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Huot S, Fortin PR, Godbout A, Laflamme C, Pouliot M. A tool to assist rheumatologists to engage their lupus patients: the Purple Butterfly. Rheumatol Adv Pract 2024; 8:rkae075. [PMID: 38915844 PMCID: PMC11194531 DOI: 10.1093/rap/rkae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
Objective Translating the highly technical medical jargon of SLE into understandable concepts for patients, their families and individuals without expertise in SLE is a serious challenge. To facilitate communication and enable self-management in SLE, we aimed to create an innovative visual tool, the Purple Butterfly. Methods We selected clinically representative criteria for SLE and transposed them as graphical features in an attractive and meaningful visual. We developed a script in R programming language that automatically transposes clinical data into this visualization. We asked SLE patients from a local cohort about the relevance, usefulness and acceptability of this visual tool in an online pilot survey. Results The innovative Purple Butterfly features 11 key clinical criteria: age; sex; organ damage; disease activity; comorbidities; use of antimalarials, prednisone, immunosuppressants and biologics; and patient-reported physical and mental health-related quality of life. Each Purple Butterfly provides the health portrait of one SLE patient at one medical visit, and the automatic compilation of the butterflies can illustrate a patient's clinical journey over time. All survey participants agreed that they would like to use the Purple Butterfly to visualize the course of their SLE over time, and 9 of 10 agreed it should be used during their medical consultations. Conclusion The Purple Butterfly nurtures effective doctor-patient communication by providing concise visual summaries of lupus patients' health conditions. We believe the Purple Butterfly has the potential to empower patients to take charge of their condition, enhance healthcare coordination and raise awareness about SLE.
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Affiliation(s)
- Sandrine Huot
- Département de Microbiologie-Infectiologie et Immunologie, Université Laval, Québec, Canada
- Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre ARThrite-UL, Québec, Canada
| | - Paul R Fortin
- Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre ARThrite-UL, Québec, Canada
- Division de Rhumatologie, Département de Médecine Spécialisée, CHU de Québec-Université Laval, Québec, Canada
| | | | - Cynthia Laflamme
- Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre ARThrite-UL, Québec, Canada
| | - Marc Pouliot
- Département de Microbiologie-Infectiologie et Immunologie, Université Laval, Québec, Canada
- Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre ARThrite-UL, Québec, Canada
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Yeboah Asiamah-Asare BK, Peprah P, Adu C, Ahinkorah BO, Addo IY. Associations of nuptiality perceptions, financial difficulties, and socio-demographic factors with mental health status in Australian adults: Analysis of the Household, Income and Labour Dynamics in Australia (HILDA) survey. PLoS One 2024; 19:e0296941. [PMID: 38354107 PMCID: PMC10866460 DOI: 10.1371/journal.pone.0296941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE This study examined the association of nuptial/relationship factors, financial difficulties, and socio-demographic factors with the mental health status of Australian adults. DESIGN Cross-sectional quantitative study design. SETTINGS, PARTICIPANTS, AND INTERVENTIONS Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey wave 19, 6846 adults were included in the analysis. Mental health was measured using the mental component summary (MCS) subscale of the Short-Form Health Survey SF-36. Hierarchical multiple linear regressions were used to examine the predictors of mental health status. RESULTS Overall, 7.1% of the participants reported poor mental health status. Individual financial difficulty factors explained 3.2% (p<0.001) of the variance in mental health scores. In addition, financial difficulties were negatively associated with mental health status. Nuptiality and relationship factors accounted for 9.8% (p<0.001) of the variance in mental health status. CONCLUSION The study suggests negative marital or relationship perceptions and financial difficulties are significant factors accounting for poor mental health. This finding suggests the need for more policy attention toward the social determinants of poor mental health especially nuptiality or relationship perceptions which have received less policy and research attention in Australia.
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Affiliation(s)
- Bernard Kwadwo Yeboah Asiamah-Asare
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Prince Peprah
- Social Policy Research Centre, UNSW, Sydney, Australia
- Centre for Primary Health Care and Equity, UNSW, Sydney, Australia
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Centre for Social Research in Health; UNSW Sydney, Sydney, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, University of Technology Sydney, Sydney, Australia
- School of Clinical Medicine, UNSW Sydney, Sydney, Australia
| | - Isaac Yeboah Addo
- Centre for Social Research in Health; UNSW Sydney, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
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Prete M, Susca N, Leone P, De Giacomo A, Bray A, Brunori G, Favoino E, Perosa F, Racanelli V. Impact of belimumab therapy on the quality of life in patients with systemic lupus erythematosus: A cohort study. Lupus 2023; 32:1528-1535. [PMID: 37903488 DOI: 10.1177/09612033231210607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic and extremely disabling connective-tissue autoimmune disease with a tremendous impact on the quality of life (QoL). Belimumab, a B-lymphocyte-stimulator-specific inhibitor, is the first biologic drug approved as add-on therapy in patients with active, refractory auto-antibody-positive SLE.The impact of belimumab on the QoL of SLE patients was evaluated using a generic questionnaire short-form health survey 36 (SF-36) and the disease-specific questionnaire SLE-specific quality of life (SLEQoL).The Italian version of the SLEQoL and the SF-36 were administered to 46 SLE patients before and after 6 months of belimumab therapy. The control population consisted of 40 age-matched healthy individuals. The questionnaires were completed before and after belimumab treatment and the results were compared using the Wilcoxon signed-rank test. In addition, data from healthy controls and SLE patients were compared using the Mann-Whitney test. Dichotomous variables were compared using Fisher's exact test.For SLE patients, the addition of belimumab to their therapeutic regimen significantly improved their health-related QoL (HRQoL), according to the results of the SF-36 and SLEQoL. The comparison of the data obtained before and after belimumab treatment showed a decrease in all six SLEQoL domains and an increase in all eight SF-36 domains. Moreover, treatment led to a reduction in the median prednisone dose, to 0 mg/day (IQR 0-4.5 mg/day). Before belimumab therapy, SLE patients had a worse HRQoL than the control group, based on both questionnaires, but after belimumab treatment the outcome scores between SLE patients and controls were similar, suggesting that belimumab therapy resulted in a strong improvement in HRQoL. These findings were supported by a decrease in the SELENA-SLEDAI score, a measure of disease activity.In addition to clinical remission and low disease activity, the goals of an innovative therapeutic strategy for SLE should include the attainment of a good HRQoL. Our study demonstrates that the combined use of the SF-36 and SLEQoL questionnaires can provide clinicians with a better understanding of the HRQoL of SLE patients.
