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Hashemi S, Farahbakhsh S, Aghakhani Z, MomayezanMarnani A, Hemati N, Hashemi S. Health-related quality of life and its related factors in patients with systemic lupus erythematosus in southwest Iran: a cross-sectional study. BMC Psychol 2023; 11:259. [PMID: 37658385 PMCID: PMC10472603 DOI: 10.1186/s40359-023-01300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Quality of life (QoL) is an important measure in health assessment. It is impacted by unclear factors in Systemic Lupus Erythematosus (SLE) patients. The study aimed to investigate the factors related to QoL in SLE patients. METHODS This cross-sectional study was performed on 140 (136 women and four men) Iranian SLE patients of Hafiz Hospital from June 2019 to August 2020. The Lupus Erythematosus Quality of Life Questionnaire (LEQoL) was used to evaluate the quality of life. The patients were evaluated with this questionnaire for four weeks in eight dimensions health, emotional health, body image, pain, planning, intimate relationships, and the burden of others. Related factors of LEQoL were evaluated using multivariable linear regression. RESULTS The mean age was 34.09(8.96) years. The total mean QoL Score was 65.5 ± 22.4. The multivariable analysis showed that duration of disease (β:-1.12, 95% CI:-1.44 to -0.79, P:0.001), physical activity(β:-12.99, 95% CI:-19.2 to -6.13, P:0.001), kidney involvement (β:-9.2, 95% CI:-16.61 to -2.79, P:0.03) and skin involvement(β:-8.7, 95% CI:-17.2 to -0.2, P:0.031) were significantly related to the total mean QOL score of SLE patients. CONCLUSION The QoL of Iranian patients with SLE was low. Age and gender can be related to the decrease in the QoL of patients with SLE. Increasing the disease duration, physical activity, kidney involvement, and skin involvement can be related to the decrease in the QOL of Iranian patients with SLE.
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Affiliation(s)
- Sakineh Hashemi
- Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Farahbakhsh
- Occupational Therapy, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | | | - Nazi Hemati
- Clinical Exercise Physiology, Shiraz University, Shiraz, Iran
| | - Somayeh Hashemi
- Clinical Exercise Physiology, Shiraz University, Shiraz, Iran
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2
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Aim MA, Queyrel V, Tieulié N, Chiche L, Faraut J, Manet C, Schleinitz N, Harlé JR, Jourde-Chiche N, Dany L. Importance of temporality and context in relation to life habit restrictions among patients with systemic lupus erythematosus: A psychosocial qualitative study. Lupus 2022; 31:1423-1433. [PMID: 35916586 DOI: 10.1177/09612033221115966] [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
OBJECTIVE Life habits (LH) encompass an individual's engagement in daily activities such as nutrition, fitness, personal care, communication, housing, and mobility, along with his/her social role (responsibility, interpersonal relationships, community life, education, employment, and recreation). This qualitative study explores the nature and context of LH restrictions in systemic lupus erythematosus (SLE) individuals across their SLE journey. METHODS Narrative interviews were conducted with adult SLE patients. Interview transcripts were subjected to a thematic content analysis, using the Disability Creation Process model as a framework. RESULTS Forty participants were interviewed. Three major themes were highlighted: (1) Temporality, capabilities, and environmental contexts: although all participants experienced LH restrictions at some point, the expression of these limitations depended on the individual's and SLE disease characteristics as well as on temporal (time of life and lupus course) and environmental (material, social, and societal) contexts. (2) Identity issues, illness stigma, and (fear of) discriminations: LH were discussed through the lens of participants' social roles and identities. While illness stigma can influence social relations, it is also expressed at a societal level. (3) Masking and minimizing strategies: due to illness stigma and fear of discrimination, participants developed strategies to manage their relationships, including masking and minimization. Their use was both advantageous and disadvantageous regarding LH. CONCLUSIONS For individuals with SLE, LH restrictions must be considered as an ongoing process that takes place within specific contexts. Our findings provide many opportunities for interventions that can benefit patients and their families, as well as healthcare providers.
