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Yan Q, Liu J, Long X, Wu C, Lin D, Wu Y, Gao F, Zhang L, Chen N. Tofacitinib therapy in systemic lupus erythematosus with arthritis: a retrospective study. Clin Rheumatol 2024; 43:3139-3145. [PMID: 39136836 DOI: 10.1007/s10067-024-07103-2] [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: 06/20/2024] [Revised: 08/03/2024] [Accepted: 08/06/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVE To estimate the effectiveness and safety of tofacitinib in treating systemic lupus erythematosus (SLE) patients with arthritis. METHODS This research was a retrospective cohort study that focused on SLE patients who had arthritis and were treated with tofacitinib at the Department of Rheumatology and Immunology from January 2020 to January 2022. Clinical outcomes, disease activity, immunological parameters, and adverse events were systematically evaluated pre- and post-treatment at 4, 12, and 24 weeks. RESULTS Twenty-two patients were analyzed. At the 4-week mark, 5 (22.7%) patients were partially relieved, and 17 (77.3%) unalleviated. By the 12-week assessment, CR off corticosteroids was observed in four patients (18.2%), and CR on corticosteroids was seen in six patients (27.3%), with an additional six (27.3%) maintaining partial remission. At 24 weeks after treatment, three patients (13.6%) achieved CR off corticosteroids, ten patients (45.5%) achieved CR on corticosteroids, and all patients received remission. Compared to before treatment, The SLEDAI and PGA scores significantly improved. The level of C3 was increased significantly, and the absolute CD3+ T cell count, the 28-tender and the 28-swollen joint count, and the levels of serum IL-6 were significantly decreased at 24 weeks after treatment. CONCLUSION Tofacitinib demonstrates significant therapeutic potential in SLE patients with arthritis, with a safety profile, and the therapeutic mechanism of tofacitinib may be related to reducing IL-6 expression and inhibiting T cell activation. Key Points • Tofacitinib demonstrates significant therapeutic potential in SLE patients with arthritis • The therapeutic mechanism of tofacitinib may be related to reducing IL-6 expression and inhibiting T cell activation.
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Affiliation(s)
- Qing Yan
- Department of Rheumatology and Immunology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Jianwen Liu
- Department of Rheumatology and Immunology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Xianming Long
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chenmin Wu
- Department of Rheumatology and Immunology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Diantian Lin
- Department of Rheumatology and Immunology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Yanfang Wu
- Department of Rheumatology and Immunology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Fei Gao
- Department of Rheumatology and Immunology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Li Zhang
- Department of Nephrology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China.
| | - Ning Chen
- Department of Infectious Diseases, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China.
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Şahin N, Uçak K, Atamyıldız Uçar S, Sönmez HE, Sözeri B. Impact of perception of illness on quality of life in juvenile systemic lupus erythematosus. Lupus 2024:9612033241285622. [PMID: 39288787 DOI: 10.1177/09612033241285622] [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: 09/19/2024]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs, notably the skin, joints, and kidneys. The primary goal in managing SLE is to enhance patients' quality of life (QoL). Illness perception can influence QoL in patients with chronic disease. We assessed illness perception in juvenile SLE (jSLE) patients and its effect on patient's and parental QoL. METHOD Patients diagnosed with jSLE according to the SLICC 2012 criteria between January and November 2023 were included. Patients' illness perceptions were gaged using the brief illness perception questionnaire (B-IPQ), while patient's and parental QoL were evaluated using PedsQL and WHOQOL- BREF, respectively. RESULTS The study comprised 32 patients and 32 parents, predominantly female (78.1%). Musculoskeletal involvement was the most common (65.6%), followed by mucocutaneous (59.4%), renal, and hematological involvement (50% each). Neuropsychiatric involvement was absent. The median SLEDAI-2K score at the last outpatient clinic visit, which was documented in the patient's file was 2 (0-18) and was not correlated with the B-IPQ score (r = 0.121, p = .51). A significant negative correlation was found between B-IPQ and patient QoL, indicating poorer QoL in patients with negative illness perceptions (r = -0.576, p < .001). No correlation was observed between parental QoL and B-IPQ (p => .05). Of note, 56.3% of patients had poor QoL, scoring below the PedsQL cut-off, while 43.8% of parents had poor QoL for general health, scoring below the WHOQOL-BREF cut-off for general health. CONCLUSION Although disease perception did not correlate with disease activation in jSLE, it significantly impacted patient QoL. Enhancing patients' perceptions of jSLE may improve their overall QoL.
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Affiliation(s)
- Nihal Şahin
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kübra Uçak
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Sıla Atamyıldız Uçar
- Department of Pediatric Rheumatology, Ümraniye Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, Ümraniye Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
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Eid R, Hammad A, Korkor MS, Fathy AA, Abd El-Ghafaar DM, Rakha S, Hamdy N. Health Related Quality of Life in Juvenile-Onset Systemic Lupus Erythematosus: A Questionnaire-Based Study. Matern Child Health J 2023:10.1007/s10995-023-03680-x. [PMID: 37308717 DOI: 10.1007/s10995-023-03680-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to evaluate health related quality of life (HRQOL) in Egyptian children with systemic lupus erythematosus (SLE) using 3 different tools. METHODS In this questionnaire-based study, 100 children with SLE were included. HRQOL was assessed using the Pediatric Quality of Life Inventory Generic Core Scales (PedsQL™ 4.0 GCS), PedsQL™ 3.0 Rheumatology Module (PedsQL3-RM) and the Simple Measure of the Impact of Lupus Erythematosus in Youngsters (SMILEY). SLE disease activity index (SLEDAI) was used to evaluate activity and SLE International Collaborating Clinics/ American College of Rheumatology Damage Index (SDI) was used to evaluate chronic damage. RESULTS All mean scores of PedsQLTM4.0 GCS domains in SLE patients were lower than published normative data and previously published results of Egyptian healthy controls (p < 0.001). All mean scores of PedsQL-3RM domains were significantly lower than published normative data except for the treatment and pain and hurt domains (p = 0.1, 0.2 respectively). SMILEY scores were low and the lowest domain scores was "Burden of SLE". Longer duration of illness, higher cumulative steroid doses, higher SLEDAI and SDI scores and presence of obesity were associated with lower scores for all 3 tools (p < 0.001). CONCLUSION FOR PRACTICE The Arabic copies of PedsQL™ 4.0 GCS, PedsQL3-RM and SMILEY are easily used for Arabic speaking subjects and easily interpreted by physician and can be implemented for frequent monitoring of SLE HRQOL. Controlling the disease activity and using lowest doses of steroids and other immunosuppressive drugs are the corner stone strategies for improving HRQOL in SLE children.