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Affiliation(s)
- Marcella Prete
- Department of Interdisciplinary Medicine, Internal Medicine Unit, "Aldo Moro" University of Bari Medical School, Bari, Italy
| | - Nicola Susca
- Department of Interdisciplinary Medicine, Internal Medicine Unit, "Aldo Moro" University of Bari Medical School, Bari, Italy
| | - Patrizia Leone
- Department of Interdisciplinary Medicine, Internal Medicine Unit, "Aldo Moro" University of Bari Medical School, Bari, Italy
| | - Andrea De Giacomo
- Department of Biomedical Sciences, Neuroscience, and Sense Organs, Child Neuropsychiatry Unit, "Aldo Moro" University of Bari Medical School, Bari, Italy
| | - Antonella Bray
- Department of Interdisciplinary Medicine, Internal Medicine Unit, "Aldo Moro" University of Bari Medical School, Bari, Italy
| | | | - Elvira Favoino
- Department of Interdisciplinary Medicine, Rheumatological and Autoimmune Systemic Diseases Unit, "Aldo Moro" University of Bari Medical School, Bari, Italy
| | - Federico Perosa
- Department of Interdisciplinary Medicine, Rheumatological and Autoimmune Systemic Diseases Unit, "Aldo Moro" University of Bari Medical School, Bari, Italy
| | - Vito Racanelli
- Centre for Medical Sciences, CISMed, Department of Internal Medicine, Santa Chiara Hospital, University of Trento, Trento, Italy
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Caruso Mazzolani B, Infante Smaira F, Mendes Sieczkowska S, Romero M, Toledo Ribeiro T, Cordeiro Amarante M, Pasoto S, de Sá Pinto AL, Rodrigues Lima F, Braga Benatti F, Bonfa E, Roschel H, Gualano B. Quality of life, fatigue, sleep quality, and mental health in systemic lupus erythematosus patients with a high cardiovascular risk profile. Lupus 2023; 32:1287-1295. [PMID: 37698181 DOI: 10.1177/09612033231202582] [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: 09/13/2023]
Abstract
Systemic lupus erythematosus (SLE) patients report worse health-related quality of life (HRQL), fatigue, anxiety, depression, and sleep quality, when compared to the general population and other chronic diseases. Furthermore, cardiometabolic diseases are highly prevalent in SLE and are also associated with these parameters. Thus, it is plausible to suggest that SLE patients with a high cardiovascular risk may report worse results for these parameters. The aim of the study is to describe HRQL, fatigue, anxiety and depression symptoms, and sleep quality in a sample of SLE patients with a high cardiovascular risk profile (i.e., BMI between 25 and 40 kg/m2 and/or dyslipidemia, hypertension, or diabetes). This was a cross-sectional study where patients were assessed for (i) demographic, anthropometric, and disease-related parameters, (ii) HRQL, (iii) fatigue, (iv) anxiety and depression symptoms, and (v) sleep quality. One-hundred patients completed the study; however, only 87 patients were assessed for sleep quality data. Patients averaged 41.7 ± 9 years, and most patients were classified as overweight/obese (87%). SF-36 scores for physical and mental components summary were 51.3 ± 9.6 and 54.2 ± 15.6, respectively, with "bodily pain" and "role emotional" presenting the lower scores. The total SLEQOL score was 105.1 ± 42.0, with lower scores reported for "self-image" and "mood." Fatigue score was 30.8 ± 8.9, and 78% and 93% reported severe symptoms of anxiety and depression, respectively. The average sleep effectiveness was 82.9 ± 6.6%. Sleep latency, total time in bed (TTiB), and total sleep time (TST) were 8.4 ± 8.9, 495.8 ± 79.7, and 409.7 ± 69.9 min, respectively. Patients reported an average of 17.8 ± 6.2 WE, with 4.5 ± 1.5 min duration and a WASO of 77.7 ± 36.6 min. Despite similar HRQL, fatigue, and sleep quality parameters to those reported by other SLE populations, SLE patients with a high cardiovascular risk had a higher prevalence of depression and anxiety. Understanding SLE patients' quality of life and psychological symptoms is of utmost importance to improve disease management. The findings of this study highlight the need for more intensive and global care regarding mental health when considering a high cardiovascular risk in SLE.
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Affiliation(s)
- Bruna Caruso Mazzolani
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Fabiana Infante Smaira
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Sofia Mendes Sieczkowska
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Marina Romero
- School of Applied Sciences, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Thainá Toledo Ribeiro
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Milla Cordeiro Amarante
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Sandra Pasoto
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | - Ana Lúcia de Sá Pinto
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | - Fernanda Rodrigues Lima
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | - Fabiana Braga Benatti
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- School of Applied Sciences, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Eloísa Bonfa
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
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Borg A, Lindblom J, Gomez A, Soltani A, Enman Y, Heintz E, Regardt M, Grannas D, Emamikia S, Parodis I. Obesity is associated with pain and impaired mobility despite therapy in systemic lupus erythematosus. Front Med (Lausanne) 2023; 10:1247354. [PMID: 37692782 PMCID: PMC10484101 DOI: 10.3389/fmed.2023.1247354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
Objective To investigate whether abnormal BMI is associated with health-related quality of life (HRQoL) impairments, defined as patient-reported problems within the different dimensions of the three-level EQ-5D (EQ-5D-3L), before and after treatment for active systemic lupus erythematosus (SLE). Patients and methods We conducted a post-hoc analysis of data from two phase III clinical trials of belimumab in SLE, i.e., BLISS-52 (n = 865) and BLISS-76 (n = 819). Underweight was defined as BMI <18.5 kg/m2, normal weight as BMI ≥18.5 but <25 kg/m2, pre-obesity as BMI ≥25 but <30 kg/m2, and obesity as BMI ≥30 kg/m2. We investigated associations between BMI groups and problems (level 2 or 3) within each one of the five EQ-5D dimensions before treatment initiation and at week 52, using logistic regression analysis adjusting for age, ethnicity, disease activity, and glucocorticoid dose, and for the post-treatment analysis also for belimumab treatment and baseline EQ-5D-3L responses. Results Of 1,684 patients included, 73 (4%) were classified as underweight, 850 (50%) as normal weight, 438 (26%) as pre-obese, and 323 (19%) as obese. At baseline, obesity was associated with mild to severe problems in all EQ-5D dimensions (p < 0.05 for all), yielding the strongest association with problems in mobility (adjusted odds ratio, aOR: 2.1; 95% confidence interval, CI: 1.6-2.8; p < 0.001). Pre-obesity was also associated with problems in mobility (aOR: 1.4; 95% CI: 1.1-1.8; p = 0.005). Post-intervention, obesity was associated with problems in mobility and pain/discomfort, and pre-obesity with problems in mobility and self-care (p < 0.05 for all). Conclusion Our study adds to the evidence that high BMI negatively affects SLE patients' HRQoL, with obesity being associated with pain and impaired mobility despite therapy.