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Affiliation(s)
- Marie-Anastasie Aim
- 36900AP-HM, Delegation a la Recherche Clinique et a l'Innovation, Marseille, France.,Aix-Marseille Univ, LPS, Aix-en-Provence, France
| | | | | | - Laurent Chiche
- Hopital Europeen, Service de Médecine Interne, Marseille, France
| | - Julien Faraut
- 36900AP-HM, Delegation a la Recherche Clinique et a l'Innovation, Marseille, France
| | - Cécile Manet
- 36900AP-HM, CHU Timone, Service de Medecine Interne, Marseille, France
| | | | - Jean-Robert Harlé
- 36900AP-HM, CHU Timone, Service de Medecine Interne, Marseille, France
| | - Noémie Jourde-Chiche
- 36900AP-HM, CHU Conception, Service de Nephrologie, Marseille, France.,Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Lionel Dany
- Aix-Marseille Univ, LPS, Aix-en-Provence, France.,36900AP-HM, CHU Timone, Service d'Oncologie Medicale, Marseille, France
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3
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Ullah S, Haroon M, Hashmi F, Tayyab Z, Javed S. A Prospective Follow-Up Study on the Disease Course and Predictors of Poor Outcomes in a Random Population-Based Cohort of Newly Diagnosed Lupus Patients. Cureus 2022; 14:e27430. [PMID: 36051712 PMCID: PMC9420196 DOI: 10.7759/cureus.27430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective Systemic lupus erythematosus (SLE) is one of the most devastating systemic autoimmune connective tissue diseases. There is a paucity of prospective data on Pakistani SLE patients, and in this prospective study, we aimed to investigate the disease course, clinical outcomes, and the predictors of poor outcomes in a random population-based cohort of newly diagnosed SLE patients (diagnosed within the last one year). Methods This was a prospective observational study carried out in the rheumatology department of the Fatima Memorial Hospital, Lahore. Lupus patients are regularly reviewed in our dedicated lupus clinic every one to three months. For the purpose of this study, a focus group of newly diagnosed patients (diagnosed within the last one year) attending our lupus clinic was identified and prospectively followed up for 12 months. A wide range of demographical and clinical parameters was recorded. The association of clinical variables with the progressive disease was determined using univariate and multivariate logistic regressions. Results Prospective data of 89 newly diagnosed SLE patients regularly attending our dedicated lupus clinic were reviewed. During the study period, (January 2021 through January 2022), these patients had multiple visits overall - median: five, minimum: three, and maximum: nine visits [interquartile range (IQR) 4-7]. All 89 patients had completed one year of follow-up. Of note, 46% of the cohort was noted to have an ongoing active disease during the majority of visits in the study period. On multiple logistic regression analysis, there was a significant association between ongoing active disease ("progressors") and low education status [odds ratio (OR): 2.81, 95% confidence interval (CI): 1.01-7.76, p=0.046], stress at home (OR: 5.8, 95% CI: 2.13-15.8, p=0.001), and hematologic manifestations (OR: 3.0, 95% CI: 1.08-8.32, p=0.03). Conclusions Almost half of our cohort of lupus patients demonstrated active disease manifestations throughout the one-year prospective follow-up, and these were found to be associated with low education status, stress at home, and hematological manifestations.
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4
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Cornet A, Mazzoni D, Edwards A, Monzani D, Pravettoni G, Andersen J, Mosca M. Coping with systemic lupus erythematosus in patients' words. Lupus Sci Med 2022; 9:9/1/e000656. [PMID: 35568437 PMCID: PMC9109093 DOI: 10.1136/lupus-2022-000656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Previous research on coping strategies of patients with SLE showed that there are no absolute adaptive or maladaptive strategies and that the range of potential coping strategies is large and heterogeneous. In this paper, we aimed to identify, in a large sample of patients with SLE (N=3222), the most frequent words used by patients to describe their coping strategies, to group them into significant themes and to test their possible association with specific patient characteristics. METHODS Our analyses were based on the data set of the European survey 'Living with Lupus in 2020' (N=3222). Through the T-LAB software, we analysed the answers that adult participants gave to an open-ended question about how they cope with the disease. We identified the most frequent words, and with hierarchical cluster analysis we grouped them into semantic clusters (ie, themes) that were characterised by specific patterns of words. Finally, we tested the possible association between clusters and illustrative variables (sociodemographics, disease characteristics, quality of life). RESULTS Five coping strategies were identified, each of them constituting an important percentage of the total word occurrences: positive attitude (22.58%), social support (25.46%), medical treatments (10.77%), healthy habits (20.74%) and avoid stress (20.45%). Each strategy was statistically associated with specific patient characteristics, such as age and organ involvement. CONCLUSIONS Learning to adapt to a lifetime of having SLE may require replacing old coping strategies with more effective ones. Investigating patients' coping strategies in relation to different patient characteristics represents a useful starting point for developing more targeted and efficacious interventions.