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Affiliation(s)
- Riham Eid
- Pediatric Nephrology Unit, Faculty of Medicine, Mansoura University Children's Hospital, Mansoura University, Mansoura, 35561, Egypt.
| | - Ayman Hammad
- Pediatric Nephrology Unit, Faculty of Medicine, Mansoura University Children's Hospital, Mansoura University, Mansoura, 35561, Egypt
| | - Mai S Korkor
- Pediatric Nephrology Unit, Faculty of Medicine, Mansoura University Children's Hospital, Mansoura University, Mansoura, 35561, Egypt
| | - Aya A Fathy
- Public Health and Community Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Dena M Abd El-Ghafaar
- Rheumatology, Rehabilitation and Physical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Shaimaa Rakha
- Pediatric Cardiology Unit, Faculty of Medicine, Mansoura University Children's Hospital, Mansoura University, Mansoura, Egypt
| | - Nashwa Hamdy
- Pediatric Nephrology Unit, Faculty of Medicine, Mansoura University Children's Hospital, Mansoura University, Mansoura, 35561, Egypt
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Blamires J, Foster M, Napier S, Dickinson A. Experiences and Perspectives of Children and Young People Living with Childhood-Onset Systemic Lupus Erythematosus-An Integrative Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1006. [PMID: 37371240 PMCID: PMC10297543 DOI: 10.3390/children10061006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) impacts the daily life of children and young people. This study aimed to describe the experiences and perspectives of children and young people living with cSLE. An integrative review guided by Whittemore and Knafl was conducted. Extant empirical research published in peer-reviewed journals from 2000 to 2021 on children's self-reported experiences living with cSLE was identified from Scopus, CINAHL, Medline via PubMed, and PsycINFO via Ovid databases. Nineteen studies involving over 1400 participants were included. Four themes and fourteen sub-themes were identified: (1) challenging symptoms (disruptions to life and altered self, severity, fatigue, depression, and anxiety), (2) medicines and side effects (dreaded steroids, conflicting feelings, and medication adherence), (3) complicated life (school sports and social, giving things up, lack of understanding, and quality of life) and (4) ways of coping (family and friends, relationships with health providers, and maintaining positivity). While cSLE shares many similarities with adult-onset SLE, awareness of differences in experiences and perceptions of children and young people is crucial. The significant psychological and social impact of the disease and its treatments necessitates a comprehensive, holistic approach to managing cSLE that considers the unique needs of youth.
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Affiliation(s)
- Julie Blamires
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand; (M.F.)
| | - Mandie Foster
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand; (M.F.)
- School of Nursing and Midwifery, Edith Cowan University, Perth 6027, Australia
| | - Sara Napier
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand; (M.F.)
| | - Annette Dickinson
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand; (M.F.)
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Trieste L, Cannizzo S, Palla I, Triulzi I, Turchetti G. State of the art and future directions in assessing the quality of life in rare and complex connective tissue and musculoskeletal diseases. Front Med (Lausanne) 2022; 9:986218. [PMID: 36213631 PMCID: PMC9537631 DOI: 10.3389/fmed.2022.986218] [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: 07/04/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background As chronic conditions, rare and complex connective tissue and musculoskeletal diseases (rCTDs) significantly affect the quality of life generating an impact on the physical, psychological, social, and economic dimensions of the patients' lives, having implications on the family, changing the lifestyle and interpersonal relationships. Traditionally, generic and disease-specific measures for Quality of Life (QoL) provide valuable information to clinicians since QoL affects healthcare services utilization, predicts morbidities and mortalities, workability, etc. Moreover, the assessment of unmet clinical needs, satisfaction, the experience with the treatment and the care, the psychological dimensions, and the effects of the diseases, such as fatigue, could represent valuable dimensions to be considered in the QoL impact assessment. It is also necessary to measure the impact of rCTDs by considering the perspectives of family members/informal caregivers, for instance considering values, beliefs, experiences, life circumstances, psychological aspects, family relationships, economic issues, changes in social activities, etc. Objective The aim of this scoping review is to better understand the status of QoL metrics used in clinical and economic research for the assessment of the individual's perspective on living with rCTDs. Research question What are the main challenges in QoL measures (and/or) measurement/assessment in rCTDs? Materials and methods Scoping review of the literature referring to QoL measures in rCTDs. Database: PUBMED, ISI-Web of Science; last date: 21/09/2021. Results Anxiety and depression, body image satisfaction, daily activity, fatigue, illness perception, pain, personality, QoL, resilience, satisfaction with the relationship, self-management, sexual QoL, sleep quality, social support, stress, uncertainty, and work productivity are the observed dimensions covered by the included studies. However, "more shadows than lights" can summarize the review's outcome in terms of Patient Reported Outcome Measures (PROMs) domains covered for each of the rCTDs. Also, for those diseases characterized by a relatively high prevalence and incidence, such as Systemic Lupus Erythematosus, Sjögren's Syndrome, and Systemic Sclerosis, the analysis of patients' resilience, satisfaction with the quality of the relationship, personality, and stress are still missing dimensions. It has been observed how reducing items, increasing the number of domains, and disease-specific questionnaires characterize the "technological trajectory," such as the evolution of questionnaires' characteristics for assessing QoL and QoL-related dimensions and the burden of rCTDs. Conclusion The scoping review presents an overview of studies focused on questionnaires used to evaluate the different dimensions of quality of life in terms of general instruments and disease-specific questionnaires. Future research should include the co-design with patients, caregivers, and patient representatives to create questionnaires focused on the unmet needs of people living with rCTDs.
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Borgia RE, Ugarte-Gil MF, Vilá LM, Reveille JD, McGwin G, Alarcón GS. Health-Related Quality of Life in Adults With Adolescent- and Adult-Onset Systemic Lupus Erythematosus: A Longitudinal Study of a Multiethnic US Cohort. Arthritis Care Res (Hoboken) 2022. [PMID: 36039942 DOI: 10.1002/acr.25006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/27/2022] [Accepted: 08/25/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The long-term impact of childhood-onset systemic lupus erythematosus (SLE) on health-related quality of life (HRQoL) in adult SLE patients in comparison to those with adult-onset SLE is unknown. We aim to examine and compare HRQoL trajectories in adults with adolescent- and adult-onset SLE. METHODS Patients enrolled in the LUpus in MInorities: NAture versus Nurture cohort were included. Adolescent-onset SLE were those diagnosed before 24 years of age, and adult-onset SLE were those diagnosed otherwise. Sociodemographic, clinical, medications, behavioral/psychological, and functioning data were obtained. Longitudinal trajectories of the physical component summary (PCS) and the mental component summary (MCS) Short Form 36 health survey scores were compared between the groups using a linear mixed model accounting for time-dependent and independent covariates. RESULTS A total of 470 SLE patients were included (95 with adolescent-onset SLE and 375 with adult-onset SLE). The mean ± SD age at diagnosis was 19.7 ± 2.8 years in the adolescent group and 39.3 ± 11.0 years in the adult group. The baseline PCS scores were higher (better physical functioning) in adolescent-onset SLE than in adult-onset SLE (38.9 versus 34.3, respectively; P < 0.001); however, the baseline MCS scores were comparable between the groups (41.4 versus 40.5, respectively; P = 0.53). The HRQoL improved equally in both groups with no statistically significant difference within and between the groups (last mean PCS and MCS scores 43.9 and 45.3 in adolescent-onset SLE; 38.1 and 43 in adult-onset SLE). CONCLUSIONS Adults with adolescent-onset SLE exhibited better physical functioning than those in the adult SLE group, despite more severe disease; noteworthy, HRQoL was below the general US population, despite clinically meaningful improvement in HRQoL over time in both groups.