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Affiliation(s)
- Alexander Borg
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Julius Lindblom
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ameneh Soltani
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Enman
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Emelie Heintz
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Malin Regardt
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - David Grannas
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sharzad Emamikia
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Osman HM, Abdel-Nasser AM, Kasem AH, Elameen NF, Omar GM. Pulmonary involvement: A potential independent factor for quality of life in systemic lupus erythematosus. Lupus 2023; 32:198-206. [PMID: 36460049 DOI: 10.1177/09612033221143934] [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: 12/04/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic multi-systemic autoimmune disease. SLE patients may experience a wide range of physical, psychological, and social perception of well-being influenced by the patient illness that are not always fully captured by descriptions of the disease's physiological consequences alone. Nowadays, patients with SLE have a better survival than decades ago, nevertheless still experience a low health related quality of life (HRQoL). Assessing disease activity in SLE is crucial to the physician as it forms the basis for treatment decisions, moreover careful evaluation for respiratory involvement should be routinely considered. More chronic lung disease related to SLE can have a significant negative effect on patient well-being and physical performance status and are detrimental to quality of life. OBJECTIVE The aim of this study was to evaluate quality of life changes in SLE patients using Lupus QoL scale, assessing their correlation with different disease aspects particularly pulmonary manifestations and predictors for worse QoL. MATERIALS AND METHODS Total of 60 SLE patients, who fulfilled the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria, were enrolled in this study. Disease activity was measured by systemic lupus erythematosus disease activity index (SLEDAI) and quality of life was assessed by Lupus QoL. Pulmonary evaluation included pulmonary function tests parameters (PFTs), mMRC dyspnea scale, HRCT score, and pulmonary damage index. RESULTS Lupus QoL had a strong significant correlations with PFTs FEV1, FVC, and DLCO (r = 0.79, 0.78, 0.76, p < .001), respectively}, while Lupus QoL had strong negative correlations with both mMRC dyspnea scale and HRCT score (r = -0.96, -0.85, p < .001), respectively, and moderate negative correlation with neuropsychiatric lupus (NPSLE) (r = -0.61, p < .001). Weak negative correlations were found between Lupus QoL, photosensitivity, alopecia, Raynaud's and renal affection (r = -0.29, -0.30, -0.30, 0.38, p = .03, .02, .02, .002), respectively. NPSLE and pulmonary involvement were the most consistent predictors of low HRQoL [contributing 36% and 18% of the variance of Lupus QoL], respectively. CONCLUSION Lupus QoL is negatively correlated with different SLE clinical parameters particularly pulmonary manifestations. Neuropsychiatric, pulmonary, renal affection, and SLEDAI are the best determinants for worse Lupus QoL.
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Affiliation(s)
- Haidy M Osman
- Department of Rheumatology and Rehabilitation, 68877Minia University, Minya, Egypt
| | - Ahmed M Abdel-Nasser
- Department of Rheumatology and Rehabilitation, 68877Minia University, Minya, Egypt
| | - Ahmed H Kasem
- Department of Chest Diseases, 68877Minia University, Minya, Egypt
| | - Nadia F Elameen
- Department of Radiodiagnosis, 68877Minia University, Minya, Egypt
| | - Gihan M Omar
- Department of Rheumatology and Rehabilitation, 68877Minia University, Minya, Egypt
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Han JY, Cho SK, Nam E, Kim H, Lee SS, Jolly M, Sung YK. Korean LupusPRO: Cross-Cultural validation study for systemic lupus erythematosus. Lupus 2022; 31:1498-1507. [PMID: 36017605 DOI: 10.1177/09612033221122984] [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: 12/31/2022]
Abstract
OBJECTIVE To establish the reliability and validity of the Korean version of LupusPRO version 1.7 (v1.7) for systemic lupus erythematosus (SLE) patients. METHODS LupusPRO v1.7 was translated into Korean, followed by pretesting among five native Korean speakers. We administered the LupusPRO v1.7 survey to five SLE patients and made minor changes to clarify the language. Then, 133 SLE patients participated in the validation procedure. In each domain, the internal consistency reliability (ICR) and test-retest reliability (TRR) were assessed using Cronbach's alpha and the intra-class correlation coefficient (ICC), respectively. Criterion validity was evaluated using Spearman's correlation coefficient with the other measures such as SF-36, EQ-5D VAS, and SELENA-SLEDAI PGA. Construct validity was assessed by confirmatory factor analysis (CFA) using the unweighted least square estimation method. RESULTS The mean age of the 133 patients was 36.14 years, and 97% of them were women. Analysis of 130 returned questionnaires revealed that most ICRs of the Korean LupusPRO v1.7 domains were acceptable, with Cronbach's alphas in the range of 0.579-0.949, and most TRRs were good with ICCs from 0.582 to 0.851. Criterion validities presented significant correlations between the LupusPRO v1.7 and other measures validated. In the analysis of the CFA model, the goodness of fit indices demonstrated an acceptable fit. Factor loadings for most individual items were between 0.548 and 0.985. The average variance extracted (AVE) and composite reliability (CR) of most domains were greater than 0.5 and 0.7, respectively, demonstrating acceptable convergent and discriminant validities. CONCLUSIONS The Korean version of LupusPRO v.17 had acceptable reliability and validity.
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Affiliation(s)
- Jung-Yong Han
- Department of Rheumatology, 26716Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.,26716Hanyang University Institute for Rheumatology Research, Seoul, South Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, 26716Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.,26716Hanyang University Institute for Rheumatology Research, Seoul, South Korea
| | - Eunwoo Nam
- Department of Rheumatology, 26716Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.,26716Hanyang University Institute for Rheumatology Research, Seoul, South Korea
| | - Hyoungyoung Kim
- Department of Rheumatology, 26716Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.,26716Hanyang University Institute for Rheumatology Research, Seoul, South Korea
| | - Shin-Seok Lee
- Division of Rheumatology, 65417Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Meenakshi Jolly
- Department of Medicine, 2468Rush University Medical Center, Chicago, IL, USA
| | - Yoon-Kyoung Sung
- Department of Rheumatology, 26716Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.,26716Hanyang University Institute for Rheumatology Research, Seoul, South Korea
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Kharawala S, Kaur G, Shukla H, Scott DA, Hawkins N, Chen WH, Gairy K. Health-related quality of life, fatigue and health utilities in lupus nephritis: A systematic literature review. Lupus 2022; 31:1029-1044. [PMID: 35607279 PMCID: PMC9277333 DOI: 10.1177/09612033221100910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease
characterized by abnormal B-cell activation and the presence of
autoantibodies, which can result in organ damage. Lupus nephritis (LN) is
the most common severe organ manifestation of SLE and may result in impaired
kidney function. However, there is limited research on the health-related
quality of life (HRQoL) burden amongst patients with LN. The objective of
this systematic literature review was to assess the HRQoL, fatigue and
health utilities associated with LN. Methods A structured literature search (GSK Study 212980) of the MEDLINE and Embase
databases was conducted in July 2019 and updated September 2021. Relevant
international congress abstracts from 2016 to 2021 were searched, and gray
literature searches and keyword-based searches in PubMed, Google, and Google
Scholar were also conducted. Results were screened according to predefined
criteria and data on the outcomes of interest were extracted. A quantitative
analysis was conducted to supplement the narrative review, to provide
36-item Short Form survey (SF-36) estimates, and to determine variation by
prognostic factors. Results Of 1155 articles identified, 26 studies for a total of 3440 patients were
included. Patients with LN showed poorer HRQoL and more fatigue than healthy
controls/the general population, although these were similar between
patients with SLE with and without LN. HRQoL was worse in patients with LN
Class III/IV or with active disease. Fatigue was generally reported as the
most burdensome symptom and was associated with lower HRQoL and increased
treatment dissatisfaction. During induction treatment, HRQoL and fatigue
were improved with mycophenolate mofetil versus cyclophosphamide. HRQoL
improved over time with treatment amongst patients with active LN. Very
limited data were identified assigning utilities to health states for
cost-effectiveness analysis. Nine studies were considered for quantitative
analysis of baseline SF-36 scores. The analysis suggested that LN has a
significant impact across all SF-36 domains, with the lowest scores in the
general health perceptions and role-physical domains and physical component
summary. Conclusions There is a large HRQoL burden in patients with LN, in particular regarding
symptoms of fatigue. Future research should focus on investigating fatigue
severity and health utilities in LN.
