their impact on health-related quality of life. BMC Musculoskelet Disord 2024; 25:272. [PMID: 38589834 PMCID: PMC11003043 DOI: 10.1186/s12891-024-07367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVES To evaluate the musculoskeletal (MSK) symptoms experienced by SLE patients and determine how those symptoms relate to their health-related quality of life (HRQoL). MATERIALS AND METHODS This is a cross-sectional study that was carried out on 103 adult SLE patients. sociodemographic, clinical, and therapeutic data were recruited. They were asked to complete the following: Nordic Musculoskeletal, Short-Form McGill Pain, and Lupus QoL Questionnaires. RESULTS The mean age was 30.81 ± 9.44 years. There was a total of 86 females and 17 males (F: M:5:1). Almost all the patients reported MSK symptoms (96.1%). The maximum number of patients reported pain in the right and left wrist and hand (64.1%, 63.1%, respectively). One-fourth (25.2%) described at least five bodily sites of MSK symptoms, while 70.9% had more than five sites of MSK symptoms. Most of the patients described the pain as discomforting (40.8%). Patients with MSK symptoms scored significantly worse in all domains. In addition, the QoL scores of patients with more than 5 body sites of MSK symptoms were significantly lower than those of patients with fewer than 5 sites of MSK symptoms. CONCLUSION SLE patients have a high MSK burden, and MSK symptoms have a negative impact on HRQoL in these patients.
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Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, Egypt.
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta, Egypt.
| | - Sara Mahmood Husain
- Mansoura Manchester Programme for Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Zhao Q, Li X, Chen H, Wang L, Wu N, Ma J, Shen B. Association between depression and pain, functional disability, disease activity and health-related quality of life in patients with systemic lupus erythematosus: a meta-analysis. BMJ Open 2023; 13:e068683. [PMID: 37821132 PMCID: PMC10583069 DOI: 10.1136/bmjopen-2022-068683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/10/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore the effect of depression on pain, disease activity, functional disability and health-related quality of life measured by Visual Analogue Scale, Systemic Lupus Erythematosus Disease Activity Index, Health Assessment Questionnaire and Short Form-36 in patients with systemic lupus erythematosus. DESIGN Meta-analysis. DATA SOURCES The PubMed, EMBASE, Cochrane Library and Web of Science were searched for obtaining available studies from inception to 7 March 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies evaluating the impact of depression on pain, disease activity, functional disability and quality of life were included. DATA EXTRACTION AND SYNTHESIS Two authors independently screened publications and extracted data according to set inclusion and exclusion criteria. Statistical analyses were conducted with RevMan V.5.3.0. Data were pooled using a fixed-effects or random-effects model according to heterogeneity. RESULTS A total of 13 identified studies met the inclusion criteria, reporting on a total of 1911 patients with systemic lupus erythematosus. The Visual Analogue Scale score was significantly higher in patients with depression than those without depression (standardised mean difference (SMD)=0.84 (95% CI 0.27 to 1.42), p=0.004). The Health Assessment Questionnaire score was significantly higher in patients with depression than those without depression (SMD=1.05 (95% CI 0.14 to 1.95), p<0.05). The Systemic Lupus Erythematosus Disease Activity Index score was significantly higher in patients with depression than those without depression (SMD=0.46 (95% CI 0.27 to 0.64), p<0.00001). Scores in most Short Form-36 dimensions (physical function, role physical function, emotional role function, vitality, mental health, social function, general health, physical component scale, mental component scale) were lower in patients with depression than those without depression. CONCLUSION This meta-analysis showed that depression was associated with increased in pain, functional disability and disease activity, and decline in health-related quality of life in patients with systemic lupus erythematosus. Awareness of the importance of the relationship between depression in systemic lupus erythematosus patients and pain, functional disability and the quality of life might assist rheumatology physicians and nurses in assessing and preventing these symptoms. PROSPERO REGISTRATION NUMBER CRD42021265694.
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Affiliation(s)
- Qian Zhao
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xin Li
- Department of Respiratory and Critical Care Medicine, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Haoyang Chen
- Department of Nursing, Nantong University Affiliated Rehabilitation Hospital, Nantong, China
| | - Lili Wang
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Ning Wu
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Ji Ma
- The Orthopaedic Spinal Ward, Shanxi Provincial People's hospital, Taiyuan, China
| | - Biyu Shen
- Department of Nursing, Shanghai Children's Medical Center, Shanghai, China
- School of Nursing, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Yao H, Yang H, Wang Y, Xing Q, Yan L, Chai Y. Gut microbiome and fecal metabolic alteration in systemic lupus erythematosus patients with depression. Front Cell Infect Microbiol 2022; 12:1040211. [PMID: 36506019 PMCID: PMC9732533 DOI: 10.3389/fcimb.2022.1040211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background Mental health disorders in systemic lupus erythematosus (SLE) are gradually getting recognized; however, less is known regarding the actual structure and compositional alterations in gut microbiome and metabolism and the mechanisms of how they affect depression development in SLE patients. Methods Twenty-one SLE patients with depression (SLE-d), 17 SLE patients without depression (SLE-nd), and 32 healthy controls (HC) were included in this study. Fecal samples were collected for 16S rRNA gene sequencing and ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS) based metabolomics. Results The structure of gut microbiome in the SLE-d group changed compared with that in the other two groups. The microbiome composition of SLE-d group showed decreased species richness indices, characterized by low ACE and Chao1 indices, a decrease in the ratio of phylum Firmicutes to Bacteroidetes, genus Faecalibacterium and Roseburia. A downregulation of the metabolite fexofenadine involved in bile secretion was positively correlated with the genus Faecalibacterium, Subdoligranulum and Agathobacter. Compared with the SLE-nd group, the SLE-d group had elevated serum levels of IL-2 and IL-6 and decreased BDNF. Interestingly, abundance of the genus Faecalibacterium and Roseburia was negatively correlated with IL-6, abundance of the genus Roseburia was negatively correlated with IL-2, and abundance of the genus Bacteroides was positively correlated with IL-2. Conclusion This study identified specific fecal microbes and their metabolites that may participate in the development of SLE-d. Our findings provide a new perspective for improving depression in SLE patients by regulating the gut-brain axis.
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Affiliation(s)
- Han Yao
- Department of Immunology and Rheumatology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, Shandong, China
| | - Hao Yang
- School of Clinical Medicine, Weifang Medical University, Weifang, Shandong, China
| | - Yueying Wang
- Department of Immunology and Rheumatology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, Shandong, China
| | - Qian Xing
- Department of Immunology and Rheumatology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, Shandong, China,*Correspondence: Qian Xing,
| | - Lin Yan
- School of Clinical Medicine, Graduate School of Dalian Medical University, Dalian, Liaoning, China
| | - Yaru Chai
- School of Clinical Medicine, Weifang Medical University, Weifang, Shandong, China
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Kósa F, Kunovszki P, Gimesi-Országh J, Kedves M, Szabó M, Karyekar CS, Nagy G. High risk of depression, anxiety, and an unfavorable complex comorbidity profile is associated with SLE: a nationwide patient-level study. Arthritis Res Ther 2022; 24:116. [PMID: 35590393 PMCID: PMC9118724 DOI: 10.1186/s13075-022-02799-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this national population-based, retrospective database study is to compare the comorbidity profiles of systemic lupus erythematosus (SLE) patients and general population controls matched for age, gender, and region and assess the risk of depression or anxiety when controlled for age, gender and adjusted for the Charlson Comorbidity Index (CCI). Methods Claims data of 1051 patients diagnosed with SLE (full population between January 01, 2011, and December 31, 2014) from the Hungarian National Health Insurance Fund have been analyzed against matched controls (1:5 ratio) with a follow-up of 30 months. The first record of SLE diagnosis was considered the diagnosis date. The odds ratio (OR) and 99.9% confidence interval (CI) of having depression or anxiety among patients with SLE vs. controls have been assessed using logistic regression models. Results SLE patients report more comorbidities than the matched general population both in pre- and post-index periods (mean CCI 1.79 vs. 1.15 and 2.78 vs. 1.22 [both p<0.001], respectively). Both SLE patients and controls diagnosed with depression or anxiety had significantly higher CCI than those without comorbid depression or anxiety (p<0.001). However, SLE patients had a twofold higher risk of depression or anxiety than matched controls when controlled for age, gender, and adjusted for CCI. Conclusion Our analysis indicates the enormity of comorbidity burden in SLE, especially that of anxiety and depression. The size and complexity of the comorbidity burden emphasizes the importance of early diagnosis and intervention with comprehensive modalities incorporating attention to comorbidities in SLE patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02799-6.
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Affiliation(s)
| | | | | | - Melinda Kedves
- Department of Rheumatology, Hospital of Bács-Kiskun County, Kecskemét, Hungary
| | - Melinda Szabó
- New Saint John Hospital and Outpatient Clinic, Budapest, Hungary
| | | | - György Nagy
- Department of Rheumatology and Clinical Immunology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary.,Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
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Depression-, Pain-, and Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus. Int J Rheumatol 2022; 2022:6290736. [PMID: 35572065 PMCID: PMC9098355 DOI: 10.1155/2022/6290736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives. A significant number of patients with systemic lupus erythematosus (SLE) have depression, and many are untreated. We aim to assess the frequency of moderate to severe depression (MSD) in a multiethnic group of SLE patients with different sociodemographic backgrounds, identify modifiable factors associated with depression, and determine the impact of depression, disease activity, damage, cognitive function, and pain severity on health-related quality of life (HRQoL). Methods. Ninety-nine patients with SLE were evaluated in a cross-sectional study. Sociodemographic data, Beck Depression Inventory (BDI II), SLE disease activity index (SLEDAI-2K), SLICC Damage Index (SLICC-DI), pain severity (10 cm visual analogue scale), cognitive function (Automated Neuropsychologic Assessment Metrics (ANAM)), and the physical (PCS) and mental (MCS) component scores of the Short Form Health Survey (SF-36) were recorded. Bivariate analysis identified potential associations of relevant variables with BDI II and SF-36. Regression analysis determined independent correlates with MSD, PCS, and MCS. Results. Over 50% of subjects (50.5%) were African-American, 37.1% had a family income of ≤$20,000, and 31.3% had MSD. In the bivariate analysis, family income, SLEDAI-2K, cognitive function, and pain severity were associated with MSD. Using binary logistic regression, SLEDAI-2K and pain severity remained independently correlated with MSD (
). In the multiple linear regression analysis, pain severity was the only independent correlate of PCS (
), while cognitive function and BDI II were the main factors associated with MCS (
and
, respectively). Conclusion. Pain severity and disease activity are associated with MSD in our unique population, are potentially modifiable, and deserve further attention in the clinic. Depression and pain significantly affect HRQoL and should be aggressively managed.