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Affiliation(s)
- R Ezequiel Borgia
- University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Manuel F Ugarte-Gil
- Hospital General Guillermo Almenara Irigoyen, EsSalud and Universidad Científica del Sur, Lima, Perú
| | - Luis M Vilá
- University of Puerto Rico, San Juan, Puerto Rico
| | | | | | - Graciela S Alarcón
- University of Alabama at Birmingham, Birmingham, and Universidad Peruana Cayetano Heredia, Lima, Perú
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González LA, Ugarte-Gil MF, Pons-Estel GJ, Durán-Barragán S, Toloza S, Burgos PI, Bertoli A, Borgia RE, Alarcón GS. Addressing health disparities as a function of ethnicity in systemic lupus erythematosus patients. Lupus 2022; 31:1691-1705. [PMID: 36036891 DOI: 10.1177/09612033221122983] [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
Systemic lupus erythematosus (SLE) is an autoimmune disorder with significant health disparities, as it disproportionately and more severely affects vulnerable and disadvantaged population groups in the United States and around the world, that is, women, ethnic minorities, individuals living in poverty, less educated, and lacking medical insurance. Both, genetic and non-genetic factors, contribute to these disparities. To overcome these health disparities and reduce poor outcomes among disadvantaged SLE populations, interventions on non-genetic amendable factors, especially on social health determinants, are necessary.
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Affiliation(s)
- Luis A González
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, 161932Universidad de Antioquia, Medellin, Antioquia, Colombia
| | - Manuel F Ugarte-Gil
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,Grupo Peruano de Estudio de Enfermedades Autoimmunes Sistémicas. Universidad Científica Del Sur, Lima, Perú
| | - Guillermo J Pons-Estel
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Sergio Durán-Barragán
- Clínica de Investigación en Reumatología y Obesidad S.C, Guadalajara, Jalisco, México.,Instituto de Investigación en Reumatología y Del Sistema Musculoesquelético, Departamento de Clínicas Médicas, 28033Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Sergio Toloza
- Department of Medicine, Rheumatology Unit, 297792Hospital San Juan Bautista, San Fernando del Valle de Catamarca, Catamarca, Argentina
| | - Paula I Burgos
- Department of Clinical Immunology and Rheumatology, School of Medicine, 3463Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Bertoli
- Sevicio de Reumatología, Clínica Universitaria Reina Fabiola, 9967Universidad Católica de Córdoba, Argentina
| | - R Ezequiel Borgia
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, College of Medicine, 3463University of Florida, Gainesville, FL, USA.,Department of Health Outcomes and Biomedical Informatics, 3463College of Medicine University of Florida, Gainesville, FL, USA
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano, Heredia, Lima, Perú
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Saez C, Nassi L, Wright T, Makris UE, Kramer J, Bermas BL, Solow EB, Bitencourt N. Therapeutic recreation camps for youth with childhood-onset systemic lupus erythematosus: perceived psychosocial benefits. Pediatr Rheumatol Online J 2022; 20:39. [PMID: 35672791 PMCID: PMC9171737 DOI: 10.1186/s12969-022-00702-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/02/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The psychosocial burden of having a chronic disease can be substantial for adolescents with childhood-onset systemic lupus erythematosus (cSLE). Current literature is scarce on interventions that can improve psychosocial outcomes for this population. Therapeutic recreation camps have been proposed as a beneficial experience for chronically ill pediatric populations. However, their effective components have not been well characterized in patients with cSLE. In this study, we sought to understand the various components of the camp experience for adolescents with cSLE from both the patient and parent perspective. METHODS We recruited patients with cSLE who had participated in one or more annual, weekend-long recreational lupus camp(s) near Dallas, Texas. Semi-structured in-depth telephone interviews were conducted from March-June 2020 with both the patients and parents. Questions focused on overall patient experience, psychosocial impact of camp participation, coping skills gained, and opportunities to prepare for the transition from pediatric to adult care. Interviews were coded and analyzed using inductive thematic analysis. RESULTS We interviewed 9 current and former campers (ages 16-24), including a current camp counselor, and 3 of their parents separately. Reported benefits included a positive impact on social support through peer bonding, opportunities to develop coping mechanisms through structured activities and peer/medical staff interactions, opportunities for education about the cSLE disease experience, improved adherence through peer modeling, overall increase in self-efficacy, and better parental insight into the patient experience. Participants also provided suggestions for expansion and improvement in program development to optimize educational opportunities for both campers and parents. In addition, they advocated for longitudinal social support and community building. CONCLUSIONS In this qualitative study, in which cSLE patients and their parents reflected on their experiences with therapeutic recreation camps, we found several perceived benefits impacting the patient and parent experience. Participants expressed a desire for more educational opportunities that could contribute to their successful transition from pediatric to adult care. Further studies are needed to demonstrate the effects of therapeutic recreation camps on the psychosocial health of this population.
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Affiliation(s)
- Cristina Saez
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA
| | - Lorien Nassi
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA ,grid.416991.20000 0000 8680 5133Texas Scottish Rite Hospital for Children, Dallas, Texas USA
| | - Tracey Wright
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA ,grid.416991.20000 0000 8680 5133Texas Scottish Rite Hospital for Children, Dallas, Texas USA
| | - Una E. Makris
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA ,grid.422201.70000 0004 0420 5441Veterans Administration North Texas Health Care System, Dallas, Texas USA
| | - Justin Kramer
- grid.264756.40000 0004 4687 2082Texas A&M University, College Station, Texas USA
| | - Bonnie L. Bermas
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA
| | - E. Blair Solow
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA
| | - Nicole Bitencourt
- Loma Linda University Medical Center, 11175 Campus Street, Coleman Pavilion, Loma Linda, CA, 92354, USA.
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Kifer N, Sestan M, Frkovic M, Kifer D, Kozmar A, Padjen I, Potocki K, Anic B, Batinic D, Malcic I, Jelusic M. 2019 ACR/EULAR classification criteria and therapy in predicting organ damage accrual in patients with childhood-onset systemic lupus erythematosus: A retrospective study over the last 29 years. Lupus 2022; 31:828-836. [PMID: 35410557 DOI: 10.1177/09612033221094707] [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
OBJECTIVE We explored damage occurrence in patients with childhood-onset SLE (cSLE) and aimed to predict the risk of organ damage occurrence in time. METHODS The retrospective study included patients treated for cSLE at the Centre of Reference for Pediatric and Adolescent Rheumatology of the Republic Croatia over a 29-year period. RESULTS The disease development of 97 patients (77 females) with cSLE was examined. The median (Q1, Q3) follow-up time was 6.5 (2.3, 12.0) years. SDI was determined at 5 time points (6, 12, 24, 36 months, and last follow-up). Thirty-eight patients (48%) had organ damage at the last follow-up. Prepubertal group of patients showed higher SLEDAI scores at the disease onset, while post-pubertal group had significantly lower proportion of patients with relapses. We estimated the time from the first symptom to the moment of damage and our findings suggest that it is unlikely that organ damage will occur in 50% of patients in the first 6 years since the diagnosis. The number of 2019 ACR/EULAR classification criteria at the time of diagnosis associated with SDI determined after 1 year of the follow-up period. The patients who received higher doses of glucocorticoids accumulated damage faster and mycophenolate mofetil was found to be a more frequent therapy in patients with SDI ≥3. CONCLUSION Knowing that damage will most likely happen after the first 6 years after diagnosis in 50% of patients enables physicians to better predict damage occurrence. High number of 2019 ACR/EULAR criteria and treatment with glucocorticoids in childhood-onset SLE are associated with damage accrual and these findings could enable us to detect patients which should be closely monitored for higher risk of damage development.