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Affiliation(s)
| | - Gavneet Kaur
- 475573Bridge Medical Consulting Ltd., London, UK
| | | | | | - Neil Hawkins
- 475573Bridge Medical Consulting Ltd., London, UK
| | - Wen-Hung Chen
- Patient Centered Outcomes, 1929GlaxoSmithKline, Collegeville, PA, USA
| | - Kerry Gairy
- Value Evidence & Outcomes, 1929GlaxoSmithKline, Brentford, Middlesex, UK
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Correa-Rodríguez M, Rueda-Medina B, Callejas-Rubio JL, Ríos-Fernández R, de la Hera-Fernández J, Ortego-Centeno N. The Relationship Between Health Literacy and Quality of Life, Attitudes and Perceptions of Covid-19 and Vaccination Among Patients with Systemic Autoimmune Diseases. Clin Nurs Res 2022; 31:981-990. [PMID: 35484917 DOI: 10.1177/10547738221090558] [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: 11/17/2022]
Abstract
We aimed to evaluate health literacy in a population of patients with systemic autoimmune diseases (SAD), and to analyze their potential relationships with health-related quality of life (HRQoL), attitudes and beliefs of Covid-19 and vaccination, and perceptions of changes in medical care during the pandemic. A cross-sectional study was conducted among 395 patients (81.1% were living in Spain). An anonymous online survey was distributed to an online SAD association. Health literacy was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the SF-36 tool was used to assess HRQoL. More than half of patients (57.7%) have inadequate health literacy and the mean health literacy level was 9.63(5.66). Patients with inadequate health literacy levels presented the lowest HRQoL scores in all SF-36 domains (p < .001). Health literacy scores were positively correlated with all SF-36 domains (p < .001). The reservations to get vaccinated against Covid-19 were linked to health literacy level (p = 0.024). There are high levels of inadequate health literacy among patients with SAD and it is associated with worse HRQoL and risk attitudes about Covid-19 vaccination and medical care during the pandemic.
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Affiliation(s)
- María Correa-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Blanca Rueda-Medina
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - José-Luis Callejas-Rubio
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Systemic Autoimmune Diseases Unit, San Cecilio University Hospital, Granada, Spain
| | - Raquel Ríos-Fernández
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Systemic Autoimmune Diseases Unit, San Cecilio University Hospital, Granada, Spain
| | - Javier de la Hera-Fernández
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Systemic Autoimmune Diseases Unit, San Cecilio University Hospital, Granada, Spain
| | - Norberto Ortego-Centeno
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Department of Medicine, University of Granada, Granada, Spain
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10
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Quality of life in lupus erythematosus female patients with cutaneous lesions in Antananarivo, Madagascar. Int J Womens Dermatol 2022; 7:743-746. [PMID: 35028375 PMCID: PMC8714573 DOI: 10.1016/j.ijwd.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/11/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Lupus erythematosus (LE) is a chronic autoimmune disease that affects more women than men. The quality of life (QoL) of patients with lupus erythematosus and skin manifestations is impaired, but little is known about Malagasy patients. Objective: This study aimed to assess the impact of cutaneous lesions on the QoL of patients who present with LE. Methods: A transversal study, during 3 months, was conducted in patients who presented with LE and cutaneous lesions at the University Hospital Antananarivo. QoL was assessed using the Dermatology Life Quality Index (DLQI) scales. Results: The impact of cutaneous lesions on the QoL was assessed in 37 patients with LE, of whom 34 were women. The mean age of patients was 37.32 years. The mean DLQI was 5.43 ± 4.67 (range, 0–21). Of the patients, 2.7% had a very important effect (DLQI >21), 18.9% reported a great effect of skin symptoms of LE in their QoL (DLQI: 11–20), 18.9% had a moderate effect (DLQI: 6–10), 40.4% had a small effect (DLQI: 2–5), and 18.9% had no effect of cutaneous lesions on their QoL. Daily activities, symptoms, and feelings were the most altered dimensions. The alteration in patients’ QOL was influenced by high monthly income, severe medical history, and localization of the cutaneous lesions on the face and neckline. No correlation was found between sex and QoL. Conclusion: This study shows that significant impairment of QoL was found in patients with LE and cutaneous manifestations, which affected their sense of well-being.
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11
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Escoda T, Jourde-Chiche N, Cornec D, Chiche L. [Toward a better clinical stratification of patients with autoimmune diseases to improve research and care within its biopsychosocial dimensions]. Rev Med Interne 2022; 43:71-74. [PMID: 35000766 DOI: 10.1016/j.revmed.2021.10.337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/28/2021] [Indexed: 01/24/2023]
Affiliation(s)
- T Escoda
- Service de médecine interne, hôpital Européen, Marseille, France
| | - N Jourde-Chiche
- Service de néphrologie, hôpital de la Conception, Marseille, France
| | - D Cornec
- Service de rhumatologie, hôpital de la Cavale Blanche, Brest, France
| | - L Chiche
- Service de médecine interne, hôpital Européen, Marseille, France.
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12
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Molina E, Petri M, Manno R, Williamson L, Williamson L, Timlin H. A prescription for exercise in systemic lupus erythematosus. Lupus 2021; 30:2183-2190. [PMID: 34903093 DOI: 10.1177/09612033211061060] [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
Patients with systemic lupus erythematosus (SLE) have increased cardiovascular risk, and fatigue is a major subjective complaint. Sedentary lifestyle has been shown to have negative health impacts in cardiovascular and rheumatic disease, though exercise has not traditionally been incorporated into routine therapy recommendations. Regular exercise in SLE may improve difficult to treat Type 2 symptoms, such as fatigue, depression, stress, and quality of life. Insufficient counseling on exercise by physicians is a notable barrier for SLE patients to engage in physical activity. Aerobic exercise regimens are more commonly studied, and have been shown to improve cardiovascular health in SLE. Exercise may improve some inflammatory markers, though does not definitively affect SLE clinical disease activity. Physical activity should be recommended to improve quality of life and cardiovascular health in patients with SLE. Developing clearer guidelines for exercise regimens in a patient-centered manner is warranted, especially given diverse phenotypes of SLE patients and varying degrees of physical limitations.