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Chegni H, Heidarvand M. The in vitro effects of vitamin 1, 25(OH) 2 D3 on expression of cytokines: In new-onset systemic lupus erythematosus patients. Lupus 2022; 31:939-943. [PMID: 35485195 DOI: 10.1177/09612033221098533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting a variety of factors in the immune system. Awareness of the role of cytokines in SLE has led to new clinical perspectives in its pathogenesis; therefore, the aim of this study was to investigate the effect of vitamin 1, 25(OH) 2 D3 (D3) on the expression of IL-2, IL-4, IL-5, IL-10, and IFN-γ cytokines in patients with lupus. METHODS A total of 65 new-onset SLE patients were enrolled in the study. After peripheral blood mononuclear cell isolation, the lymphocytes of each patient were divided into two groups, one treated with a concentration of 50 μmol vitamin D3 (test) and the other untreated with vitamin D3 (control), were cultured. After 24 hours, the cultured cells were collected and the expressions of IL-2, IL-4, IL-5, IL-10, and IFN-γ genes were analyzed by RT-qPCR. RESULTS It was observed that vitamin D3 reduced expression of IFN-γ, IL-4, IL-5, and IL-10 genes by 73, 50, 37, and 29%, respectively, and increased IL-2 gene expression by 31% (p ≤ 0.05). CONCLUSION With different patterns of cytokine changes in patients with lupus in different studies, it seems that the pattern of cytokine changes is largely dependent on the phase of the disease and with this study it can be concluded that vitamin D3 administration at the time of diagnosis and in the early stages and before starting treatment have different effects from its administration in the acute stage of the disease, which requires further studies to prove. It seems that in patients with systemic lupus erythematosus, vitamin D should be administered taking into account the phase of the disease.
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Affiliation(s)
- Hamid Chegni
- Department of Medical Laboratory Sciences, 556492School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Heidarvand
- Department of Immunology, Faculty of Medical Sciences, 48455Isfahan University of Medical Science, Tehran, Iran
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Borg A, Gomez A, Cederlund A, Cobar F, Qiu V, Lindblom J, Emamikia S, Enman Y, Pettersson S, Parodis I. Contribution of abnormal BMI to adverse health-related quality of life outcomes after a 52-week therapy in patients with SLE. Rheumatology (Oxford) 2021; 60:4205-4217. [PMID: 33404659 PMCID: PMC8410008 DOI: 10.1093/rheumatology/keaa909] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/30/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To investigate whether abnormal BMI is associated with adverse health-related quality of life (HRQoL) outcome, including severe fatigue, after 52 weeks of standard therapy plus belimumab or placebo in patients with SLE. METHODS We analysed data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials (n = 1684). Adverse HRQoL was defined as SF-36 scores ≤ the fifth percentile in age- and sex-matched US population-based subjects, and FACIT-F scores <30. We compared BMI groups using the Pearson's χ2 test, and assessed independence with multivariable logistic regression analysis. RESULTS Overweight (BMI ≥25 kg/m2) and obese (BMI ≥30 kg/m2) patients showed increased likelihood to exhibit adverse SF-36 physical component summary (OR: 1.8; 95% CI: 1.4, 2.3; P <0.001 and OR: 2.4; 95% CI: 1.8, 3.2; P <0.001, respectively) and FACIT-F (OR: 1.3; 95% CI: 1.1, 1.6; P = 0.010 and OR: 1.5; 95% CI: 1.2, 2.0; P = 0.002, respectively) scores at week 52. Underweight was associated with adverse SF-36 mental component summary scores, also after adjustment for sex, ancestry, age, disease duration, disease activity, organ damage and prednisone dose during the study period (OR: 2.1; 95% CI: 1.2, 3.6; P = 0.007). Addition of belimumab to standard therapy independently protected against adverse SF-36 general health (OR: 0.8; 95% CI: 0.6, 1.0; P = 0.025) and FACIT-F < 30 (OR: 0.8; 95% CI: 0.6, 1.0; P = 0.018). CONCLUSION Overweight and obesity contributed to adverse physical and mental HRQoL outcomes after therapeutic intervention in SLE patients, and underweight contributed to adverse mental HRQoL outcome. A protective effect of belimumab against adverse general health and severe fatigue was implicated.
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Affiliation(s)
- Alexander Borg
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
| | - Arvid Cederlund
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
| | - Flordelyn Cobar
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
| | - Victor Qiu
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
| | - Julius Lindblom
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
| | - Sharzad Emamikia
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
| | - Yvonne Enman
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
| | - Susanne Pettersson
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
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Falasinnu T, Drenkard C, Bao G, Mackey S, Lim SS. The Problem of Pain in Systemic Lupus Erythematosus: An Explication of the Role of Biopsychosocial Mechanisms. J Rheumatol 2021; 48:1279-1289. [PMID: 33262298 PMCID: PMC8245006 DOI: 10.3899/jrheum.200595] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To define biopsychosocial mechanisms of pain that go above and beyond disease activity and organ damage in systemic lupus erythematosus (SLE). METHODS We conducted a cross-sectional analysis of patient-reported data in a population-based registry of 766 people with SLE. Predictors of pain intensity and interference were examined using hierarchical linear regression. We built 2 main hierarchical regression models with pain intensity and interference as outcomes, both regressed on disease activity and organ damage. For each model, we sought to establish the relationship between pain outcomes and the primary exposures using sequential steps comprising the inclusion of each construct in 6 stages: demographic, socioeconomic, physical, psychological, behavioral, and social factors. We also conducted sensitivity analyses eliminating all overt aspects of pain in the disease activity measure and reestimated the models. RESULTS Disease activity and organ damage explained 32-33% of the variance in pain intensity and interference. Sociodemographic factors accounted for an additional 4-9% of variance in pain outcomes, whereas psychosocial/behavioral factors accounted for the final 4% of variance. In the sensitivity analyses, we found that disease activity and organ damage explained 25% of the variance in pain outcomes. CONCLUSION Disease activity only explained 33% of the variance in pain outcomes. However, there was an attenuation in these associations after accounting for psychosocial/behavioral factors, highlighting their roles in modifying the relationship between disease activity and pain. These findings suggest that multilevel interventions may be needed to tackle the negative effect of pain in SLE.
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Affiliation(s)
- Titilola Falasinnu
- T. Falasinnu, PhD, Department of Epidemiology and Population Sciences, Stanford University School of Medicine, and Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California;
| | - Cristina Drenkard
- C. Drenkard, MD, PhD, S.S. Lim, MD, MPH, Department of Medicine, Division of Rheumatology, Emory University, and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Gaobin Bao
- G. Bao, MS, MPH, Department of Medicine, Division of Rheumatology, Emory University, Atlanta, Georgia
| | - Sean Mackey
- S. Mackey, MD, PhD, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - S Sam Lim
- C. Drenkard, MD, PhD, S.S. Lim, MD, MPH, Department of Medicine, Division of Rheumatology, Emory University, and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Rahman A. Why Do Patients With Systemic Lupus Erythematosus Suffer Pain? J Rheumatol 2021; 48:1195-1197. [PMID: 33934072 DOI: 10.3899/jrheum.210057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Anisur Rahman
- A. Rahman, PhD, FRCP, Professor of Rheumatology, Centre for Rheumatology Research, Division of Medicine, University College London, London, UK. The author declares no conflicts of interest.
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Pisetsky DS, Eudy AM, Clowse MEB, Rogers JL. The Categorization of Pain in Systemic Lupus Erythematosus. Rheum Dis Clin North Am 2021; 47:215-228. [PMID: 33781491 DOI: 10.1016/j.rdc.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Systemic lupus erythematous is a systemic autoimmune disease that can cause severe pain and impair quality of life. Pain in lupus can arise from a variety of mechanisms and is usually assessed in terms of activity and damage. In contrast, categorization of symptoms as type 1 and type 2 manifestations encompasses a broader array of symptoms, including widespread pain, fatigue, and depression that may track together. The categorization of symptoms as type 1 and type 2 manifestations can facilitate communication between patient and provider as well as provide a framework to address more fully the complex symptoms experienced by patients.
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Affiliation(s)
- David S Pisetsky
- Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA; Medical Research Service, Durham Veterans Administration Medical Center, Durham, NC, USA.
| | - Amanda M Eudy
- Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA
| | - Megan E B Clowse
- Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA
| | - Jennifer L Rogers
- Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA
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12
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Moazzami M, Strand V, Su J, Touma Z. Dual trajectories of fatigue and disease activity in an inception cohort of adults with systemic lupus erythematosus over 10 years. Lupus 2021; 30:578-586. [PMID: 33413006 DOI: 10.1177/0961203320983892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Fatigue is one of the most common symptoms reported in patients living with SLE. We aim to: 1) determine if different trajectories of fatigue associate with specific latent classes of disease activity and 2) define the patient characteristics and associated factors in different latent classes. METHODS Data from an inception cohort of adult patients from the Toronto Lupus Clinic from 1997-2018 were analyzed. Fatigue levels were measured using Fatigue Severity Scale (FSS) and disease activity by the Adjusted Mean Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) (AMS). Dual latent class trajectory analysis, for fatigue and AMS, was performed. Univariable and multivariable logistic regression analyses assessed the association of baseline variables with class membership. RESULTS Among 280 patients, 4 dual classes (C) of fatigue and disease activity were identified: C1- lowest disease activity and second highest fatigue trajectory (27%); C2- second highest disease activity and highest fatigue trajectory (30%); C3-moderate disease activity and lowest fatigue trajectory (33%); and C4- highest disease activity and moderate fatigue trajectory (10%). CONCLUSION 4 distinct latent classes of dual fatigue and disease activity trajectories were identified. Fatigue and disease activity follow distinct trajectories and disease activity alone cannot fully explain fatigue trajectories. Trajectories with higher FSS scores were associated with more fibromyalgia and trajectories with higher disease activity were associated with higher cumulative glucocorticoid use. Higher baseline glucocorticoid use was more likely associated with more fatigue while older age at SLE diagnosis was associated with less fatigue.