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Affiliation(s)
- Nastasia Kifer
- Division of Rheumatology and Immunology, Department of Pediatrics, 415458University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mario Sestan
- Division of Rheumatology and Immunology, Department of Pediatrics, 415458University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijan Frkovic
- Division of Rheumatology and Immunology, Department of Pediatrics, 415458University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Domagoj Kifer
- Department of Biophysics, 87162University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Ana Kozmar
- Department of Laboratory Diagnostics, 314581University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivan Padjen
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, 534752University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Kristina Potocki
- Diagnostic and Interventional Radiology Department, 415458University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Branimir Anic
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, 534752University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Drago Batinic
- Department of Laboratory Diagnostics, 314581University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivan Malcic
- Division of Rheumatology and Immunology, Department of Pediatrics, 415458University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marija Jelusic
- Division of Rheumatology and Immunology, Department of Pediatrics, 415458University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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Radin M, El Hasbani G, Barinotti A, Roccatello D, Uthman I, Taher A, Sciascia S. Quality of life measures in Systemic Lupus Erythematosus: A systematic review. Reumatismo 2022; 73. [DOI: 10.4081/reumatismo.2021.1447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
In this study we systematically investigated the health-related quality of life (HRQoL) tools, which have been most often used over the last five years to evaluate the QoL in patients with systemic lupus erythematosus (SLE), focusing on their items and applications. A detailed literature search was conducted: the inclusion criteria were as follows: 1) studies including at least 50 patients; 2) studies including at least 25 patients with SLE; 3) quality of life testing with validated measures. The systematic review was based on 119 studies for a total of 32,449 SLE patients and 3092 controls. A total of 35 different patients-reported quality of life measures, applied in cohorts of patients with SLE, were retrieved with the 36-item Medical Outcome Short Form (SF-36) (63 studies of 119 =52.95%), Lupus Quality of Life (LupusQoL) (17 studies =14.3%) and Lupus Patient-Reported Outcome (LupusPRO) (12 studies =10%) being the most commonly used tools. Overall, this systematic review of the literature indicated that quality of life in patients with SLE appears to be poor and generally lower compared to both the general population and patients with other chronic conditions, as was shown by a few studies that used SF-36 and LupusPRO. The use of HRQoL scoring in SLE is gaining increasing interest and is used both in randomized controlled trials and in real-life. Future efforts are needed to improve the understanding of the impact of the disease burden on quality of life from the patient’s perspective.
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11
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Zigler CK, Randell RL, Reeve BB. Assessing Patient-Reported Outcomes in Pediatric Rheumatic Diseases: Considerations and Future Directions. Rheum Dis Clin North Am 2022; 48:15-29. [PMID: 34798944 PMCID: PMC9311483 DOI: 10.1016/j.rdc.2021.09.008] [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: 02/03/2023]
Abstract
For children with pediatric rheumatic diseases (PRDs), the inclusion of patient-reported outcomes (PROs) is critical to inform decision making in health care delivery and research settings. PROs are direct reports from a child on their health status, without interpretation by anyone else. PROs improve understanding of the patient experience, allow clinicians to provide patient-centered care, and add value to clinical trials. When PROs cannot be collected directly from the patient, caregiver-proxy reports can provide important information on the child's more observable symptoms and functioning. In this article, we describe the current use of PROs in specific PRDs, align current research with best practice recommendations for both clinical care and research settings, highlight exciting new developments, and identify areas for future research.
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Affiliation(s)
- Christina K. Zigler
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Rachel L. Randell
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Bryce B. Reeve
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Pediatrics, Duke University School of Medicine, Durham, North Carolina
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12
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Rodríguez-Lozano AL, Rivas-Larrauri FE, García-de la Puente S, Alcivar-Arteaga DA, González-Garay AG. Prognostic Factors at Diagnosis Associated With Damage Accrual in Childhood-Onset Systemic Lupus Erythematosus Patients. Front Pediatr 2022; 10:849947. [PMID: 35529331 PMCID: PMC9074833 DOI: 10.3389/fped.2022.849947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To associate prognostic factors present at diagnosis with damage accrual in childhood-onset systemic lupus erythematosus (cSLE) patients. METHODS We designed a cohort study of eligible children age 16 or younger who fulfilled the 1997 American College of Rheumatology (ACR) classification criteria for SLE. Excluded were those with previous treatment of steroids or immunosuppressants. The diagnosis date was cohort entry. We followed up on all subjects prospectively for at least 2 years. Two experts assessed the disease activity with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Mexican-SLEDAI (MEX-SLEDAI) every 3-6 months. Damage was measured annually, applying Pediatric Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) to their last visit. We analyzed prognostic factors by relative risks (RR) and used logistic regression to construct the clinimetric table. RESULTS Ninety patients with a median age of 11.8 years at diagnosis had a SLEDAI score of 15.5 (2-40) and a MEX-SLEDAI score of 12 (2-29); and of them, forty-eight children (53%) had SDI ≥ 2. The associated variables to damage (SDI ≥ 2) are as follows: neurologic disease RR 9.55 [95% CI 1.411-64.621]; vasculitis RR 2.81 [95% CI 0.991-7.973], and hemolytic anemia RR 2.09 [95% CI 1.280-3.415]. When these three features are present at diagnosis, the probability of damage ascends to 98.97%. CONCLUSION At diagnosis, we identified neurologic disease, vasculitis, and hemolytic anemia as prognostic factors related to the development of damage in cSLE. Their presence should lead to a closer follow-up to reduce the likelihood of damage development.
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Affiliation(s)
- Ana Luisa Rodríguez-Lozano
- Servicio de Inmunología, Instituto Nacional de Pediatría, Ciudad de México, México; Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
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13
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Treemarcki EB, Hersh AO. Health-Related Quality of Life Measures in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:593-607. [PMID: 33091261 DOI: 10.1002/acr.24374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | - Aimee O Hersh
- University of Utah and Primary Children's Hospital, Salt Lake City
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14
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AlAhmed O, Sivaraman V, Moore-Clingenpeel M, Ardoin SP, Bout-Tabaku S. Autoimmune thyroid diseases, autoimmune hepatitis, celiac disease and type 1 diabetes mellitus in pediatric systemic lupus erythematosus: Results from the CARRA Legacy Registry. Lupus 2020; 29:1926-1936. [PMID: 33016198 DOI: 10.1177/0961203320961469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Polyautoimmunity (PA) with systemic lupus erythematosus (SLE) is reported as a poor prognostic factor, but little is known about its effect in childhood-onset SLE (cSLE). We describe PA in cSLE within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry and evaluate its association to lupus disease outcomes. METHODS CARRA Legacy Registry is the largest pediatric rheumatology registry that collected data at enrollment and every 6 months thereafter. We describe the co-occurrence of selected autoimmune disorders (autoimmune thyroid diseases, autoimmune hepatitis, celiac disease and type 1 diabetes mellitus) in cSLE. To assess outcomes, we studied measures of lupus disease activity, complications, and patient's quality of life (QoL). Comparisons by PA status were made using chi-square, Fisher's exact test, two-sample t-tests, Wilcoxon rank sum tests, and mixed effects models as appropriate. RESULTS 1285 patients met the American College of Rheumatology criteria for SLE. Of those, 388 (30%) had data on comorbidity. The prevalence of PA was 8.8%. Patients with PA reported more hospitalizations and aggressive immunotherapy use. SLEDAI and PGA scores improved over time, but did not differ by PA status. No significant differences were found in QoL measures or their trajectory over time by PA status. CONCLUSION In cSLE, PA is associated with more hospitalizations and aggressive immunotherapy use. Although lupus disease activity improved over time, patients' QoL neither improved over time nor differed by having other autoimmune disease. Prospective, case-control, long-term follow-up studies on cSLE are needed to validate our results. MESH KEY INDEXING TERMS Pediatric systemic lupus erythematosus; Autoimmune diseases; Outcome assessment.