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Affiliation(s)
- Emily Molina
- Department of Internal Medicine, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michelle Petri
- Department of Internal Medicine, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca Manno
- Department of Rheumatology, 249252Comprehensive Orthopaedic Global, Saint Thomas, VI, USA
| | - Luke Williamson
- Department of Rheumatology, 8539Westmead Hospital, Westmead, NSW, USA
| | - Lyn Williamson
- Department of Rheumatology, 8539Great Western Hospital Wiltshire, Swindon, UK
| | - Homa Timlin
- Division of Rheumatology, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Lindblom J, Gomez A, Borg A, Emamikia S, Ladakis D, Matilla J, Pehr M, Cobar F, Enman Y, Heintz E, Regardt M, Parodis I. EQ-5D-3L full health state discriminates between drug and placebo in clinical trials of systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:4703-4716. [PMID: 33502473 PMCID: PMC8487305 DOI: 10.1093/rheumatology/keab080] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/17/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The objectives of this study were to investigate the discriminative ability of EQ-5D-3L full health state (FHS) in clinical trials of SLE, and to identify factors associated with FHS after treatment. METHODS Data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials of belimumab (N = 1684) were utilized. FHS was defined as a response of no problems in all five EQ-5D-3L dimensions, yielding an index score of 1. The Pearson's χ2 or Fisher's exact test was employed for comparisons, and logistic regression for adjustments and assessment of independence. RESULTS We demonstrated higher EQ-5D-3L FHS frequencies among patients given standard therapy (ST) plus the licensed belimumab dose vs ST alone (26.1% vs 19.4%; P = 0.001; week 52), and within SRI-4 responders vs non-responders (27.0% vs 19.8%; P < 0.001; week 52) from weeks 36 to 52. In multivariable regression analysis, SLEDAI-2K (OR: 0.90; 95% CI: 0.87, 0.94; P < 0.001) and SLICC/ACR Damage Index (OR: 0.79; 95% CI: 0.69, 0.91; P = 0.001) scores were independently associated with lower FHS frequencies at week 52, while adding monthly infusions of belimumab 10 mg/kg to ST favoured FHS perception (OR: 1.60; 95% CI: 1.15, 2.24; P = 0.006). Add-on belimumab 10 mg/kg yielded higher FHS frequencies in antimalarial users vs non-users (29.9% vs 20.1%; P = 0.011), and in anti-dsDNA- and anti-Sm- positive vs negative patients (31.4% vs 13.4%; P < 0.001 and 33.0% vs 22.6%; P = 0.010, respectively), whereas no significant differences were observed in patients given ST alone. CONCLUSION EQ-5D-3L FHS distinguished belimumab from placebo and responders from non-responders, and exhibited known-group validity in subgroup analysis. FHS may prove a useful patient-reported outcome in SLE studies.
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Affiliation(s)
- Julius Lindblom
- 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
| | - Alexander Borg
- 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
| | - Dimitris Ladakis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
| | - Joaquin Matilla
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
| | - Martin Pehr
- 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
| | - Yvonne Enman
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital
| | - Emelie Heintz
- Department of Learning, Informatics, Management and Ethics (LIME)
| | - Malin Regardt
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet
- Occupational Therapy and Physiotherapy, Karolinska University Hospital, 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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Misra DP, Rathore U, Patro P, Agarwal V, Sharma A. Patient-Reported Outcome Measures in Takayasu Arteritis: A Systematic Review and Meta-Analysis. Rheumatol Ther 2021; 8:1073-1093. [PMID: 34398434 PMCID: PMC8380612 DOI: 10.1007/s40744-021-00355-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION We conducted a systematic review of patient-reported outcome measures (PROMs) regarding quality of life, disability, mood abnormalities (anxiety, depression), fatigue, illness perceptions and fibromyalgia in Takayasu arteritis (TAK). Wherever available, comparisons with healthy controls, disease controls or longitudinal changes in PROMs were noted. METHODS MEDLINE, EMBASE, Scopus, Web of Science and Pubmed Central databases, major recent international rheumatology conference abstracts, clinical trial databases and the Cochrane library were searched for relevant articles. Wherever possible, outcome measures across studies were pooled using the restricted maximum likelihood model. Inter-group differences were pooled and compared using standardized mean differences (SMD) with 95% confidence intervals (95% CI). Heterogeneity was assessed using the I2 statistic. Quality of randomized controlled trials was assessed using the Cochrane risk of bias tool. For cross-sectional and cohort studies, the Joana Briggs Institute checklist and Newcastle-Ottawa scale were used, respectively. GRADE methodology was used to determine the certainty of evidence for outcomes. RESULTS Twenty-one studies (all but one observational) involving 1311 patients with TAK and 308 healthy controls were identified. Ten studies (559 TAK patients, 182 healthy controls were synthesized in a meta-analysis. Patients with TAK had worse quality of life (pooled SMD - 6.66, 95% CI - 10.08 to - 3.23 for individual domains; - 0.64, 95% CI - 1.19 to - 0.09 for pooled physical and mental component scores of 36-item Short Form Survey), depression (SMD 0.26, 95% 0.05-0.47) and anxiety (SMD 0.34, 95% CI - 0.06 to 0.75) scores and higher disability (SMD 0.64, 95% CI 0.43-0.84) than healthy controls. Patients with active TAK had worse quality of life, depression and work impairment when compared with those with inactive disease. Included studies were of moderate to high quality. Certainty of evidence for individual outcomes was low to very low. CONCLUSION Literature on PROMs in TAK, albeit sparse, appears to indicate worse scores in patients with TAK compared to healthy individuals. These results, however, require cautious interpretation. Development of a TAK-specific PROM is an important focus of the research agenda.
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Affiliation(s)
- Durga P. Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014 India
| | - Upendra Rathore
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014 India
| | - Pallavi Patro
- School of Telemedicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014 India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014 India
| | - Aman Sharma
- Clinical Immunology and Rheumatology Services, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
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15
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Yan H, Guo J, Zhou W, Dong C, Liu J. Health-related quality of life in osteoarthritis patients: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2021; 27:1859-1874. [PMID: 34465255 DOI: 10.1080/13548506.2021.1971725] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this meta-analysis was to compare health-related quality of life (HRQoL) of Osteoarthritis (OA) patients and controls. A systematic literature search was performed on PubMed, Web of Science and EMBASE from database inception to 7 January 2020. Random effect model was performed to summarize the scores of each domain and the forest plot was used to compare the scores of OA patients with healthy controls. Subgroup analyses were conducted to explore the source of heterogeneity. Statistical analyses were executed using Review Manager (version 5.1). In total, six studies were included in this study, including 7094 patients with OA and 12 100 healthy controls, which were all reliable to summarize the scores of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Meta-analyses found that pooled mean HRQoL score for the SF-36 each domain (physical function, physical role function, body pain, general health, vitality, social function, emotional role function, mental health) was lower in patients with OA than in healthy controls, especially the score in the dimension of physical role function. OA have a substantial impact HRQoL. HRQoL is a significant component of measuring overall health, which contributes to formulate successful self-disease management plan, patient-centered care, and develop effective interventions target confidence.
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Affiliation(s)
- Hongsheng Yan
- Department of Orthopaedics, Jiangsu Rugao Boai Hospital, Nantong, Jiangsu, China
| | - Jiaxin Guo
- Nursing Department, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.,Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.,Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Wei Zhou
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.,Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Chen Dong
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.,Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jun Liu
- Department of Orthopaedics, Jiangsu Rugao Boai Hospital, Nantong, Jiangsu, China
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Psychological Backgrounds of Medically Compromised Patients and Its Implication in Dentistry: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168792. [PMID: 34444548 PMCID: PMC8392062 DOI: 10.3390/ijerph18168792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
The number of medically compromised dental patients is increasing every year with the increase in the super-aged population. Many of these patients have underlying psychiatric problems and diseases, which need to be recognized by dental professionals for better treatment outcomes. The aim of this narrative review article is to summarize the psychological and psychiatric backgrounds of medically compromised patients who are frequently visited and taken care of by dentists using findings from recent systematic reviews and meta-analyses. Anxiety and symptoms of depression, post-traumatic stress disorders, panic disorders, poor cognitive functions, and poor quality of life were some of the common psychological backgrounds in medically compromised patients. Additionally, the consequences of these psychological problems and the considerations that need to be taken by the dentist while treating these patients have been discussed. Dental professionals should be aware of and recognize the different psychological backgrounds of medically compromised dental patients in order to provide appropriate dental treatment and to prevent oral conditions from worsening.