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Affiliation(s)
| | - Davide Mazzoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | | | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Marta Mosca
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy
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5
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Lew D, Huang X, Kellahan SR, Xian H, Eisen S, Kim AHJ. Anxiety Symptoms Among Patients With Systemic Lupus Erythematosus Persist Over Time and Are Independent of
SLE
Disease Activity. ACR Open Rheumatol 2022; 4:432-440. [PMID: 35191213 PMCID: PMC9096521 DOI: 10.1002/acr2.11417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
Abstract
Objective The objectives of this study are to identify patterns of anxiety symptomology over time among patients with systemic lupus erythematosus (SLE) and to assess the longitudinal relationship between SLE disease activity and anxiety symptomology. Methods Longitudinal data from 139 patients with American College of Rheumatology or Systemic Lupus International Collborating Clinic (SLICC)‐classified SLE were analyzed. Anxiety symptomology was assessed using the Patient‐Reported Outcomes Measurement Information System (PROMIS) Emotional Distress: Anxiety Short Form 8a. SLE disease activity was measured using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)‐2000 (S2K) and S2K Responder Index 50 (S2K RI‐50). Group‐based trajectory modeling (GBTM) identified longitudinal trajectories of anxiety symptomology. The relationship between disease activity and anxiety over time was assessed using multilevel linear regressions. Results The mean patient age was 40.2 years (standard deviation [SD], 12.7); 90.6% were female, and 56.1% were of Black race. All patients had at least three PROMIS anxiety scores over an average of 30.9 months (SD, 13.0). GBTM identified four trajectories of anxiety symptomology, labeled as the following: low (LA), average (AA), moderate (MA), and high anxiety (HA). Black patients were 2.47 (95% confidence interval: 1.19‐5.12) times as likely as White patients to be classified into the MA or HA groups compared with the LA or AA groups. On multivariable analysis, active SLE disease was not significantly associated with anxiety over time (P = 0.19). Conclusion Anxiety trajectories remained stable over time, and racial differences in anxiety severity were observed. SLE disease activity was not longitudinally associated with anxiety after controlling for depression and other factors. Further understanding of the factors that contribute to the persistence of anxiety among individuals with SLE is necessary.
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Affiliation(s)
- Daphne Lew
- Washington University in St. Louis School of Medicine St. Louis Missouri
| | - Xinliang Huang
- Washington University in St. Louis School of Medicine St. Louis Missouri
| | - Sarah R. Kellahan
- Washington University in St. Louis School of Medicine St. Louis Missouri
| | - Hong Xian
- Saint Louis University St. Louis Missouri
| | - Seth Eisen
- Washington University in St. Louis School of Medicine St. Louis Missouri
| | - Alfred H. J. Kim
- Washington University in St. Louis School of Medicine St. Louis Missouri
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6
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Li J, Shi Y, Zhou W. Sandplay therapy could be a method to decrease disease activity and psychological stress in children with systemic lupus erythematosus. Lupus 2022; 31:212-220. [PMID: 35034478 DOI: 10.1177/09612033211072398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Although the prevalence rate of childhood-onset systemic lupus erythematosus (cSLE) is far lower than that of adults, cSLE has a high rate of organ involvement, rapid development and poor prognosis, which is more serious than that in adults. And studies have shown that a wide range of physiological, functional, nerve, and organ damage will have a great impact on the mental health of children. At present, there is no relevant psychological intervention research for cSLE in China. This paper aimed to explore the effect of Sandplay therapy on mental health and disease activity of children with cSLE. METHODS Forty childrens with cSLE were randomly divided into control group (CG) and intervention group (IG); the CG were treated with glucocorticoid, immunosuppressant and other drugs, while the IG were treated with Sandplay therapy in addition to drug therapy, at the time of 0, 2, and 4 weeks after initial diagnosis, respectively. The questionnaire evaluation and related clinical indicators of the two groups were compared and analyzed (before psychotherapy intervention) at 0, 2, 4, and 12 weeks after initial diagnosis. RESULTS There was no significant difference between the two groups in the evaluation of questionnaire and related clinical indicators at the time 0, 2 weeks after initial diagnosis respectively. At 12 weeks after the intervention, the score of Short version of the Children's Depression Inventory (CDI-S) in the IG was significantly lower than that in the CG, the score of The Screen for Child Anxiety Related Emotional Disorders (SCARED) scale in the IG was significantly lower than that in the CG, and the Pediatric Quality of Life Inventory (PedsQL 4.0) showed that the scores of social function, school performance, and emotional health of the IG were higher than those of the CG (p < 0.05), and the clinical indexes of the IG were better than those of the CG (p < 0.05). CONCLUSION Sandplay therapy may help to slow down the occurrence and development of anxiety and depression and reduce disease activity in patients with cSLE.