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Affiliation(s)
- Ohoud AlAhmed
- Department of Rheumatology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vidya Sivaraman
- Department of Rheumatology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Stacy P Ardoin
- Department of Rheumatology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Rheumatology, Ohio State University Medical Center, Columbus, OH, USA
| | - Sharon Bout-Tabaku
- Division of Pediatric Rheumatology, Sidra Medicine, Doha, Qatar.,Department of Pediatrics, Weill Cornell Medicine, Doha, Qatar
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Abstract
Disparities in prevalence, disease severity, physical and mental morbidity, and mortality exist in childhood-onset systemic lupus (cSLE) that lead to worse outcomes in children with systemic lupus erythematosus from socially disadvantaged backgrounds. Important gaps exist in knowledge regarding many individual race/ethnicities across the globe, the interaction between race/ethnicity and poverty, and drivers for identified disparities. Large cSLE registries will facilitate investigating disparities in groups of patients that have yet to be identified. Social-ecological models can inform approaches to investigate, monitor, and address disparities in cSLE.
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16
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Tanaka Y, O'Neill S, Li M, Tsai IC, Yang YW. Systemic Lupus Erythematosus: Targeted literature review of the epidemiology, current treatment and disease burden in the Asia Pacific region. Arthritis Care Res (Hoboken) 2020; 74:187-198. [PMID: 32841537 DOI: 10.1002/acr.24431] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/09/2020] [Accepted: 08/18/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To understand the epidemiology, current treatment and disease burden of systemic lupus erythematosus (SLE) in the Asia Pacific region (APAC). METHODS A targeted literature review of published evidence on SLE in APAC was conducted, using the MEDLINE® database (2008-2018), conference proceedings and other supplementary sources. RESULTS The review identified 70 studies conducted in China (n=15), Japan (n=13), Taiwan (n=12), Korea (n=9), Australia (n=7), Hong Kong (n=6), Singapore (n=4), and multiple places within the APAC region (n=4). Incidence rates (per 100,000 per year) ranged from 0.9-8.4, while prevalence rates ranged from 3.7-127 (per 100,000); however, recent data was limited. Asian SLE patients were reported to have higher disease severity, activity (higher SLE disease activity index scores) and organ damage accrual; along with increased morbidity, mortality, and susceptibility to renal involvement compared with other ethnicities in APAC. The risk of developing SLE is higher in the Asian population. Routinely used SLE therapies included belimumab, hydroxychloroquine, cyclophosphamide, tacrolimus, azathioprine, mycophenolate mofetil, and corticosteroids; however, prescribing patterns varied across the region. Increased disease activity was associated with high economic burden and poor quality of life for SLE patients in APAC. CONCLUSION SLE remains a disease with a significant unmet medical need for an innovative therapy that is well-tolerated and effective for patients in APAC. Further evidence is required to better characterize the disease and fully capture the burden and impact of SLE in APAC. This review has highlighted where there is a paucity of data from patients across the APAC region.
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Affiliation(s)
- Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Sean O'Neill
- Department of Rheumatology, Royal North Shore Hospital, Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - I-Ching Tsai
- Janssen: Pharmaceutical Companies of Johnson & Johnson, 11F, No.2, Sec.3, Minsheng East Rd, Taipei City, Taiwan
| | - Ya-Wen Yang
- Janssen Global Services, LLC, Horsham, PA, USA
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Groot N, Kardolus A, Bijl M, Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Burdorf A, Bultink IE, Kamphuis S. Effects of Childhood-onset Systemic Lupus Erythematosus on Academic Achievements and Employment in Adult Life. J Rheumatol 2020; 48:915-923. [PMID: 32739896 DOI: 10.3899/jrheum.191004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Long-term outcome data in adults with childhood-onset systemic lupus erythematosus (cSLE) are limited. Here, we report the effects of cSLE on education, vocation, and employment in a large cohort of adults with cSLE. METHODS Patients were seen for a single study visit comprising a structured history and physical examination. Medical records were retrieved to supplement information obtained during the study visit. Education and employment status were assessed by questionnaires. Health-related quality of life (HRQOL) was measured with the 36-Item Short Form Health Survey (SF-36). RESULTS One hundred six patients with cSLE (93% female, 73% White), with a median disease duration of 20 years, completed the visit and questionnaires. Almost all patients stated that cSLE had influenced their education, but the level of completed education was similar to the general Dutch population. Half of the patients had adjusted their vocational choice due to the disease. Still, 44% of patients who had finished education did not have a paid job. Of the employed patients, 61% worked part time. Disease damage was equally prevalent in patients with and without paid employment. A high percentage of patients (51%) were declared work disabled, due to disease damage. Patients who did not have paid employment were often work disabled. Both had a negative effect on HRQOL. CONCLUSION The effect of cSLE on academic achievements and employment is substantial, despite patients adjusting their educational and vocational choices. To optimize participation in the community, ongoing support is necessary, not only to help patients find suitable education and vocations but also to offer guidance regarding potential adjustments during their career.
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Affiliation(s)
- Noortje Groot
- N. Groot, MD, PhD, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, and Department of Pediatric Immunology, Wilhemina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne Kardolus
- A. Kardolus, MD, MSc, S. Kamphuis, MD, PhD, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marc Bijl
- M. Bijl, MD, PhD, Department of Internal Medicine and Rheumatology, Martini Hospital, Groningen, the Netherlands
| | - Radboud J E M Dolhain
- R.J.E.M. Dolhain, MD, PhD, Department of Rheumatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Y K Onno Teng
- Y.K.O. Teng, MD, PhD, Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Els Zirkzee
- E. Zirkzee, MD, PhD, Department of Rheumatology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Karina de Leeuw
- K. de Leeuw, MD, PhD, Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
| | - Ruth Fritsch-Stork
- R. Fritsch-Stork, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands, and 1st Medical Department & Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Center, Meidling, Hanusch Hospital, and Sigmund Freud University, Vienna, Austria
| | - Alex Burdorf
- A. Burdorf, PhD, Professor, Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Irene E Bultink
- I.E. Bultink, MD, PhD, Amsterdam Rheumatology and Immunology Center, Location VUmc, Amsterdam, the Netherlands
| | - Sylvia Kamphuis
- A. Kardolus, MD, MSc, S. Kamphuis, MD, PhD, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands;
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Abstract
PURPOSE OF REVIEW Provide an update of studies published in last 2 years on the outcomes and therapies in childhood-onset systemic lupus erythematous (cSLE). RECENT FINDINGS Additional evidence has been provided about the benefits of universal hydroxychloroquine in SLE patients, although antimalarial maculopathy may be more prevalent than previously thought. Recent studies support lower glucocorticoid doses than used in the past may provide comparable therapeutic benefits, and cSLE patients can mount adequate immunogenic response and sustain long-term seroprotective titers when vaccinated. Long-term studies of adults with cSLE confirmed that damage accrual increases with disease duration. Cardiovascular disease, renal transplants, replacement arthroplasties, and myocardial infarctions occur between 20 and 40 years of age. Higher prednisone doses predicted higher damage trajectory and antimalarial exposure was protective. There were no prospective clinical trials published in pediatric patients with cSLE, but positive results from phase II trials with bariticinib and ustekinumab in adult SLE may raise the expectation that these drugs could be beneficial when used in cSLE. SUMMARY The dire need for more clinical trials and licensed medications for cSLE persist as well as decreasing damage accrual.