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17
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Louthrenoo W, Kasitanon N, Morand E, Kandane-Rathnayake R. Associations between physicians' global assessment of disease activity and patient-reported outcomes in patients with systemic lupus erythematosus: A longitudinal study. Lupus 2021; 30:1586-1595. [PMID: 34192957 DOI: 10.1177/09612033211027943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine longitudinal associations between Physician Global Assessment (PGA) and patient-reported outcomes (PROs) in patients with systemic lupus erythematosus (SLE). METHODS Patients attending a rheumatology clinic between 2013 and 2017 completed specific (SLEQOL) and generic (SF36) health-related quality of life (HRQoL) surveys and rated their global rating of change (GRC) at each visit. PGA, SLEDAI-2K and SLE Flare Index (SFI) were also captured on all visits. Generalised estimating equations (GEE) methods were used to examine longitudinal associations of PGA with PROs and clinical indicators. RESULTS 337 patients were followed for a median [IQR] of 3.2 [1.6, 3.4] years (2,059 visits). High PGA (>1) was strongly associated with high SLEDAI-2K scores, the presence of flares and poor PROs. Odd ratios (OR) [95% CI] of PGA > 1 in patients with SLEDAI-2K >4 & <10 and SLEDAI-2K ≥10, compared to SLEDAI-2K ≤ 4, were 3.46 [2.36, 5.08], p < 0.001 and 6.39 [4.30, 9.49], p < 0.001, respectively. OR [95% CI] of PGA > 1 in patients with mild-to-moderate or severe flares were 2.09 [1.62, 2.71], p < 0.001 and 4.42 [3.21, 6.07], p < 0.001, respectively. Mental components of both SLEQOL (mood, self-image) and SF36 (MCS) surveys demonstrated significant associations with high PGA. After adjusting for SLEDAI-2K, one-point increase in PGA was associated with reductions in SLEQOL total score and SF36-MCS by 2.33 (regression coefficient (RC) [95% CI] = -2.33 [-3.77, -0.88], p = 0.002), and 4.16 (RC [95% CI] = -4.16 [-5.19, -3.13], p < 0.001) points, respectively. Associations of some physical components (SLEQOL-symptoms, and SF36-PCS) with PGA attenuated when adjusted for SLEDAI-2K. Patients who rated low scores of GRC, which indicate health deterioration, were twice as likely to have PGA > 1 (OR [95%CI] 1.99 [1.25, 3.16], p = 0.004). CONCLUSION High PGA was strongly associated with poor mental health, high disease activity and flares. This study confirms the value of PGA as an efficient assessment tool for SLE.
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Affiliation(s)
- Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nuntana Kasitanon
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Eric Morand
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Tadrous R, O'Rourke D, Mockler D, Broderick J. Health-related quality of life in narcolepsy: A systematic review and meta-analysis. J Sleep Res 2021; 30:e13383. [PMID: 34036640 DOI: 10.1111/jsr.13383] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
To date, there has been no systematic analysis of the literature regarding health-related quality of life in narcolepsy. This systematic review aimed to examine the impact of narcolepsy on health-related quality of life, measured through standardised health-related quality of life questionnaires such as the Short Form 36 and Functional Outcome of Sleep Questionnaire. The following databases: Medline, Embase, Cinahl, and Web of Science were searched for studies that investigated health-related quality of life in adults with narcolepsy. Studies were reviewed independently by two reviewers, and a random-effects meta-analysis was performed. A total of 30 studies were eligible for inclusion in the review. Additionally, meta-analyses were conducted for the Short Form 36 and the EQ5D. The Short Form 36 meta-analysis identified that the pooled mean scores for the Physical Component Summary (45.91) were less affected than the Mental Component Summary (42.98). People with narcolepsy experience substantially lower health-related quality of life when compared with the general population norms of the USA, UK, France and Norway, as well as compared with people with chronic diseases such as multiple sclerosis, diabetes, hypertension and epilepsy. Further research is warranted to identify the longitudinal effects of narcolepsy on health-related quality of life, and to develop a narcolepsy-specific health-related quality of life tool.
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19
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Northcott M, Gearing LJ, Nim HT, Nataraja C, Hertzog P, Jones SA, Morand EF. Glucocorticoid gene signatures in systemic lupus erythematosus and the effects of type I interferon: a cross-sectional and in-vitro study. THE LANCET. RHEUMATOLOGY 2021; 3:e357-e370. [PMID: 38279391 DOI: 10.1016/s2665-9913(21)00006-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/14/2020] [Accepted: 01/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Glucocorticoids, used as a therapy in systemic lupus erythematosus (SLE), interact with the cytoplasmic glucocorticoid receptor to modulate gene transcription. Minimising the use of glucocorticoids is a goal in SLE; however, pharmacological measures to support clinical guidelines are scarce. We evaluated glucocorticoid-regulated genes for their potential use as biomarkers of glucocorticoid exposure in SLE. We examined interactions between changes in gene expression that are induced by glucocorticoids and type I interferon. METHODS Genes regulated by glucocorticoids and type I interferon were analysed in relation to glucocorticoid exposure in adult patients meeting the American College of Rheumatology criteria for SLE from three cross-sectional cohorts: a local cohort from a tertiary hospital in Melbourne, VIC, Australia, and two public datasets (GSE49454, Hospital de la Conception, Marseille, France, and GSE88884, patients enrolled in a large, multicentre clinical trial). RNA sequencing was done using RNA from healthy donor leucocytes treated with the glucocorticoid dexamethasone, or type I interferon, or both. FINDINGS Glucocorticoid-regulated genes were analysed in a local SLE cohort (n=18) and public dataset GSE49454 (n=62). Five genes correlated with glucocorticoid dose in both cohorts and were combined to make a glucocorticoid gene signature. Validity of the glucocorticoid gene signature was tested in the public dataset GSE88884 (n=1756). A dose-dependent association was observed with glucocorticoid dose (p<0·0001), and the glucocorticoid gene signature had moderate ability to identify patients taking high-dose glucocorticoid (area under the curve [AUC]=0·77) although was less discriminatory when including all doses (AUC=0·69). We saw no effect of glucocorticoid dose on type I interferon -regulated gene expression. Patients with a high type I interferon gene signature had reduced glucocorticoid gene signature expression compared with patients with a low type I interferon gene signature matched for glucocorticoid dose, suggesting type I interferon inhibits glucocorticoid-stimulated gene expression. In RNA sequencing experiments, type I interferon impaired the expression of glucocorticoid-induced genes, whereas dexamethasone had minimal effect on the expression of type I interferon-stimulated genes. We identified genes regulated by dexamethasone but not affected by type I interferon; combined signatures using these genes also showed moderate ability to distinguish patients taking glucocorticoids. INTERPRETATION A gene signature for glucocorticoid exposure was identified, but the substantial effect of type I interferon on glucocorticoid-induced genes might limit its application in SLE. These data confirm the insensitivity of type I interferon-regulated genes to glucocorticoids, and together support the concept that type I interferon has a role in glucocorticoid resistance in SLE. FUNDING Lupus Research Alliance and Australian National Health and Medical Research Council.
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Affiliation(s)
- Melissa Northcott
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Linden J Gearing
- Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia; Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Hieu T Nim
- Australian Regenerative Medicine Institute, Monash University, Clayton, VIC, Australia; Systems Biology Laboratory, Monash University, Clayton, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Champa Nataraja
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Paul Hertzog
- Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia; Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Sarah A Jones
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia.