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Affiliation(s)
- Mitra Moazzami
- George Washington University School of Medicine, Washington, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, USA
| | - Jiandong Su
- Division of Rheumatology, Department of Medicine; Toronto Western Hospital-Lupus Clinic; University of Toronto, Toronto, Canada
| | - Zahi Touma
- Division of Rheumatology, Department of Medicine; Toronto Western Hospital-Lupus Clinic; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Use of Antimalarial Agents is Associated with Favourable Physical Functioning in Patients with Systemic Lupus Erythematosus. J Clin Med 2020; 9:jcm9061813. [PMID: 32532059 PMCID: PMC7355692 DOI: 10.3390/jcm9061813] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/21/2022] Open
Abstract
Impaired health-related quality of life (HRQoL) is a major problem in patients with systemic lupus erythematosus (SLE). Antimalarial agents (AMA) are the cornerstone of SLE therapy, but data on their impact on HRQoL are scarce. We investigated this impact using baseline data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials (n = 1684). HRQoL was self-reported using the Medical Outcomes Study short-form 36 (SF-36), functional assessment of chronic illness therapy (FACIT)-Fatigue and 3-level EuroQoL 5-Dimension (EQ-5D) questionnaires. Patients on AMA (n = 1098/1684) performed better with regard to SF-36 physical component summary, physical functioning, role physical, bodily pain, FACIT-Fatigue, EQ-5D utility index and EQ-5D visual analogue scale scores. The difference in SF-36 physical functioning (mean ± standard deviation (SD): 61.1 ± 24.9 versus 55.0 ± 26.5; p < 0.001) exceeded the minimal clinically important difference (≥5.0). This association remained significant after adjustment for potential confounding factors in linear regression models (standardised coefficient, β = 0.07; p = 0.002). Greater proportions of AMA users than non-users reported no problems in the mobility, self-care, usual activities and anxiety/depression EQ-5D dimensions. AMA use was particularly associated with favourable HRQoL in physical aspects among patients with active mucocutaneous and musculoskeletal disease, and mental aspects among patients with active renal SLE. These results provide support in motivating adherence to AMA therapy. Exploration of causality in the relationship between AMA use and favourable HRQoL in SLE has merit.
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Abstract
Systemic lupus erythematosus is an autoimmune disease that promotes chronic inflammation, with periods of activation and remission. Pain is commonly one of the first symptoms reported by patients with lupus. It interferes with patients' quality of life, leading to a decrease in strength and difficulty in performing daily activities. Given the chronic nature of the disease, the high prevalence of pain and its negative impact on the quality of life of patients with lupus, the present literature review study aims to explain the pathophysiology of pain in systemic lupus erythematosus and the implications of the chronic process and contributing factors. During periods of systemic lupus erythematosus activity, pain is a significant symptom. Despite this, several studies show that severe pain can occur in patients with in mild to moderate disease activity. Also, in the early stages of the disease, the pain may be accentuated by the greater activity of the disease. However, even when advanced disease is under control, there can be comorbidities and accumulated damage that can also cause high levels of pain. This sensitivity is due to the overlap of primary, secondary, and tertiary pain pathologies, which feedback and make this symptom one of the main concerns of patients with lupus. Understanding the pathophysiology of pain in systemic lupus erythematosus, as well as its chronification and contribution factors, is essential to identify effective therapeutic alternatives in these patients at each stage of pain pathology (primary, secondary, and tertiary).
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15
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Arnaud L, Gavand PE, Voll R, Schwarting A, Maurier F, Blaison G, Magy-Bertrand N, Pennaforte JL, Peter HH, Kieffer P, Bonnotte B, Poindron V, Fiehn C, Lorenz H, Amoura Z, Sibilia J, Martin T. Predictors of fatigue and severe fatigue in a large international cohort of patients with systemic lupus erythematosus and a systematic review of the literature. Rheumatology (Oxford) 2020; 58:987-996. [PMID: 30597077 DOI: 10.1093/rheumatology/key398] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/01/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Fatigue is reported in up to 90% of patients with SLE. This study was conducted to identify the determinants associated with fatigue in a large cohort of patients with SLE, as well as to provide a systematic review of the literature. METHODS Patients from the Lupus BioBank of the upper Rhein, a large German-French cohort of SLE patients, were included in the FATILUP study if they fulfilled the 1997 ACR criteria for SLE and had Fatigue Scale for Motor and Cognitive Functions scores collected. Multivariate logistic regression analyses were performed to assess the determinants of fatigue and severe fatigue. RESULTS A total of 570 patients were included (89.1% female). The median age was 42 years (interquartile range 25-75: 34-52). The median value of the SAfety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI was 2 (0-4). Fatigue was reported by 386 patients (67.7%) and severe fatigue by 209 (36.7%). In multivariate analyses, fatigue was associated with depression [odds ratio (OR): 4.72 (95% CI: 1.39-16.05), P = 0.01], anxiety [OR: 4.49 (95% CI: 2.60-7.77), P < 0.0001], glucocorticoid treatment [OR: 1.59 (95% CI 1.05-2.41), P = 0.04], SELENA-SLEDAI scores [OR: 1.05 (95% CI: 1.00-1.12) per 1 point increase, P = 0.043] and age at sampling [OR: 1.01 (95% CI: 1.00-1.03) per 1 year increase, P = 0.03]. Severe fatigue was independently associated with anxiety (P < 0.0001), depression (P < 0.0001), glucocorticoid treatment (P = 0.047) and age at sampling (P = 0.03). CONCLUSION Both fatigue and severe fatigue are common symptoms in SLE, and are strongly associated with depression and anxiety. Disease activity and the use of glucocorticoids were also independently associated with fatigue, although more weakly.
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Affiliation(s)
- Laurent Arnaud
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS
| | - Pierre Edouard Gavand
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service d'immunologie clinique Nouvel hôpital civil, Strasbourg, France
| | - Rheinardt Voll
- Klinik für Rheumatologie und Klinische Immunologie & Center of Chronic Immunodeficiency (CCI) Universitätsklinikum, Freiburg
| | - Andreas Schwarting
- I.st Department of Internal Medicine, Universitätsmedizin, Mainz, Germany
| | | | - Gilles Blaison
- Service de médecine interne - Centre de compétence en maladies auto-immunes et systémiques rares, Hôpitaux Civils de COLMAR, Colmar
| | | | | | - Hans-Harmut Peter
- Freiburg University Hospital, Uniklinikum Medizinische Klinik Abt, Rheumatologie and Klinische Immunologie, Freiburg, Germany
| | - Pierre Kieffer
- Centre de compétence des maladies autoimmunes et systemiques rares, Service de médecine interne et soins continus du, centre hospitalier de Mulhouse, Mulhouse
| | - Bernard Bonnotte
- CHU Dijon Bourgogne, Service de médecine interne et immunologie clinique, France
| | - Vincent Poindron
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service d'immunologie clinique Nouvel hôpital civil, Strasbourg, France
| | | | - Hannes Lorenz
- Department of Medicine V, University Hospital Heidelberg, Center for Rheumatic Diseases Baden-Baden, Heidelberg, Germany
| | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, Assistance Publique-Hôpitaux de Paris (APHP), Groupement Hospitalier Pitié-Salpêtrière, Paris
| | - Jean Sibilia
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, Strasbourg, France
| | - Thierry Martin
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service d'immunologie clinique Nouvel hôpital civil, Strasbourg, France
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Altabás-González I, Pérez-Gómez N, Pego-Reigosa JM. How to investigate: Suspected systemic rheumatic diseases in patients presenting with muscle complaints. Best Pract Res Clin Rheumatol 2019; 33:101437. [PMID: 31810549 DOI: 10.1016/j.berh.2019.101437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Muscular symptoms, which may be due to multiple causes, are one of the most common early complaints in a rheumatology practice. Musculoskeletal symptoms in rheumatic conditions are very varied, ranging from mechanical problems to muscular symptoms derived from inflammatory and systemic autoimmune diseases. Several drugs commonly used by different specialists and certain drugs used in rheumatology can also cause a wide variety of muscle symptoms. A description of different systemic autoimmune diseases follows to describe the different forms of involvement of the musculoskeletal system that they cause, as well as the main causes with which a differential diagnosis should be made. In this chapter, we will try to give some clues to reach an early diagnosis using clinical criteria, particularly based on a directed anamnesis and physical examination, discussing possible guidelines for the complimentary tests that may be required in patients with muscle complaints.
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Affiliation(s)
- Irene Altabás-González
- Rheumatology Department, University Hospital of Vigo, IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Study Group, Health Research Institute from Galicia Sur (IISGS), Consulta n. 4 (Planta 0), Alto do Meixoeiro s/n, 36214, Vigo, Spain.
| | - Naír Pérez-Gómez
- Rheumatology Department, University Hospital of Vigo, IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Study Group, Health Research Institute from Galicia Sur (IISGS), Consulta n. 4 (Planta 0), Alto do Meixoeiro s/n, 36214, Vigo, Spain.
| | - José María Pego-Reigosa
- Rheumatology Department, University Hospital of Vigo, IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Study Group, Health Research Institute from Galicia Sur (IISGS), Consulta n. 4 (Planta 0), Alto do Meixoeiro s/n, 36214, Vigo, Spain.