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19
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Cintrón D, Alanis JM, Álvarez-Villalobos N, Rodríguez-Gutiérrez R, Vilá LM. A systematic review of pharmacological therapies and their effectiveness on health-related quality of life outcomes in patients with juvenile-onset systemic lupus erythematosus. Lupus 2020; 29:303-310. [PMID: 32031032 DOI: 10.1177/0961203320904145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Juvenile-onset systemic lupus erythematosus (JSLE) presents with an aggressive course and high morbidity associated with disease and treatment. JSLE patients have a poorer health-related quality of life (HRQoL) when compared with age-matched patients with other rheumatologic disorders. We aim to summarize the impact of current pharmacological therapies on the HRQoL of JSLE patients. Search strategies were developed across seven databases. Randomized clinical trials (RCTs) and cohort studies comparing interventions to standard therapy, placebo or pre-post cohort comparisons for more than 4 weeks were included. The outcome included self-reported scales compared at baseline and a therapeutic time point. Risk of bias was evaluated by using the Cochrane risk of bias tool and the Newcastle-Ottawa quality assessment scale. A total of 2812 articles were narrowed down to 309 for full-text screening. Four RCTs and one prospective cohort study, with a total of 634 JSLE patients, met the inclusion criteria. Four of the studies had a controlled intervention plus standard therapy compared with standard therapy alone or placebo. Multiple indices were used to evaluate HRQoL. These included the Pediatric Quality of Life Inventory, Childhood Health Assessment Questionnaire, Simple Measure of Impact of Lupus Erythematosus in Youngsters tool, Kids Fatigue Severity Scale and Child Depression Inventory. A single study reported a significant improvement while remaining studies reported no difference or failed to report the statistical analysis. Although HRQoL is significantly impaired in JSLE, evidence regarding its improvement is limited due to the small number of eligible studies, heterogeneity in scales, and HRQoL domains. A universal HRQoL questionnaire for JSLE needs to be established and used in both the research and clinical setting. All studies should adhere to reporting guidelines.
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Affiliation(s)
- D Cintrón
- Internal Medicine-Pediatrics Residency Program, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - J M Alanis
- Clinical Research Unit, "Dr José E González" University Hospital, Autonomous University of Nuevo León, Nuevo León, Mexico
| | - N Álvarez-Villalobos
- Clinical Research Unit, "Dr José E González" University Hospital, Autonomous University of Nuevo León, Nuevo León, Mexico
| | - R Rodríguez-Gutiérrez
- Clinical Research Unit, "Dr José E González" University Hospital, Autonomous University of Nuevo León, Nuevo León, Mexico.,Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - L M Vilá
- Division of Rheumatology, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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20
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Quilter MC, Hiraki LT, Korczak DJ. Depressive and anxiety symptom prevalence in childhood-onset systemic lupus erythematosus: A systematic review. Lupus 2019; 28:878-887. [PMID: 31188723 DOI: 10.1177/0961203319853621] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Depressive and anxiety symptoms are common in children and youth and may impact outcomes for individuals with childhood-onset systemic lupus erythematosus. Research into the prevalence of depressive and anxiety symptoms and childhood-onset systemic lupus erythematosus comorbidity has reported conflicting results. OBJECTIVE To synthesize current knowledge regarding the prevalence of depressive and anxiety symptoms in childhood-onset systemic lupus erythematosus. METHODS Studies were identified through a comprehensive search of MEDLINE, EMBASE, PsychINFO, LILACS and Web of Science (from database inception to July 2018) using MESH headings and keywords for 'lupus erythematosus', and 'depression' or 'anxiety'. Included studies measured depressive and/or anxiety symptoms prospectively among children and youth aged 8 to 21 years with a diagnosis of childhood-onset systemic lupus erythematosus. Neuropsychiatric systemic lupus erythematosus was included. Studies without use of validated screening tools for major depressive disorder or anxiety disorders were excluded, as were studies where diagnosis was by retrospective analysis of patient charts. Data were extracted by two independent coders and where discrepancies occurred, agreement was reached by consensus. RESULTS In total, 70 studies met the criteria for full text review and of these, 14 were included in the final analysis. The majority (70%) of studies were of cross-sectional design, with sample sizes ranging from 20 to 100 (mean = 48) participants. The mean age of participants was 15.9 years and participants were predominantly female. Prevalence rates for depressive symptoms ranged from 6.7% to 59%. Anxiety symptom prevalence was 34% to 37%. All studies employed self-report instruments to assess depressive and anxiety symptoms; none of the studies utilized a semi-structured diagnostic interview to make psychiatric diagnoses. Significant heterogeneity precluded meta-analysis of the data. CONCLUSIONS Depressive and anxiety symptoms may be common comorbidities of childhood-onset systemic lupus erythematosus; however, current research is limited by a paucity of studies, small sample sizes and an inability to confirm psychiatric diagnoses. Future research addressing these limitations is needed.
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Affiliation(s)
- M C Quilter
- 1 Department of Psychiatry, Hospital for Sick Children, Toronto, Canada.,2 Department of Psychiatry, University of Toronto, Canada
| | - L T Hiraki
- 3 Department of Rheumatology, Hospital for Sick Children, Toronto, Canada
| | - D J Korczak
- 1 Department of Psychiatry, Hospital for Sick Children, Toronto, Canada.,2 Department of Psychiatry, University of Toronto, Canada
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Quality of life among female patients with systemic lupus erythematosus in remission. Rheumatol Int 2019; 39:1351-1358. [PMID: 31129711 DOI: 10.1007/s00296-019-04329-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/17/2019] [Indexed: 12/13/2022]
Abstract
The objective is to assess quality-of-life (QoL) parameters among Indian female systemic lupus erythematosus (SLE) patients with durable remission. Indian female SLE patients in remission determined by the European consensus criteria and age-matched female control participants were included in the study. All included participants underwent measurements of QoL [Medical Outcomes Study Short-Form-12 (SF12)], Fatigue Severity Scale, and structured interview with a clinical psychologist. The population comprised of 126 female SLE patients [median age: 27.5 years [interquartile range (IQR): 11]; median disease duration: 36 months (IQR 26)] and 110 female controls [median age 30 years (IQR 9)]. Clinical remission was seen in 65.9% (83/126) and complete remission in 34.1% (43/126). Significant fatigue was present in 18.3% (23/126). Both SF-12 physical component summary (PCS) and mental component summary (MCS) were similar between SLE patients and controls [median PCS: 50.3 (IQR: 16.2) vs. 48.6 (IQR: 11.6); median MCS: 57.2 (IQR: 4.8) vs. 57.9 (IQR: 7.6)]. In generalised linear modelling, PCS was associated with fatigue [odd's ratio (OR) 0.012, 95% confidence interval (CI) 0.006-0.025, p < 0.001], disease duration ≥ 5 years (OR 23.16, 95% CI 1.548-346.58, p = 0.023), and complete remission (OR 33.16, 95% CI 4.43-248.15, p = 0.001); MCS with fatigue (OR 0.53, 95% CI 0.34-0.84, p = 0.007) and absence of depression (OR 3.65, 95% CI 1.07-12.44, p = 0.038). Patients with SLE in remission report significant fatigue in 18.3% of subjects. Both PCS and MCS scores are similar to healthy controls. Better PCS was associated with less fatigue, longer disease duration, and complete remission. Better MCS was associated with less fatigue and absence of depression.