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Natalucci F, Ceccarelli F, Cipriano E, Perricone C, Olivieri G, Pirone C, Mettola G, Truglia S, Spinelli FR, Alessandri C, Conti F. Joint involvement influences quality of life in systemic lupus erythematosus patients. Lupus 2020; 30:478-483. [PMID: 33323011 DOI: 10.1177/0961203320979039] [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: 11/15/2022]
Abstract
INTRODUCTION Joint involvement represents the major determinant in quality of life (QoL)in Systemic Lupus Erhytematosus (SLE) patients. However, QoLhas been generally evaluated by non-specific questionnaires. We evaluated the relationship between SLE musculoskeletal manifestations and QoL, assessed by LupusQoL. METHODS Patients with joint involvement (group A) were compared with those without this feature (group B). Disease activity was assessed by SLEDAI-2k in the whole population, while DAS28 and swollen to tender ratio were applied to assess joint activity. LupusQoL was administered to all the patients. RESULTS Group A included 110 patients [M/F 8/102; median age 49 years (IQR 13), median disease duration 156 months (IQR 216)], group B 58 [M/F 11/47; median age 40 years (IQR 15), median disease duration 84 months (IQR 108)].We found significanlty lower values in all the LupusQoL domains except for one (burden to others) in group A in comparison with group B. A significant correlation between DAS28 values and all the LupusQoL domains in group A was found; only three domains correlated with SLEDAI-2k. CONCLUSIONS SLE-related joint involvement significantly influences disease-specific QoL. DAS28 better correlated with LupusQoL domains in comparison with SLEDAI-2k, confirming the need for specific musculoskeletal activity indices.
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Affiliation(s)
- Francesco Natalucci
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
| | - Fulvia Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
| | - Enrica Cipriano
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
| | - Carlo Perricone
- Reumatologia, Dipartimento di Medicina, Universitá di Perugia, Perugia, Italy
| | - Giulio Olivieri
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
| | - Carmelo Pirone
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
| | - Giuseppe Mettola
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
| | - Simona Truglia
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
| | - Fabrizio Conti
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
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Samala N, Desai A, Vilar-Gomez E, Smith ER, Gawrieh S, Kettler CD, Pike F, Chalasani N. Decreased Quality of Life Is Significantly Associated With Body Composition in Patients With Nonalcoholic Fatty Liver Disease. Clin Gastroenterol Hepatol 2020; 18:2980-2988.e4. [PMID: 32360826 DOI: 10.1016/j.cgh.2020.04.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS We studied impaired quality of life (QOL) and its determinants among individuals with nonalcoholic fatty liver disease (NAFLD). METHODS We collected data from 341 patients with NAFLD who completed the short form 36 (SF-36) questionnaire. Body composition and liver fibrosis were assessed in patients with NAFLD using bioelectrical impedance and transient elastography, respectively. Advanced fibrosis was defined as liver stiffness measurements (LSMs) of 12.1 kPa or greater. SF-36 scores of patients with NAFLD were compared with SF36 scores of individuals with chronic medical illnesses and the general population obtained from the published literature. RESULTS Among patients with NAFLD, percent body fat was negatively associated with scores from all 8 SF-36 scales, whereas lean body mass was positively associated with scores from 5 of 8 SF-36 scales. On multivariable analysis, SF-36 PF scores were negatively associated with type 2 diabetes, body mass index, and LSM and positively associated with lean body mass and level of alanine aminotransferase. Patients with NAFLD, and even those without advanced fibrosis, had significantly lower mean QOL scores than the control group or the general population. CONCLUSIONS Individuals with NAFLD, even those without advanced fibrosis, have lower QOL than controls. Body composition associates with QOL in patients with NAFLD; both of the modifiable factors independently associated with QOL are related to body composition. Further studies are needed to investigate if interventions to improve body composition can increase QOL for patients with NAFLD.
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Affiliation(s)
- Niharika Samala
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Archita Desai
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Eduardo Vilar-Gomez
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Emily R Smith
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samer Gawrieh
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Carla D Kettler
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Francis Pike
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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Jin Z, Yang C, Xiao C, Wang Z, Zhang S, Ren J. Systemic lupus erythematosus and risk of sexual dysfunction: A systematic review and Meta-Analysis. Lupus 2020; 30:238-247. [PMID: 33210559 DOI: 10.1177/0961203320974081] [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: 01/23/2023]
Abstract
OBJECTIVE To systematically review and summarize the available literature regarding the association between systemic lupus erythematosus (SLE) and sexual dysfunction (SD) in both sexes. METHODS We retrieved relevant studies from the following databases: PubMed, Embase,Cochrane Library, and Web of Science. Two reviewers independently reviewed the studies in our sample, assessed their validity, and extracted relevant data. Sensitivity and subgroup analyses were performed to distinguish sources of heterogeneity. RESULTS Our search resulted in a sample of eight eligible studies, which involved 758 patients in the SLE group and 1724 individuals in the control group. The pooled RR for the increased risk for SD compared to those in the control group was 1.80 (95%CI 1.12-2.87). Subgroup analysis by sex revealed that males (pooled RR = 2.98, 95%CI 2.41-3.68) had a higher risk of SD compared to females (pooled RR = 1.56, 95%CI 0.99-2.48). Females with SLE had significantly lower values in FSFI compared to the healthy individuals (WMD=-0.224, 95%CI -0.441 to -0.078). Age of participants and the quality of studies might influence the results. CONCLUSIONS Our meta-analysis suggests that SLE is significantly associated with an increased risk of sexual dysfunction. It is of great urgency to implement for active interventions that aimed to treat or prevent SD among SLE patients.
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Affiliation(s)
- Zhao Jin
- Department of internal medicine, China-Japan Friendship Hospital, Beijing, China
| | - Cong Yang
- Department of internal medicine, China-Japan Friendship Hospital, Beijing, China
| | - Chu Xiao
- Department of internal medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Zizhen Wang
- Department of internal medicine, China-Japan Friendship Hospital, Beijing, China
| | - Suxin Zhang
- Department of internal medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Jie Ren
- Department of internal medicine, Peking University Third Hospital, Beijing, China
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Chiche L, Jourde-Chiche N, Cornec D. Should the Biopsychosocial Model Be Considered in Systemic Autoimmune Diseases? Comment on the Article by Posada et al. Arthritis Rheumatol 2020; 73:717-718. [PMID: 33164342 DOI: 10.1002/art.41582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 11/09/2022]
Affiliation(s)
| | - Noémie Jourde-Chiche
- Centre de Nephrologie et Transplantation Renale, Hôpital de la Conception, AP-HM, Marseillle, France
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Relationship between disease activity, organ damage and health-related quality of life in patients with systemic lupus erythematosus: A systemic review and meta-analysis. Autoimmun Rev 2020; 20:102691. [PMID: 33190803 DOI: 10.1016/j.autrev.2020.102691] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) is a common systemic autoimmune disease that may lead to considerable physical, psychological, and socioeconomical burden. In previous studies, inconsistent results were reported for the association of disease activity and organ damage with health-related quality of life (HRQoL). This paper aimed to explore the relationship between disease activity, organ damage, and HRQoL measured by SF-36, EQ-5D, LupusQoL, and LupusPRO and investigate whether the correlation is region-specific. METHODS We systematically searched for studies reporting the association between SLE disease activity, organ damage, and HRQoL in MEDLINE, EMBASE, PsycINFO, World of Science, the Cochrane Library, and CINAHL from inception to December 2019. A meta-analysis and region subgroup analysis were performed with a random-effects model to estimate pooled correlation coefficients and heterogeneity. RESULTS Forty articles were included representing of 6079 adult SLE patients. The meta-analysis of SF-36 and LupusPRO studies revealed mild to moderate negative correlations between disease activity and domains of these HRQoL measurements (correlation coefficient r ranging from -0.27 to -0.07). Likewise, negative correlations were found between organ damage and domains of SF-36 and LupusPRO (r ranging from -0.25 to -0.08). The pooled correlation coefficient is relatively higher in physical functioning related domains than mental health. In the region subgroup analysis, disease activity had strong negative correlations with SF-36 domains in African and European SLE patients, while organ damage had the strongest negative correlation with SF-36 domains in Asian SLE patients (p < 0.010). CONCLUSION This study provides the first comprehensive assessment of the relationship between disease activity, organ damage, and four popular HRQoL instruments, which provides useful insight into the target therapy in SLE management.