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17
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Kwan A, Katz P, Touma Z. The Assessment of Anxiety and Depression and its Associated Factors in SLE. Curr Rheumatol Rev 2019; 15:90-98. [PMID: 30255761 DOI: 10.2174/1573397114666180926101513] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/13/2018] [Accepted: 09/23/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depression and anxiety are common neuropsychiatric complaints in patients with Systemic Lupus Erythematosus (SLE). While numerous studies have been performed to investigate the prevalence, impact, and associated factors of depression and anxiety, current literature presents mixed results. In particular, the prevalence of anxiety and depression varies substantially between studies due to methodological limitations, and heterogeneity in defining anxiety and depression, patient selection, and metrics used. Moreover, there is a lack of studies evaluating the validity, reliability, and interpretability of commonly used screening tools for depression and anxiety in SLE patients. RESULT AND CONCLUSION Further investigations should aim to reach a consensus surrounding the role of controversial associated factors in depression and anxiety of SLE patients, while also focusing on the identification of novel factors that have not yet been highlighted in the literature.
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Affiliation(s)
- Andrew Kwan
- Queen's University, Kingston, Ontario, Canada.,University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
| | - Patricia Katz
- Department of Medicine, UCSF, Philip R. Lee Institute for Health Policy Studies, St, San Francisco, CA 94117, United States
| | - Zahi Touma
- University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
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18
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Kanapathy A, Nik Jaafar NR, Shaharir SS, Chan LF, Rozita M, Ch’ng SS. Prevalence of cognitive impairment using the Montreal Cognitive Assessment questionnaire among patients with systemic lupus erythematosus: a cross-sectional study at two tertiary centres in Malaysia. Lupus 2019; 28:854-861. [DOI: 10.1177/0961203319852153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction Cognitive impairment is a common neuropsychiatric manifestation of systemic lupus erythematosus (SLE). However, it is not routinely assessed for despite its high prevalence and significant disease burden. Aims This study aimed to determine the prevalence of mild cognitive impairment (MCI) using the Montreal Cognitive Assessment (MoCA) and its associated factors among patients diagnosed with SLE in Malaysia. Methods A total of 200 SLE patients were recruited prospectively from the outpatient clinics of two tertiary hospitals in Malaysia. Standardized clinical interview was utilized to obtain information on socio-demographic characteristics. All patients were then assessed using the MoCA questionnaire for presence of cognitive impairment; the Patient Health Questionnaire 9 (PHQ-9) for presence of depressive symptoms; and the Wong–Baker Faces Pain Scale (WBFPS) for severity of pain. The evaluation of disease activity and severity were performed by the treating rheumatologists and nephrologists using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC DI). Results The prevalence of MCI was 35%. The significant associated factors from the bivariate analysis were male gender ( p = 0.04), educational level ( p = 0.00), WBFPS score ( p = 0.035) and anticardiolipin IgM ( p = 0.01). Further analysis using logistic regression model found that male gender (OR = 7.43, 95% confidence interval 1.06–52.06, p = 0.04), lower educational level (OR = 4.4, 95% confidence interval 1.47–13.21, p = 0.01) and presence of anticardiolipin IgM (OR = 6.81, 95% confidence interval 1.45–32.01, p = 0.031) were associated with impaired MoCA scores. Also, increasing pain scores increased the risk of patients being affected by cognitive impairment. Conclusion Over one-third of patients with SLE in our cohort were found to have MCI. Risk factors included male gender, lower educational level, higher pain score and presence of anticardiolipin IgM. Physicians are encouraged to perform routine screening to detect cognitive dysfunction in patients with SLE in their clinical practice as part of a more comprehensive management.
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Affiliation(s)
- A Kanapathy
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - N R Nik Jaafar
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - S S Shaharir
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - L F Chan
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - M Rozita
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - S S Ch’ng
- Department of Medicine, Selayang Hospital, Selangor, Malaysia
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19
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Hackett KL, Davies K, Tarn J, Bragg R, Hargreaves B, Miyamoto S, McMeekin P, Mitchell S, Bowman S, Price EJ, Pease C, Emery P, Andrews J, Lanyon P, Hunter J, Gupta M, Bombardieri M, Sutcliffe N, Pitzalis C, McLaren J, Cooper A, Regan M, Giles I, Isenberg D, Vadivelu S, Coady D, Dasgupta B, McHugh N, Young-Min S, Moots R, Gendi N, Akil M, Griffiths B, Lendrem DW, Ng WF. Pain and depression are associated with both physical and mental fatigue independently of comorbidities and medications in primary Sjögren's syndrome. RMD Open 2019; 5:e000885. [PMID: 31168409 PMCID: PMC6525628 DOI: 10.1136/rmdopen-2018-000885] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/20/2019] [Accepted: 03/27/2019] [Indexed: 01/01/2023] Open
Abstract
Objectives To report on fatigue in patients from the United Kingdom primary Sjögren's syndrome (pSS) registry identifying factors associated with fatigue and robust to assignable causes such as comorbidities and medications associated with drowsiness. Methods From our cohort (n = 608), we identified those with comorbidities associated with fatigue, and those taking medications associated with drowsiness. We constructed dummy variables, permitting the contribution of these potentially assignable causes of fatigue to be assessed. Using multiple regression analysis, we modelled the relationship between Profile of Fatigue and Discomfort physical and mental fatigue scores and potentially related variables. Results Pain, depression and daytime sleepiness scores were closely associated with both physical and mental fatigue (all p ≤ 0.0001). In addition, dryness was strongly associated with physical fatigue (p ≤ 0.0001). These effects were observed even after adjustment for comorbidities associated with fatigue or medications associated with drowsiness. Conclusions These findings support further research and clinical interventions targeting pain, dryness, depression and sleep to improve fatigue in patients with pSS.This finding is robust to both the effect of other comorbidities associated with fatigue and medications associated with drowsiness.
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Affiliation(s)
- Kate L Hackett
- Department of Life & Health Sciences, Northumbria University Department of Public Health and Wellbeing, Newcastle upon Tyne, UK
| | - Kristen Davies
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Jessica Tarn
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Rebecca Bragg
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Ben Hargreaves
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Samira Miyamoto
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espirito Santo, Vitoria, Brazil
| | - Peter McMeekin
- Department of Life & Health Sciences, Northumbria University Department of Public Health and Wellbeing, Newcastle upon Tyne, UK
| | - Sheryl Mitchell
- Musculoskeletal Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Simon Bowman
- Rheumatology Research Group, University of Birmingham, Birmingham, UK
| | - Elizabeth J Price
- Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Colin Pease
- Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Rheumatology, University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
- Musculoskeletal, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Jacqueline Andrews
- Musculoskeletal, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Peter Lanyon
- Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Michele Bombardieri
- Experimental Medicine and Rheumatology, Queen Mary University of London, London, UK
| | - Nurhan Sutcliffe
- Barts Health NHS Trust, London, UK
- Rheumatology, Barts and The London School of Medicine and Dentistry, London, UK
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, William Harvey Research Institute Experimental Medicine and Musculoskeletal Sciences, London, UK
| | | | | | | | - Ian Giles
- Centre for Rheumatology, University College London, London, UK
| | - David Isenberg
- Centre for Rheumatology, University College London, London, UK
| | | | - David Coady
- City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
| | - Neil McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | | | - Robert Moots
- Rheumatology, Aintree University Hospitals, Liverpool, UK
| | - Nagui Gendi
- Department of Rheumatology, Basildon Hospital, Basildon, UK
| | - Mohammed Akil
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bridget Griffiths
- Musculoskeletal Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Dennis W Lendrem
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Musculoskeletal Ageing, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - Wan-Fai Ng
- Musculoskeletal Ageing, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
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Health-Related Quality of Life and Emotional Health in X-Linked Carriers of Chronic Granulomatous Disease in the United Kingdom. J Clin Immunol 2019; 39:195-199. [PMID: 30868346 PMCID: PMC6445821 DOI: 10.1007/s10875-019-00607-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/25/2019] [Indexed: 02/02/2023]
Abstract
X-linked chronic granulomatous disease (XL-CGD), a rare primary immunodeficiency due to a defect in the gp91phox NADPH oxidase subunit, results in recurrent, severe infection, inflammation, and autoimmunity. Patients have an absent, or significantly reduced, neutrophil oxidative burst. Due to lyonization, XL-CGD carriers have a dual population of functional and non-functional phagocytes and experience a range of symptoms including increased risk of autoimmunity, fatigue, and infection. Patients with CGD have poorer quality of life (QoL) than normal controls. We evaluated QoL and psychological health in UK XL-CGD carriers. Recruited participants completed the Medical Outcomes Study Short Form 36 version 2 (SF-36 V2), providing an overall score for mental and physical health. Psychological health was assessed using the Hospital Anxiety and Depression Scale (HADS) questionnaire. Seventy-five XL-CGD carriers were recruited from 62 families, median age 43 years (range 3-77). Fifty-six were mothers, 6 grandmothers, and 13 siblings. Sixty-two completed the SF36v2 and had reduced QoL scores compared with adult CGD patients and a UK age-matched female control cohort, indicating a reduced QoL. Sixty-one completed a HADS questionnaire. Over 40% experienced moderate or greater levels of anxiety with only one third being classified as normal. Higher anxiety scores significantly correlated with higher depression scores, lower self-esteem, presence of joint or bowel symptoms, and higher levels of fatigue (p < 0.05). This is the first study to evaluate QoL of XL-CGD carriers, and demonstrates high rates of anxiety and significantly reduced QoL scores. XL-CGD carriers should be considered as potential patients and pro-actively assessed and managed.