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Groot N, Shaikhani D, Teng YKO, de Leeuw K, Bijl M, Dolhain RJEM, Zirkzee E, Fritsch‐Stork R, Bultink IEM, Kamphuis S. Long-Term Clinical Outcomes in a Cohort of Adults With Childhood-Onset Systemic Lupus Erythematosus. Arthritis Rheumatol 2019; 71:290-301. [PMID: 30152151 PMCID: PMC6590133 DOI: 10.1002/art.40697] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Childhood-onset systemic lupus erythematosus (SLE) is a severe, lifelong, multisystem autoimmune disease. Long-term outcome data are limited. This study was undertaken to identify clinical characteristics and health-related quality of life (HRQoL) of adults with childhood-onset SLE. METHODS Patients participated in a single study visit comprising a structured history and physical examination. Disease activity (scored using the SLE Disease Activity Index 2000 [SLEDAI-2K]), damage (scored using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and HRQoL (scored using the Short Form 36 Health Survey) were assessed. Medical records were reviewed. RESULTS In total, 111 childhood-onset SLE patients were included; the median disease duration was 20 years, 91% of patients were female, and 72% were white. Disease activity was low (median SLEDAI-2K score 4), and 71% of patients received prednisone, hydroxychloroquine (HCQ), and/or other disease-modifying antirheumatic drugs. The vast majority of new childhood-onset SLE-related manifestations developed within 2 years of diagnosis. Damage such as myocardial infarctions began occurring after 5 years. Most patients (62%) experienced damage, predominantly in the musculoskeletal, neuropsychiatric, and renal systems. Cerebrovascular accidents, renal transplants, replacement arthroplasties, and myocardial infarctions typically occurred at a young age (median age 20 years, 24 years, 34 years, and 39 years, respectively). Multivariate logistic regression analysis showed that damage accrual was associated with disease duration (odds ratio [OR] 1.15, P < 0.001), antiphospholipid antibody positivity (OR 3.56, P = 0.026), and hypertension (OR 3.21, P = 0.043). Current HCQ monotherapy was associated with an SDI score of 0 (OR 0.16, P = 0.009). In this cohort, HRQoL was impaired compared to the overall Dutch population. The presence of damage reduced HRQoL scores in 1 domain. High disease activity (SLEDAI-2K score ≥8) and changes in physical appearance strongly reduced HRQoL scores (in 4 of 8 domains and 7 of 8 domains, respectively). CONCLUSION The majority of adults with childhood-onset SLE in this large cohort developed significant damage at a young age and had impaired HRQoL without achieving drug-free remission, illustrating the substantial impact of childhood-onset SLE on future life.
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Affiliation(s)
- N. Groot
- Sophia Children’s HospitalErasmus University Medical Center, Rotterdam, The Netherlands, and Wilhelmina Children’s HospitalUniversity Medical CenterUtrechtThe Netherlands
| | - D. Shaikhani
- Sophia Children’s HospitalErasmus University Medical CenterRotterdamThe Netherlands
| | - Y. K. O. Teng
- Leiden University Medical CenterLeidenThe Netherlands
| | - K. de Leeuw
- University Medical CenterGroningenThe Netherlands
| | - M. Bijl
- Martini HospitalGroningenThe Netherlands
| | | | - E. Zirkzee
- Maasstad HospitalRotterdamThe Netherlands
| | - R. Fritsch‐Stork
- University Medical Center, Utrecht, The Netherlands, Hanusch Hospital of WGKK and AUVA Trauma Center, Vienna, Austria, and Sigmund Freud UniversityViennaAustria
| | - I. E. M. Bultink
- Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - S. Kamphuis
- Sophia Children’s HospitalErasmus University Medical CenterRotterdamThe Netherlands
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23
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Affiliation(s)
- Stephanie Jessica Wan
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Irene Lara-Corrales
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada
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24
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AlE'ed A, Aydin POA, Al Mutairi N, AlSaleem A, Sonmez HE, Henrickson M, Huggins JL, Ozen S, Al-Mayouf SM, Brunner HI. Validation of the Cutaneous Lupus Erythematosus Disease Area and Severity Index and pSkindex27 for use in childhood-onset systemic lupus erythematosus. Lupus Sci Med 2018; 5:e000275. [PMID: 30538816 PMCID: PMC6257379 DOI: 10.1136/lupus-2018-000275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 11/13/2022]
Abstract
Objective To determine the measurement properties of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the paediatric adaptation of the Skindex29 (pSkindex27) when used in childhood-onset SLE (cSLE). Methods Patients with mucocutaneous involvement of cSLE were evaluated at the study entry and 6 months later. Besides the CLASI and pSkindex27, the Pediatric Quality of Life Inventory Generic Core scale (PedsQL-GC), its Rheumatology Module (PedsQL-RM), the SLE Disease Activity Index (SLEDAI) and the SLE Damage Index (SDI) were completed. Results The CLASI and pSkindex27 had high internal consistency (both Cronbach α >0.82). Children were able to complete the pSkindex27, with self-report and caregiver proxy-reports showing excellent agreement (intraclass correlation coefficient=0.97). The CLASI Activity Score (CLASI-A) was strongly correlated with the mucocutaneous domain score of the SLEDAI as was the CLASI Damage Score (CLASI-D) with that of the SDI (both: Spearman correlation coefficients (rs) >0.68). pSkindex27 summary scores were moderately correlated with those of the PedsQL-GC and PedsQL-RM (all: rs>|0.51|), the CLASI-A and CLASI-D (both: rs> 0.64), respectively. Patients who experienced a >50% improvement of the CLASI-A between study visits had significantly higher PedsQL-GC and pSkindex27 scores than those without improvement of mucocutaneous features. Conclusion Both CLASI and pSkindex27 are useful assessment tools in cSLE, active and chronic mucocutaneous lesions and their changes over time can be measured using the CLASI and the pSkindex27 can capture the impact of mucocutaneous involvement on patient health-related quality of life.