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van Campen C(LMC, Rowe PC, Visser FC. Validation of the Severity of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome by Other Measures than History: Activity Bracelet, Cardiopulmonary Exercise Testing and a Validated Activity Questionnaire: SF-36. Healthcare (Basel) 2020; 8:healthcare8030273. [PMID: 32823979 PMCID: PMC7551321 DOI: 10.3390/healthcare8030273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe and disabling chronic disease. Grading patient’s symptom and disease severity for comparison and therapeutic decision-making is necessary. Clinical grading that depends on patient self-report is subject to inter-individual variability. Having more objective measures to grade and confirm clinical grading would be desirable. Therefore, the aim of this study was to validate the clinical severity grading that has been proposed by the authors of the ME International Consensus Criteria (ICC) using more standardized measures like questionnaires, and objective measures such as physical activity tracking and cardiopulmonary exercise testing. Methods and results: The clinical database of a subspecialty ME/CFS clinic was searched for patients who had completed the SF 36 questionnaire, worn a SensewearTM armband for five days, and undergone a cardiopulmonary exercise test. Only patients who completed all three investigations within 3 months from each other—to improve the likelihood of stable disease—were included in the analysis. Two-hundred-eighty-nine patients were analyzed: 121 were graded as mild, 98 as moderate and 70 as having severe disease. The mean (SD) physical activity subscale of the SF-36 was 70 (11) for mild, 43 (8) for moderate and 15 (10) for severe ME/CFS patients. The mean (SD) number of steps per day was 8235 (1004) for mild, 5195 (1231) for moderate and 2031 (824) for severe disease. The mean (SD) percent predicted oxygen consumption at the ventilatory threshold was 47 (11)% for mild, 38 (7)% for moderate and 30 (7)% for severe disease. The percent peak oxygen consumption was 90 (14)% for mild, 64 (8)% for moderate and 48 (9)% for severe disease. All comparisons were p < 0.0001. Conclusion: This study confirms the validity of the ICC severity grading. Grading assigned by clinicians on the basis of patient self-report created groups that differed significantly on measures of activity using the SF-36 physical function subscale and objective measures of steps per day and exercise capacity. There was variability in function within severity grading groups, so grading based on self-report can be strengthened by the use of these supplementary measures.
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Affiliation(s)
| | - Peter C. Rowe
- Department of Paediatrics, John Hopkins University School of Medicine, Baltimore, MD 21205, USA;
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Aitken M, Basu N. Improving quality of life in vasculitis patients. Rheumatology (Oxford) 2020; 59:iii132-iii135. [PMID: 32348508 DOI: 10.1093/rheumatology/kez546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
Systemic vasculitis are a complex cluster of diseases with high associated morbidity. As disease-related mortality diminishes, the cumulative impact of poor health-related quality of life becomes more pertinent to patients than the initial pathological insult. In this article we explore health-related quality of life in ANCA-associated vasculitis, large-vessel vasculitis and therapeutic strategies that may enhance this critical outcome.
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Affiliation(s)
- M Aitken
- Department of Rheumatology, NHS Greater Glasgow & Clyde
| | - N Basu
- Department of Rheumatology, NHS Greater Glasgow & Clyde.,Institute of Infection, Immunology & Inflammation, University of Glasgow, Glasgow, UK
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Seguier J, Jouve E, Bobot M, Whalen E, Dussol B, Gentile S, Burtey S, Halfon P, Retornaz F, Chaussabel D, Chiche L, Jourde-Chiche N. Paradoxical association between blood modular interferon signatures and quality of life in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2019; 59:1975-1983. [DOI: 10.1093/rheumatology/kez541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/02/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract
Objectives
Blood transcriptomic IFN signature is a hallmark of SLE. The impaired health-related quality of life (HRQOL) observed in SLE is poorly related to disease activity. The aim of this study was to test how IFN signatures were associated with HRQOL in SLE patients.
Methods
Among consecutive patients, blood transcriptomic profiles were analysed with a modular framework comprising 3 IFN modules: M1.2, M3.4 and M5.12. Disease activity was evaluated by the SLEDAI score, and HRQOL was assessed with the SF-36 questionnaire, which includes eight domains: physical function, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health (MH) and physical component summary and mental component summary scores.
Results
A total of 57 SLE patients were evaluated, among whom 27 (47%) were clinically quiescent, 30 (53%) were flaring, and 19 (33%) had active lupus nephritis. All SF-36 domains were altered in SLE patients compared with the general French population (P < 0.0001). In multivariate analysis, taking into account flares, age, ethnicity, smoking and renal severity, social functioning was independently associated with the IFN score (P = 0.027). Analyses restrained to quiescent patients (n = 27) yielded greater associations between social functioning and the three IFN modules, and between MH and M3.4. Considering all quiescent visits (n = 51), the IFN score was independently correlated with social functioning (P = 0.022) and MH (P = 0.038).
Conclusion
This unexpected paradoxical association between IFN signature and some specific HRQOL domains argues against a pivotal role of IFNs in the persistently altered HRQOL of SLE patients.
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Affiliation(s)
- Julie Seguier
- AP-HM, Service de Médecine Interne, Hôpital de la Timone, Marseille, France
| | - Elisabeth Jouve
- EA 3279 CEReSS, AP-HM, Service Evaluation Médicale, Marseille, France
| | - Mickaël Bobot
- C2VN, INRA 1263, INSERM 1260, Aix-Marseille Université, Marseille, France
- AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Elisabeth Whalen
- Department of Systems Immunology, Benaroya Research Institute, Seattle, WA, USA
| | - Bertrand Dussol
- C2VN, INRA 1263, INSERM 1260, Aix-Marseille Université, Marseille, France
- AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Stéphanie Gentile
- EA 3279 CEReSS, AP-HM, Service Evaluation Médicale, Marseille, France
| | - Stéphane Burtey
- C2VN, INRA 1263, INSERM 1260, Aix-Marseille Université, Marseille, France
- AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Philippe Halfon
- Service de Médecine Interne, Hôpital Européen, Marseille, France
| | | | | | - Laurent Chiche
- Service de Médecine Interne, Hôpital Européen, Marseille, France
| | - Noémie Jourde-Chiche
- C2VN, INRA 1263, INSERM 1260, Aix-Marseille Université, Marseille, France
- AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
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