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Barbacki A, Petri M, Aviña-Zubieta A, Alarcón GS, Bernatsky S. Fatigue Measurements in Systemic Lupus Erythematosus. J Rheumatol 2019; 46:1470-1477. [PMID: 30709953 DOI: 10.3899/jrheum.180831] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Fatigue is a frequent, disabling issue in systemic lupus erythematosus (SLE). It is, however, difficult to quantify. The Ad Hoc Committee on SLE Response Criteria for Fatigue in 2007 recommended using the Krupp Fatigue Severity Scale (FSS). Since then, the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale has also been validated in SLE. We performed a review of instruments used to measure fatigue in adult SLE patients from 2007 onward. METHODS We searched PubMed, Medline, and Embase (January 2008-October 2017), identifying clinical trials and observational studies in adult SLE, where fatigue was a specifically measured outcome. All English and French studies were reviewed to determine fatigue measures and results. RESULTS Thirty-seven studies met inclusion criteria. Eight scales were used. The visual analog scale (VAS), FSS, and FACIT-Fatigue Scale were most frequent. FSS was the most often used instrument in both clinical trials and observational studies. Twenty-five of the 37 studies demonstrated a difference in fatigue that was statistically significant and clinically meaningful. Of the 12 studies that did not, 6 used FSS, 3 used VAS, 2 used the Multidimensional Assessment of Fatigue, and 1 used the Brief Fatigue Index. All 6 studies using the FACIT-Fatigue Scale detected clinically meaningful and statistically significant differences. CONCLUSION VAS, FSS, and FACIT-Fatigue Scale were the most frequently used instruments in adult SLE studies from 2008 to 2017. Many studies detected clinically important changes in fatigue. Fatigue remains a key measure in both clinical trials and observational SLE studies.
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Affiliation(s)
- Ariane Barbacki
- From the Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia; Arthritis Research Centre of Canada, Richmond, British Columbia; Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,A. Barbacki, MD, Department of Medicine, Division of Rheumatology, McGill University Health Centre; M. Petri, MD, MPH, Division of Rheumatology, Johns Hopkins University School of Medicine; A. Aviña-Zubieta, MD, MSc, PhD, Division of Rheumatology, Department of Medicine, and Department of Experimental Medicine, University of British Columbia Faculty of Medicine, and Arthritis Research Centre of Canada; G.S. Alarcón, MD, MPH, Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham; S. Bernatsky, MD, PhD, Department of Medicine, Division of Rheumatology, McGill University Health Centre
| | - Michelle Petri
- From the Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia; Arthritis Research Centre of Canada, Richmond, British Columbia; Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,A. Barbacki, MD, Department of Medicine, Division of Rheumatology, McGill University Health Centre; M. Petri, MD, MPH, Division of Rheumatology, Johns Hopkins University School of Medicine; A. Aviña-Zubieta, MD, MSc, PhD, Division of Rheumatology, Department of Medicine, and Department of Experimental Medicine, University of British Columbia Faculty of Medicine, and Arthritis Research Centre of Canada; G.S. Alarcón, MD, MPH, Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham; S. Bernatsky, MD, PhD, Department of Medicine, Division of Rheumatology, McGill University Health Centre
| | - Antonio Aviña-Zubieta
- From the Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia; Arthritis Research Centre of Canada, Richmond, British Columbia; Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,A. Barbacki, MD, Department of Medicine, Division of Rheumatology, McGill University Health Centre; M. Petri, MD, MPH, Division of Rheumatology, Johns Hopkins University School of Medicine; A. Aviña-Zubieta, MD, MSc, PhD, Division of Rheumatology, Department of Medicine, and Department of Experimental Medicine, University of British Columbia Faculty of Medicine, and Arthritis Research Centre of Canada; G.S. Alarcón, MD, MPH, Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham; S. Bernatsky, MD, PhD, Department of Medicine, Division of Rheumatology, McGill University Health Centre
| | - Graciela S Alarcón
- From the Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia; Arthritis Research Centre of Canada, Richmond, British Columbia; Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,A. Barbacki, MD, Department of Medicine, Division of Rheumatology, McGill University Health Centre; M. Petri, MD, MPH, Division of Rheumatology, Johns Hopkins University School of Medicine; A. Aviña-Zubieta, MD, MSc, PhD, Division of Rheumatology, Department of Medicine, and Department of Experimental Medicine, University of British Columbia Faculty of Medicine, and Arthritis Research Centre of Canada; G.S. Alarcón, MD, MPH, Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham; S. Bernatsky, MD, PhD, Department of Medicine, Division of Rheumatology, McGill University Health Centre
| | - Sasha Bernatsky
- From the Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia; Arthritis Research Centre of Canada, Richmond, British Columbia; Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. .,A. Barbacki, MD, Department of Medicine, Division of Rheumatology, McGill University Health Centre; M. Petri, MD, MPH, Division of Rheumatology, Johns Hopkins University School of Medicine; A. Aviña-Zubieta, MD, MSc, PhD, Division of Rheumatology, Department of Medicine, and Department of Experimental Medicine, University of British Columbia Faculty of Medicine, and Arthritis Research Centre of Canada; G.S. Alarcón, MD, MPH, Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham; S. Bernatsky, MD, PhD, Department of Medicine, Division of Rheumatology, McGill University Health Centre.
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22
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Azizoddin DR, Gandhi N, Weinberg S, Sengupta M, Nicassio PM, Jolly M. Fatigue in systemic lupus: the role of disease activity and its correlates. Lupus 2018; 28:163-173. [PMID: 30580659 DOI: 10.1177/0961203318817826] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that leads to a variety of negative health outcomes resulting from inflammation in various organ systems. Although treatment continues to advance, fatigue remains one of the most salient, poorly understood and addressed patient complaints. Understanding the mechanisms of fatigue can help guide the development of interventions to improve health outcomes. The aim of this research was to evaluate the contribution of six variables (disease activity, insomnia, depression, stress, pain and physical health) to fatigue in SLE without concomitant fibromyalgia (FM). METHODS A total of 116 ethnically diverse, primarily female participants (91%) with SLE, receiving care at university medical centers, completed assessments of disease activity and quality of life outcomes (FACIT-FT, Insomnia Severity Index, Perceived Stress Scale (PSS-4), Pain Inventory, Depression-PHQ-9, and LupusPRO-physical function). All patients met the American College of Rheumatology classification criteria for SLE and did not have a known diagnosis of FM. Multivariate linear and stepwise regression analyses were conducted with fatigue (FACIT-FT) as the dependent variable, and the above six variables as independent variables. RESULTS Mean (SD) age was 39.80 (13.87) years; 50% were African American, 21% Caucasian, 13% Hispanic, 9% Asian and 8% other. Mean (SD) FACIT-FT was 20.09 (12.76). Collectively, these six variables explained 57% of the variance in fatigue. In the multivariate model, depression, stress and pain were significantly and independently associated with fatigue, but not disease activity, sleep or physical health. Stress had the largest effect on fatigue (β 0.77, 95% CI 0.17-1.38, p = 0.01), followed by depression (β 0.66, 95% CI 0.21-1.10, p = 0.005). On stepwise regression analysis, only stress, depression and pain were retained in the model, and collectively explained 56% of the variance in fatigue. All three remained independent correlates of fatigue, with the largest contribution being stress (β 0.84, 95% CI 0.27-1.42, p = 0.005), followed by depression (β 0.79, 95% CI 0.44-1.14, p < 0.001) with fatigue. CONCLUSION Stress, depression and pain are the largest independent contributors to fatigue among patients with SLE, without concurrent FM. Disease activity, sleep and physical health were not associated with fatigue. The evaluation of stress, depression and pain needs to be incorporated during assessments and clinical trials of individuals with SLE, especially within fatigue. This stress-depression-fatigue model requires further validation in longitudinal studies and clinical trials. Significance and innovation: • Disease activity, sleep, pain, stress, depression, and physical health have been reported individually to be associated with fatigue in lupus. This analysis evaluated the role of each and all of these six variables collectively in fatigue among patients with SLE without a known diagnosis of FM. • Disease activity, sleep and physical health were not significantly related to fatigue, but depression, stress and pain were. • The results emphasize the need to evaluate and treat fatigue in individuals with SLE utilizing a biopsychosocial approach, particularly in the realm of clinical trials. Behavioral medicine interventions are shown to be most effective for the treatment of depression, stress and pain.
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Affiliation(s)
- D R Azizoddin
- 1 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Health Care, Redwood City, USA.,2 Division of Rheumatology, Rush University Medical Center, Chicago, USA
| | - N Gandhi
- 3 Division of Rheumatology, Department of Medicine, John H Stroger Hospital, Chicago, USA
| | - S Weinberg
- 2 Division of Rheumatology, Rush University Medical Center, Chicago, USA
| | - M Sengupta
- 3 Division of Rheumatology, Department of Medicine, John H Stroger Hospital, Chicago, USA
| | - P M Nicassio
- 4 Cousins Center of Psychoneuroimmunology, University of California, Los Angeles, USA
| | - M Jolly
- 2 Division of Rheumatology, Rush University Medical Center, Chicago, USA
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23
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Faith TD, Flournoy-Floyd M, Ortiz K, Egede LE, Oates JC, Williams EM. My life with lupus: contextual responses of African-American women with systemic lupus participating in a peer mentoring intervention to improve disease self-management. BMJ Open 2018; 8:e022701. [PMID: 30413505 PMCID: PMC6231552 DOI: 10.1136/bmjopen-2018-022701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The current article seeks to examine the ways in which African-American women with systemic lupus erythematosus (SLE) describe their disease experience and how they cope with their disease. This qualitative study provides deeper insight into whether experiences of African-American women with SLE differ from previous qualitative study findings. METHODS Qualitative data were gathered using interviews and a focus group, from participants in the Peer Approaches to Lupus Self-management (PALS) programme. Data were analysed for themes related to disease experience and how participants cope with their disease. Twenty-seven African-American women with SLE were recruited into the peer mentoring programme, of which 7 served as mentors and 20 served as mentees. A 12-week peer mentoring intervention delivered by phone and based on the Chronic Disease Self-Management and Arthritis Self-Management Programs. RESULTS Three categories encompassing a total of 10 subcategories emerged from analyses: (A) interpersonal, familialandromantic relationships; (B) individual experiences of living with SLE; and (C) physician-patient relationships. CONCLUSION We gained insight on several issues related to patient perspectives of African-American women with SLE, and the context surrounding their thoughts and feelings related to lupus, including their providers, families and other social support networks. Additional research efforts could explore and address the thematic domains and respective subthemes identified here. Although limited due to the preliminary nature of the study, this information can be used to create future evidence-based interventions to decrease the impact of SLE on African-American patients.