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Affiliation(s)
- Ashwaq AlE'ed
- Department of Pediatrics, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Pinar Ozge Avar Aydin
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nora Al Mutairi
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Alhanouf AlSaleem
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hafize Emine Sonmez
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Michael Henrickson
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer L Huggins
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Hermine I Brunner
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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25
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Elera-Fitzcarrald C, Fuentes A, González LA, Burgos PI, Alarcón GS, Ugarte-Gil MF. Factors affecting quality of life in patients with systemic lupus erythematosus: important considerations and potential interventions. Expert Rev Clin Immunol 2018; 14:915-931. [DOI: 10.1080/1744666x.2018.1529566] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Claudia Elera-Fitzcarrald
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
| | - Alejandro Fuentes
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Alonso González
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Paula I. Burgos
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Graciela S. Alarcón
- The University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Manuel F. Ugarte-Gil
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
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26
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Chiang YC, Huang JL, Wang CH, Lee HC, Lee MY, Hsiao YC. Symptom clustering in patients with childhood-onset systemic lupus erythematosus. J Adv Nurs 2018; 75:54-62. [DOI: 10.1111/jan.13825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Yi-Chien Chiang
- Department of Nursing; Chang Gung University of Science and Technology; Taiwan
- Department of Pediatrics; Chang Gung Memorial Hospital at Linkou; Taiwan
| | - Jing-Long Huang
- Department of Pediatrics; Chang Gung Memorial Hospital at Linkou; Taiwan
- School of Medicine; Chang Gung University; Taiwan
| | - Chao-Hui Wang
- Department of Nursing; Chang Gung Memorial Hospital at Linkou; Taiwan
- Department of Nursing; Chang Gung University; Taiwan
| | - Hsiang-Chun Lee
- Department of Nursing; Chang Gung University of Science and Technology; Taiwan
| | - Ming-Ying Lee
- Department of Nursing; Chang Gung Memorial Hospital at Linkou; Taiwan
| | - Ya-Chu Hsiao
- Department of Nursing; Chang Gung University of Science and Technology; Taiwan
- Department of Nursing; Chang Gung Memorial Hospital at Linkou; Taiwan
- Department of Nursing; Chang Gung University; Taiwan
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27
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Wallace DJ, Furie RA, Tanaka Y, Kalunian KC, Mosca M, Petri MA, Dörner T, Cardiel MH, Bruce IN, Gomez E, Carmack T, DeLozier AM, Janes JM, Linnik MD, de Bono S, Silk ME, Hoffman RW. Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 2 trial. Lancet 2018; 392:222-231. [PMID: 30043749 DOI: 10.1016/s0140-6736(18)31363-1] [Citation(s) in RCA: 335] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/02/2018] [Accepted: 06/08/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with systemic lupus erythematosus have substantial unmet medical need. Baricitinib is an oral selective Janus kinase (JAK)1 and JAK2 inhibitor that we hypothesised might have therapeutic benefit in patients with systemic lupus erythematosus. METHODS In this double-blind, multicentre, randomised, placebo-controlled, 24-week phase 2 study, patients were recruited from 78 centres in 11 countries. Eligible patients were aged 18 years or older, had a diagnosis of systemic lupus erythematosus, and had active disease involving skin or joints. We randomly assigned patients (1:1:1) to receive once-daily baricitinib 2 mg, baricitinib 4 mg, or placebo for 24 weeks. The primary endpoint was the proportion of patients achieving resolution of arthritis or rash at week 24, as defined by Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K). Efficacy and safety analyses included all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT02708095. FINDINGS Between March 24, 2016, and April 27, 2017, 314 patients were randomly assigned to receive placebo (n=105), baricitinib 2 mg (n=105), or baricitinib 4 mg (n=104). At week 24, resolution of SLEDAI-2K arthritis or rash was achieved by 70 (67%) of 104 patients receiving baricitinib 4 mg (odds ratio [OR] vs placebo 1·8, 95% CI 1·0-3·3; p=0·0414) and 61 (58%) of 105 patients receiving baricitinib 2 mg (OR 1·3, 0·7-2·3; p=0·39). Adverse events were reported in 68 (65%) patients in the placebo group, 75 (71%) patients in the baricitinib 2 mg group, and 76 (73%) patients in the baricitinib 4 mg group. Serious adverse events were reported in ten (10%) patients receiving baricitinib 4 mg, 11 (10%) receiving baricitinib 2 mg, and five (5%) receiving placebo; no deaths were reported. Serious infections were reported in six (6%) patients with baricitinib 4 mg, two (2%) with baricitinib 2 mg, and one (1%) with placebo. INTERPRETATION The baricitinib 4 mg dose, but not the 2 mg dose, significantly improved the signs and symptoms of active systemic lupus erythematosus in patients who were not adequately controlled despite standard of care therapy, with a safety profile consistent with previous studies of baricitinib. This study provides the foundation for future phase 3 trials of JAK1/2 inhibition with baricitinib as a new potential oral therapy for systemic lupus erythematosus. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Daniel J Wallace
- Division of Rheumatology, Cedars-Sinai Medical Center, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Richard A Furie
- Division of Rheumatology, Zucker School of Medicine at Hofstra, Northwell, New York, NY, USA
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kenneth C Kalunian
- Division of Rheumatology, University of California at San Diego School of Medicine, La Jolla, CA, USA
| | - Marta Mosca
- Division of Rheumatology, University of Pisa, Pisa, Italy
| | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas Dörner
- Division of Rheumatology, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Mario H Cardiel
- Centro de Investigación Clínica de Morelia SC, Morelia, México
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Elisa Gomez
- Eli Lilly and Company, Indianapolis, IN, USA
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28
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Elera-Fitzcarrald C, Alva M, Gamboa-Cardenas R, Mora-Trujillo CS, Zevallos F, García-Poma A, Medina M, Rodriguez-Bellido Z, Perich-Campos RA, Pastor-Asurza CA, Segami MI, Ugarte-Gil MF. Factors associated with health-related quality of life in Peruvian patients with systemic lupus erythematosus. Lupus 2018; 27:913-919. [DOI: 10.1177/0961203317751062] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Claudia Elera-Fitzcarrald
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud
- School of Medicine, Universidad Científica del Sur
| | - Magaly Alva
- Medical Specialties Department, Hospital Edgardo Rebagliati Martins-EsSalud
| | | | - Claudia S Mora-Trujillo
- Medical Specialties Department, Hospital Edgardo Rebagliati Martins-EsSalud
- School of Medicine, Universidad Nacional Mayor de San Marcos
- School of Medicine, Universidad Ricardo Palma
| | | | | | - Mariela Medina
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud
| | - Zoila Rodriguez-Bellido
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud
- School of Medicine, Universidad Nacional Mayor de San Marcos
| | - Risto A Perich-Campos
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud
- School of Medicine, Universidad Nacional Mayor de San Marcos
| | | | - María I Segami
- Medical Specialties Department, Hospital Edgardo Rebagliati Martins-EsSalud
- School of Medicine, Universidad Nacional Mayor de San Marcos
| | - Manuel F Ugarte-Gil
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud
- School of Medicine, Universidad Científica del Sur
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29
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Donnelly C, Cunningham N, Jones JT, Ji L, Brunner HI, Kashikar-Zuck S. Fatigue and depression predict reduced health-related quality of life in childhood-onset lupus. Lupus 2018; 27:124-133. [PMID: 28662595 PMCID: PMC5537044 DOI: 10.1177/0961203317716317] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to identify risk factors for persistently reduced health-related quality of life in childhood-onset lupus and describe a risk profile for persistently reduced health-related quality of life. At a tertiary rheumatology clinic, 50 childhood onset lupus patients were assessed twice, approximately six months apart. Measures of disease activity and patient-reported measures of health-related quality of life, pain, depressive symptoms, anxiety and disability were collected at each visit. At visits 1 and 2, respectively, clinically relevant fatigue was present in 66% and 56% of patients; clinically significant depressive symptoms in 26% and 24%; and clinically significant anxiety in 34% and 28%. Poorer health-related quality of life at follow-up was significantly predicted by higher fatigue and depressive symptoms at the initial visit. Using clinically relevant cut-offs for fatigue and depressive symptoms, patients were assigned to Low ( n = 27) or High Risk ( n = 23) groups. A profile of significantly greater pain, anxiety and coping difficulties was seen in the High Risk group. Routine assessment of fatigue and mood symptoms in youth with childhood-onset lupus could be helpful in identifying those at risk for persistently poor health-related quality of life. Integration of behavioral interventions to address fatigue and mood symptoms into medical care for such patients may be beneficial, but more research in this area is needed.
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Affiliation(s)
- Catherine Donnelly
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati Medical Center, Cincinnati, OH
| | - Natoshia Cunningham
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jordan T Jones
- Department of Pediatrics, University of Missouri-Kansas City, Children’s Mercy Kansas City, Kansas City, MO
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Li Ji
- Peking Union Medical College Hospital, Beijing, China
| | - Hermine I Brunner
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, University of Missouri-Kansas City, Children’s Mercy Kansas City, Kansas City, MO
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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