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Affiliation(s)
- Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Minnjuan Flournoy-Floyd
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, Maryland, USA
| | - Kasim Ortiz
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Leonard E Egede
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jim C Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
- Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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24
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Azizoddin DR, Zamora-Racaza G, Ormseth SR, Sumner LA, Cost C, Ayeroff JR, Weisman MH, Nicassio PM. Psychological Factors that Link Socioeconomic Status to Depression/Anxiety in Patients with Systemic Lupus Erythematosus. J Clin Psychol Med Settings 2018; 24:302-315. [PMID: 28776205 DOI: 10.1007/s10880-017-9505-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Our analyses examined whether reserve capacity factors would explain the relationship between socioeconomic status (SES) and symptoms of depression/anxiety in patients with systemic lupus erythematosus (SLE). We assessed disease activity, depression/anxiety symptoms, and intrapersonal and interpersonal reserve capacity measures in 128 patients with SLE. Multiple meditational analyses revealed that intrapersonal and interpersonal psychosocial aspects of reserve capacity fully mediated the relationship between SES and depression/anxiety. Lower SES was indirectly associated with higher symptoms of depression and anxiety through the effects of psychosocial resilience. Interventions aimed at improving modifiable reserve capacity variables, such as self-esteem and optimism, may improve anxious/depressive symptomatology in patients with SLE.
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Affiliation(s)
- Desiree R Azizoddin
- Department of Psychology, Loma Linda University, Loma Linda, CA, 92350, USA. .,Department of Anesthesiology, Stanford University Medical Center, Palo Alto, CA, USA.
| | - Geraldine Zamora-Racaza
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Sarah R Ormseth
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lekeisha A Sumner
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Julia R Ayeroff
- Postbaccalaureate Premedical Program, University of Southern California, Los Angeles, CA, USA
| | - Michael H Weisman
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Perry M Nicassio
- Cousins Center for Psychoneuroimmunology, University of California Los Angeles, Los Angeles, CA, USA
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25
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Waldheim E, Ajeganova S, Bergman S, Frostegård J, Welin E. Variation in pain related to systemic lupus erythematosus (SLE): a 7-year follow-up study. Clin Rheumatol 2018; 37:1825-1834. [PMID: 29654486 PMCID: PMC6006213 DOI: 10.1007/s10067-018-4079-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/11/2018] [Accepted: 03/23/2018] [Indexed: 12/18/2022]
Abstract
We have previously shown that most patients with systemic lupus erythematosus (SLE) reported low degree of SLE-related pain. However, 24% of the patients reported high degree of SLE-related pain, more fatigue, anxiety and depression, and worse health-related quality of life (HRQoL). To explore SLE-related pain, the presence of long-standing widespread pain, and patient-reported outcomes (PROs) after 7 years. Sixty-four out of 84 patients participated in a 7-year follow-up of the original survey and completed the same questionnaires answered at inclusion: pain (VAS 100 mm), fatigue (MAF), HRQoL (SF-36), anxiety and depression (HADS), and, if appropriate, a pain-drawing. Differences between inclusion and follow-up (change) were calculated. The patients with a low degree of SLE-related pain at inclusion reported no changes at follow-up in pain and PROs except for worsening in physical function in SF-36, median change (IQR) 0 (- 10 to 5), p = 0.024. Half of the patients with high degree of pain at inclusion reported decreased pain at follow-up, median change (IQR) 45 (35 to 65), p = 0.021; fatigue, 8 (8 to 17), p = 0.018; anxiety, 4 (1 to 4), p = 0.035; and depression, 4 (2 to 5), p = 0.018 and improvements in most dimensions of SF-36. The remaining half of the patients reported no changes regarding pain and PROs except for a worsening in vitality in SF-36, 20 (15 to 35), p = 0.0018. All patients with remaining high level of pain indicated long-standing widespread pain. After 7 years, a subgroup of patients with SLE reported remaining high level of SLE-related pain and a high symptom burden, including long-standing widespread pain. Such patients require more observant attention to receive appropriate treatment.
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Affiliation(s)
- Eva Waldheim
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Sofia Ajeganova
- Department of Medicine, Huddinge H7, Unit for Gastroenterology and Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Bergman
- Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Johan Frostegård
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Welin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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26
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Li J, Jones JT, Donnelly C, Cunningham N, Kashikar-Zuck S, Brunner HI. RETRACTED: Pain predicts poorer health-related quality of life in childhood-onset systemic lupus erythematosus: a cohort study. J Int Med Res 2017; 46:NP2-NP10. [DOI: 10.1177/0300060517732486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
At the request of the Journal’s Editor, the Publisher and the authors, the following article has been retracted. Li J, Jones JT, Donnelly C, Cunningham N, Kashikar-Zuck S and Brunner HI. Pain predicts poorer health-related quality of life in childhood-onset systemic lupus erythematosus: a cohort study. Journal of International Medical Research. Epub ahead of print 6 December 2017. DOI: 10.1177/0300060517732486. http://journals.sagepub.com/doi/full/10.1177/0300060517732486 The article has been retracted from Journal of International Medical Research because the co-authors of the paper had not consented to the paper’s submission for publication, and because the paper does not present the complete findings of the authors’ research. The corresponding author, Dr Li, submitted the paper with fraudulent contact details for his co-authors and without their consent to submit. Furthermore, the paper made use of an incomplete measurement scale that did not accurately reflect the complete findings of the study, which found other significant variables affected the value of using pain to measure the health-related quality of life of lupus patients. The complete findings of the study are presented in another paper published by the same authors: Donnelly C, Cunningham N, Jones JT, Li J, Brunner HI and Kashikar-Zuck S. Fatigue and depression predict reduced health-related quality of life in childhood-onset lupus. Lupus 2017; 27: 124–133. http://journals.sagepub.com/doi/full/10.1177/0961203317716317
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Affiliation(s)
- Ji Li
- Department of Paediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jordan T. Jones
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Centre, Cincinnati, OH, USA
| | - Catherine Donnelly
- Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Natoshia Cunningham
- Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioural Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Centre, Cincinnati, OH, USA
| | - Susmita Kashikar-Zuck
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Centre, Cincinnati, OH, USA
- Division of Behavioural Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Centre, Cincinnati, OH, USA
| | - Hermine I. Brunner
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Centre, Cincinnati, OH, USA
- Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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27
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Azizoddin DR, Weinberg S, Gandhi N, Arora S, Block JA, Sequeira W, Jolly M. Validation of the LupusPRO version 1.8: an update to a disease-specific patient-reported outcome tool for systemic lupus erythematosus. Lupus 2017; 27:728-737. [PMID: 29087259 DOI: 10.1177/0961203317739128] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives LupusPRO has shown good measurement properties as a disease-specific patient-reported outcome tool in systemic lupus erythematosus (SLE). For the purpose of clinical trials, the version 1.7 (v1.7) domain of Pain-Vitality was separated into distinct Pain, Vitality and Sleep domains in v1.8, and the psychometric properties examined. Methods A total of 131 consecutive SLE patients were self-administered surveys assessing fatigue (FACIT, SF-36), pain (Pain Inventory, SF-36), insomnia (Insomnia Severity Index), emotional health (PHQ-9, SF-36) and quality of life (SF-36, LupusPRO) at routine care visits. Internal consistency reliability (ICR) for each domain was obtained using Cronbach's alpha. The convergent construct validity of LupusPRO domains with corresponding SF-36 domains or tools were tested using Spearman correlation. Varimax rotations were conducted to assess factor structures of the LupusPRO v1.8. Results Mean (SD) age was 40.04 (14.10) years. Scores from the LupusPRO-Sleep domain strongly correlated with insomnia scores, while LupusPRO-Vitality correlated strongly with fatigue (FACIT) and SF-36 vitality. The LupusPRO-Pain domain correlated strongly with pain (SF36 Bodily-Pain, Pain Inventory) scores. Similarly, the LupusPRO domains of Physical and Emotional Health had significant correlations with corresponding SF-36 domains. The ICR for HRQoL and non-HRQoL were 0.96 and 0.81. LupusPRO (domains HRQoL and QoL) scores correlated with disease activity. Principal component analysis included seven factor loadings presenting for the HRQOL subscales (combined Sleep, Vitality, and Pain), and three factors for the NHRQoL (Combined Coping and Social Support). Conclusions LupusPRO v1.8 (including its Sleep, Vitality, and Pain domains) has acceptable reliability and validity. Use of LupusPRO as an outcome measure in clinical trials would facilitate responsiveness assessment.
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Affiliation(s)
- D R Azizoddin
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - S Weinberg
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - N Gandhi
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - S Arora
- 2 Division of Rheumatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - J A Block
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - W Sequeira
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - M Jolly
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
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28
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Georgopoulou S, Efraimidou S, MacLennan SJ, Ibrahim F, Cox T. The relationship between social support and health-related quality of life in patients with antiphospholipid (hughes) syndrome. Mod Rheumatol 2017; 28:147-155. [DOI: 10.1080/14397595.2017.1317319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sofia Georgopoulou
- Academic Department of Rheumatology, King’s College London, School of Medicine, London, United Kingdom
| | - Sofia Efraimidou
- Centre for Sustainable Working Life, Birkbeck University of London, United Kingdom
| | | | - Fowzia Ibrahim
- Academic Department of Rheumatology, King’s College London, School of Medicine, London, United Kingdom
| | - Thomas Cox
- Centre for Sustainable Working Life, Birkbeck University of London, United Kingdom
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29
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Lai JS, Beaumont JL, Jensen SE, Kaiser K, Van Brunt DL, Kao AH, Chen SY. An evaluation of health-related quality of life in patients with systemic lupus erythematosus using PROMIS and Neuro-QoL. Clin Rheumatol 2016; 36:555-562. [PMID: 27848056 DOI: 10.1007/s10067-016-3476-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/12/2016] [Accepted: 11/04/2016] [Indexed: 01/09/2023]
Abstract
Systemic lupus erythematosus (SLE) is a multi-organ chronic autoimmune disease that can negatively affect patients' health-related quality of life (HRQOL). This study evaluated HRQOL of SLE patients using questionnaires from the Patient-Reported Outcomes Measurement Information System (PROMIS) and Quality of Life in Neurological Disorders (Neuro-QoL). Individuals with SLE completed an online survey consisting of the PROMIS-29 health profile, PROMIS Psychosocial Illness Impact-Negative, and Neuro-QoL Applied Cognition. PROMIS and Neuro-QoL scores have a mean of 50 in the US general population. Patients self-rated SLE disease severity as negligible, mild, moderate, or severe. Of the 333 participants (mean age 45 years; 92% female; 26% Black; mean SLE disease duration 12 years, 56% with SLE disease severity as moderate or severe), mean HRQOL scores were worse than those of the general population by ≥0.5 SD with the greatest deficits observed in the domains of fatigue, applied cognition, psychosocial illness impact-negative, pain interference, and physical function. Greater SLE disease severity was associated with worse mean HRQOL scores (all p < 0.05). Pain severity was also associated with worse HRQOL scores on all domains (p < 0.05) except for satisfaction with social role. Test-retest reliability exceeded 0.70 for all PROMIS and Neuro-QoL scores. PROMIS-29 and Neuro-QoL are valid tools to assess HRQOL in patients with SLE. These patients reported substantial deficits that correlated with their SLE disease severity, with pain being an important independent contributor. These deficits should be monitored in SLE patients during their routine clinical care and evaluated when investigating new therapies.
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Affiliation(s)
- Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair, 19th Floor, Chicago, IL, 60611, USA.
| | - Jennifer L Beaumont
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair, 19th Floor, Chicago, IL, 60611, USA
| | - Sally E Jensen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair, 19th Floor, Chicago, IL, 60611, USA
| | - Karen Kaiser
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair, 19th Floor, Chicago, IL, 60611, USA
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30
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Rodríguez-Rivera DV, Rodríguez-Navedo Y, Nieves-Plaza M, Vilá LM. Patient-reported outcome measures in a population of medically indigent patients with systemic lupus erythematosus in Puerto Rico. SAGE Open Med 2016; 4:2050312116670927. [PMID: 27721978 PMCID: PMC5036258 DOI: 10.1177/2050312116670927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/28/2016] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine patient-reported outcomes measures in indigent patients with systemic lupus erythematosus receiving their healthcare through the Puerto Rico government managed care system and compare these measures with non-indigent patients treated in a private fee-for-service setting. Methods: A cross-sectional study was conducted in a cohort of 98 Puerto Ricans with systemic lupus erythematosus. Patients from the public group (n = 40) were treated in a university-based specialized systemic lupus erythematosus clinic and the private group (n = 58) in a community-based rheumatology practice. Demographic and clinical features and patient-reported outcomes measures per LupusPRO instrument were determined. LupusPRO captures quality-of-life measures in 12 domains. Differences among study groups were examined using chi-square, Fisher’s exact, t-tests, and the Wilcoxon signed-rank test. Results: The mean (standard deviation) age of the study population was 44.9 (12.0) years; 94 (95.9%) were women. Patients in the public setting were younger and were more likely to have renal disease and elevated anti-double-stranded DNA antibodies, and being treated with azathioprine and cyclophosphamide. Patients from the public sector were more likely to have better quality-of-life measures in the LupusPRO domains of pain/vitality and coping. No significant differences were observed for the domains of lupus symptoms, physical health, emotional health, body image, cognition, procreation, lupus medications, desires/goals, social support, and satisfaction with medical care. Conclusion: Despite having a lower socioeconomic status and worse clinical status, systemic lupus erythematosus patients from the public sector had equal or better patient-reported outcomes measures than those treated in the private setting. This favorable outcome may be associated with the comprehensive healthcare received by these patients in a specialized lupus clinic.
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Affiliation(s)
- Diana V Rodríguez-Rivera
- Division of Rheumatology, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Yerania Rodríguez-Navedo
- Division of Rheumatology, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | - Luis M Vilá
- Division of Rheumatology, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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31
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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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Dendritic Cells in Systemic Lupus Erythematosus: From Pathogenic Players to Therapeutic Tools. Mediators Inflamm 2016; 2016:5045248. [PMID: 27122656 PMCID: PMC4829720 DOI: 10.1155/2016/5045248] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/13/2016] [Indexed: 12/20/2022] Open
Abstract
System lupus erythematosus (SLE) is a multifactorial systemic autoimmune disease with a wide variety of presenting features. SLE is believed to result from dysregulated immune responses, loss of tolerance of CD4 T cells and B cells to ubiquitous self-antigens, and the subsequent production of anti-nuclear and other autoreactive antibodies. Recent research has associated lupus development with changes in the dendritic cell (DC) compartment, including altered DC subset frequency and localization, overactivation of mDCs and pDCs, and functional defects in DCs. Here we discuss the current knowledge on the role of DC dysfunction in SLE pathogenesis, with the focus on DCs as targets for interventional therapies.
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Zhang X, Tian Y, Li J, Zhao X. Effect of targeted nursing applied to SLE patients. Exp Ther Med 2016; 11:2209-2212. [PMID: 27284302 PMCID: PMC4887837 DOI: 10.3892/etm.2016.3173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/18/2016] [Indexed: 01/23/2023] Open
Abstract
The aim of the present study was to evaluate the efficacy of targeted nursing for patients with systemic lupus erythematosus (SLE). A total of 114 patients clinically diagnosed with stable SLE were prospectively selected. The patients were randomly divided into the regular special nursing group, comprising 56 patients and the targeted nursing group (i.e., taylor made according to different pathogenic conditions and treatment period), comprising 58 patients. The patients received standard medical treatment for SLE, irrespective of their group, and the efficacy of targeted nursing on disease activity, incidence of complications, therapeutic compliance, quality of life and nursing satisfaction was compared with regular special nursing. The patients were followed up for a period of 20 months. The results showed that, disease activity and injury index score and incidence of complications were significantly less in the targeted nursing group than in the regular special nursing group (P<0.05). Additionally, therapeutic compliance, quality of life score and nursing content satisfaction were significantly higher in the targeted nursing group in comparison with the regular special nursing group (P<0.05). Thus, the results indicated that targeted nursing significantly improved therapeutic compliance and quality of life, and simultaneously, reduced complications and disease activity in patients receiving standard treatment for SLE.
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Affiliation(s)
- Xiangying Zhang
- Department of Rheumatism and Immunology, Binzhou People's Hospital, Binzhou, Shandong 256600, P.R. China
| | - Yali Tian
- Department of Pediatric Surgery, Binzhou People's Hospital, Binzhou, Shandong 256600, P.R. China
| | - Junbao Li
- Department of Emergency, Binzhou People's Hospital, Binzhou, Shandong 256600, P.R. China
| | - Xingli Zhao
- Department of Oncology, Binzhou People's Hospital, Binzhou, Shandong 256600, P.R. China
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Abstract
Up to 50% of patients with autoimmune diseases show an impairment of health-related quality of life and exhibit depression-like symptoms. The immune system not only leads to inflammation in affected organs, but also mediates behavior abnormalities including fatigue and depression-like symptoms. This review focuses on the different pathways involved in the communication of the immune system with the neuronal network and the body's timing system. The latter is built up by a hierarchically organized expression of clock genes. As discussed here, the activation of the immune system interferes with high amplitude expression of clock genes, an effect which may play a pivotal role in depression-like behavior in autoimmune diseases.
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Affiliation(s)
- Christopher R Pryce
- Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, Psychotherapy & Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Adriano Fontana
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
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Nishimura K, Omori M, Katsumata Y, Sato E, Kawaguchi Y, Harigai M, Yamanaka H, Ishigooka J. Psychological distress in corticosteroid-naive patients with systemic lupus erythematosus: A prospective cross-sectional study. Lupus 2015; 25:463-71. [PMID: 26527504 DOI: 10.1177/0961203315615223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Psychological distress, such as depression and anxiety, has been intensively studied in patients with systemic lupus erythematosus (SLE). However, those studies have mostly included patients who were treated with corticosteroids, which might themselves induce mood disturbances. We investigated psychological distress in corticosteroid-naive patients with SLE who did not exhibit any overt neuropsychiatric manifestations. METHODS Forty-three SLE in-patients with no current or past abnormal neuropsychiatric history participated in the study. Patients and 30 healthy control subjects with similar demographic and personality characteristics were administered a comprehensive battery of psychological/neuropsychological tests. The Profile of Mood States (POMS) was used to assess depression and anxiety. Results of clinical, laboratory, and neurological tests were compared with regard to their presence. RESULTS Prevalence of depression was higher in patients (n = 11, 25.6%) than in controls (n = 2, 6.7%; p = 0.035), although prevalence of anxiety did not differ across groups (patients: 34.9%, n = 15; controls: 16.7%, n = 5; p = 0.147). Using multiple logistic regression analysis, we identified avoidance coping methods (OR, 1.3; 95% CI 1.030-1.644; p = 0.027) as an independent risk factor for depression. CONCLUSION Our results indicate that depression presents more frequently in corticosteroid-naive patients with early-stage, active SLE than in the normal population, but anxiety does not. Depression may be related to psychological reactions to suffering from the disease.
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Affiliation(s)
- K Nishimura
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - M Omori
- Kanagawa Psychiatric Center, Yokohama, Japan
| | - Y Katsumata
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - E Sato
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Y Kawaguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - M Harigai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - J Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Tay SH, Cheung PPM, Mak A. Active disease is independently associated with more severe anxiety rather than depressive symptoms in patients with systemic lupus erythematosus. Lupus 2015; 24:1392-9. [DOI: 10.1177/0961203315591026] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 05/21/2015] [Indexed: 01/14/2023]
Abstract
Objective The inter-correlation between and co-existence of depression and anxiety may engender inconsistency in addressing the relationship between the severity of depression and disease activity of systemic lupus erythematosus (SLE). We aimed at identifying whether lupus disease activity is independently associated with depression and anxiety in lupus patients. Methods Adult lupus patients were assessed for the severity of depressive and anxiety symptoms and lupus disease activity by using the Hospital Anxiety and Depression Scale (HADS) and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), respectively. Age- and gender-matched healthy controls (HCs) were recruited for comparison. Prevalence and severity of depressive and anxiety symptoms were compared between lupus patients and HCs. Independent relationships between the severity of anxiety (HADS-Anxiety) and depressive (HADS-Depression) symptoms, and SLEDAI were studied with regression models. Results In total, 110 lupus patients and 110 HCs were studied. Lupus patients had significantly higher HADS scores than HCs (10.82 ± 6.5 vs 7.34 ± 4.9, p < 0.001). Significantly more lupus patients had anxiety (40.9 vs 21.8%, p = 0.002) and depressive symptoms (15.5 vs 6.4%, p = 0.025) than HCs. Multiple linear regression analyses revealed that SLEDAI (β = 0.160, p = 0.016), calcineurin inhibitor non-use (β = –1.929, p = 0.041) and past cyclophosphamide non-use (β = –1.603, p = 0.039) independently predicted HADS-Anxiety amongst lupus patients even after adjusting for HADS-Depression. Conversely, SLEDAI (β = 0.014, p = 0.834) lost its significant univariate correlation with HADS-Depression after controlling for HADS-Anxiety and other covariates. Conclusion Anxiety is more common in lupus patients than in HCs, and its severity is independently associated with more active SLE regardless of the presence or absence of concomitant depression.
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Affiliation(s)
- S H Tay
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P P M Cheung
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A Mak
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Pollard C, Hartz S, Leage SL, Paget MA, Cook J, Enstone A. Elicitation of health state utilities associated with varying severities of flares in Systemic Lupus Erythematosus. Health Qual Life Outcomes 2015; 13:66. [PMID: 26018556 PMCID: PMC4445979 DOI: 10.1186/s12955-015-0262-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background Systemic Lupus Erythematosus (SLE) is characterised by fluctuating periods of minimal disease activity and ‘flare’. Flare is an important outcome variable impacting the disease burden associated with SLE. The objective of this study was to obtain population-based utility values for varying severities of flare to measure the impact on health-related quality of life (HRQoL) in Australia, Canada, France, Japan, Spain and the UK. Methods Six health states (HS) for varying severities of flare were developed based on literature, patient blogs, and interviews with patients (n = 12), rheumatologists (n = 7) and nurses (n = 2). HS were validated by independent clinical experts (n = 6) and pilot interviews (n = 10, UK). HS were evaluated using the time-trade-off (TTO) method during face-to-face interviews with a minimum representative sample (n = 100) of the general population, per-country. Visual Analog Scale (VAS) scores were obtained to validate TTO scores. TTO scores were converted into utility values. Results The highest mean TTO utility scores were observed for the anchor HS (minimal disease activity) across all countries; means ranged from 0.66 in Japan to 0.82 in UK. All flare HS were associated with a disutility compared with the anchor HS (p < 0.001), means ranged across countries: mild flare HS: 0.55–0.71, moderate flare HS: 0.38–0.53, severe renal flare HS: 0.33–0.45, severe central nervous system (CNS) flare HS: 0.30–0.45 and severe generalised flare HS: 0.19–0.33. Mean VAS scores followed the same trend. Conclusions These results show increasing severity of flare has a detrimental impact on HRQoL. The severe generalised flare HS received the lowest mean utility score suggesting that the perceived day-to-day impact of a severe generalised flare was greater than a severe CNS or severe renal flare. This is, to the best of our knowledge, the first utility study to assess varying severities of flare in SLE across six different countries.
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Affiliation(s)
- C Pollard
- Adelphi Values, Adelphi Mill, Bollington, Macclesfield, SK10 5JB, Cheshire, UK.
| | - S Hartz
- Eli Lilly, Erl Wood Manor, Windlesham, GU20 6PH, Surrey, UK.
| | - S Liu Leage
- Eli Lilly, Erl Wood Manor, Windlesham, GU20 6PH, Surrey, UK.
| | - M A Paget
- Eli Lilly, Erl Wood Manor, Windlesham, GU20 6PH, Surrey, UK.
| | - J Cook
- Adelphi Values, Adelphi Mill, Bollington, Macclesfield, SK10 5JB, Cheshire, UK.
| | - A Enstone
- Adelphi Values, Adelphi Mill, Bollington, Macclesfield, SK10 5JB, Cheshire, UK.
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Zirkzee EJM, Ndosi ME, Vliet Vlieland TPM, Meesters JJL. Measuring educational needs among patients with systemic lupus erythematosus (SLE) using the Dutch version of the Educational Needs Assessment Tool (D-ENAT). Lupus 2014; 23:1370-6. [PMID: 25059487 DOI: 10.1177/0961203314544188] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The Educational Needs Assessment Tool (ENAT) was developed in the United Kingdom (UK) to systematically assess the educational needs of patients with rheumatic diseases. The aim of the present study was to describe the educational needs of Dutch patients with systemic lupus erythematosus (SLE) by means of a Dutch version of the ENAT (D-ENAT). METHODS The D-ENAT was sent to a random sample of 244 SLE patients registered at the outpatient clinic of a university hospital. D-ENAT consists of 39 items in seven domains. The D-ENAT domain scores range from 0-16 to 0-28 (higher scoring equals higher educational needs) depending of the number of items in the domain. A total D-ENAT score (0-156) is calculated by summing all 39 items. In addition, age, disease duration, gender, educational level, present information need (yes/no) and the extent of information need (1-4: nothing-everything) were recorded. Univariate regression analysis was used to examine the D-ENAT's potential determinants. RESULTS The response rate was 122 out of 244 (50%). The mean (% of maximum score) educational needs scores were 56% for 'D-ENAT total score', 62% for 'Self-help measures', 60% for 'Disease process', 58% for 'Feelings', 56% for 'Treatments', 50% for 'Movement', 49% for 'Support systems' and 46% for 'Managing pain'. Being female was significantly associated with higher scoring on the D-ENAT total score (β 23.0; 95% CI 5.9, 40.3). CONCLUSION SLE patients demonstrated substantial educational needs, especially in the domains: 'Self-help measures', 'Disease process' and 'Feelings'. The validity and practical applicability of the D-ENAT to make an inventory of SLE patients' educational needs requires further investigation.
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Affiliation(s)
- E J M Zirkzee
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - M E Ndosi
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - T P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden Sophia Rehabilitation Center, The Hague, The Netherlands Rijnlands Rehabilitation Center, Leiden, The Netherlands
| | - J J L Meesters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden Sophia Rehabilitation Center, The Hague, The Netherlands
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Wang SL, Wu B, Zhu LA, Leng L, Bucala R, Lu LJ. Construct and criterion validity of the Euro Qol-5D in patients with systemic lupus erythematosus. PLoS One 2014; 9:e98883. [PMID: 24892282 PMCID: PMC4043925 DOI: 10.1371/journal.pone.0098883] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/08/2014] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the construct and criterion validity of the Euro Qol-5D (EQ-5D), which allows quality-adjusted life-years to be calculated, in patients with systemic lupus erythematosus (SLE). Methods Consecutive SLE patients who had been followed at the Renji Hospital, School of Medicine, Shanghai Jiao Tong University were recruited. Cross-sectional correlations of the EQ-5D with equivalent domains in disease-specific health-related quality of life (HRQoL), LupusQol, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) measures, the Systemic Lupus International Collaborating Clinics Damage Index (SDI), and patient characteristics were tested. Discriminant validity to assess the ability to distinguish between patients of different disease severity was assessed. There also were evaluations of ceiling and floor effects. Results 240 patients were recruited in total. The EQ-5D correlated moderately to strongly with all domains of the LupusQoL (r: 0.44–0.7) apart from intimate relationships (r = 0.25) and body image (r = 0.18). There was moderate negative correlation between EQ-5D and clinical assessment of disease, SLEDAI (r = −0.589) and SDI (r = −0.509). When compared with equivalent domains on LupusQoL, there was good construct validity in EQ-5D (r: 0.631–0.812). EQ-5D could also discriminate patients with varied disease severity (according SLEDAI and SDI). There was no floor effect in EQ-5D but the ceiling effect remains strong (34%). Conclusion Our results provide sufficient evidence that the EQ-5D displays construct and criterion validity for use in SLE patients. Disease-specific measures of HRQoL used alongside may be a better choice.
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Affiliation(s)
- Su-li Wang
- Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Wu
- Clinical Outcomes and Economics Group, Department of pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-an Zhu
- Department of Medicine, Section of Rheumatology, Yale University School of Medicine, The Anlyan Center, New Haven, Connecticut, United States of America
| | - Lin Leng
- Department of Medicine, Section of Rheumatology, Yale University School of Medicine, The Anlyan Center, New Haven, Connecticut, United States of America
| | - Richard Bucala
- Department of Medicine, Section of Rheumatology, Yale University School of Medicine, The Anlyan Center, New Haven, Connecticut, United States of America
| | - Liang-jing Lu
- Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
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