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Affiliation(s)
- Jinjiao Li
- 518873Shandong First Medical University, Taian, China.,Department of Rheumatology, 426111Liaocheng People's Hospital, Liaocheng, China
| | - Yanjun Shi
- Department of Rheumatology, 426111Liaocheng People's Hospital, Liaocheng, China
| | - Wei Zhou
- Department of Rheumatology, 426111Liaocheng People's Hospital, Liaocheng, China
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7
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Hawker K, Barnabe C, Barber CE. A scoping Review of tools used to assess patient Complexity in rheumatic disease. Health Expect 2021; 24:556-565. [PMID: 33595914 PMCID: PMC8077158 DOI: 10.1111/hex.13200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Patients with rheumatic diseases often have multiple comorbidities which may impact well-being leading to high psychosocial complexity. This scoping review was undertaken to identify complexity measures/tools used in rheumatology that could help in planning and coordinating care. METHODS MEDLINE, EMBASE and CINAHL were searched from database inception to 14 December 2019 using keywords and Medical Subject Headings for "care coordination", "complexity" and selected rheumatic diseases and known complexity measures/tools. Articles describing the development or use of complexity measures/tools in patients with adult rheumatologic diagnoses were included regardless of study design. Included articles were evaluated for risk of bias where applicable. RESULTS The search yielded 407 articles, 37 underwent full-text review and 2 were identified during a hand search with 9 included articles. Only 2 complexity tools used in populations of adult patients with rheumatic disease were identified: the SLENQ and the INTERMED. The SLENQ is a 97-item patient needs questionnaire developed for patients with systemic lupus (n = 1 study describing tool development) and applied in 5 cross-sectional studies. Three studies (a practice article, trial and a cross-sectional study) applied the INTERMED, a clinical interview to ascertain complexity and support coordinated care, in patients with rheumatologic diagnoses. CONCLUSIONS There is limited information on the use of patient complexity measures/tools in rheumatology. Such tools could be applied to coordinate multidisciplinary care and improve patient experience and outcomes. PATIENT CONTRIBUTION This scoping review will be presented to patient research partners involved in co-designing a future study on patient complexity in rheumatic disease.
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Affiliation(s)
- Kara Hawker
- Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Cheryl Barnabe
- Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Arthritis ResearchCanada
| | - Claire E.H. Barber
- Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Arthritis ResearchCanada
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8
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Moghadam ZB, Faezi ST, Zareian A, Rezaei E. Experiences of Iranian female patients with systemic lupus erythematosus: A qualitative study. Arch Rheumatol 2020; 36:120-128. [PMID: 34046577 PMCID: PMC8140862 DOI: 10.46497/archrheumatol.2021.7989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/31/2020] [Indexed: 12/03/2022] Open
Abstract
Objectives
This study aims to explore the perceptions, concerns, expectations, and viewpoints of female patients with systemic lupus erythematosus (SLE) regarding reproductive health in Iran. Patients and methods
This qualitative research was conducted using 27 semi-structured deep interviews with 19 married female patients (mean age 37.4±7.0 years; range, 15 to 49 years) suffering from SLE selected through purposive sampling in the Rheumatology Center of Shariati Hospital, Tehran, Iran between August 2017 and March 2018. Results
Patients’ perceptions were classified into six categories and 14 subcategories: physical suffering (debilitating pain, gradual disability, and apparent transformation), psychological stress (family disturbance and sexual dissatisfaction), challenging fertility (bothersome pregnancy and impaired parenting), adaptation to the disease (self-care and lifestyle modification), need for a supporter (support from the spouse, support from the family and acquaintances, and lack of occupational and social support), and spirituality (forgiveness of sins and resorting to God). Conclusion The findings clearly suggested the negative effects of SLE on the reproductive health of these patients. This study emphasized the importance of care and support for female patients with SLE. We hope that this research enhances the awareness of care providers about physical, sexual, psychological, social, and spiritual factors, since taking care of these patients requires strategic and multidisciplinary management.
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Affiliation(s)
- Zahra Behboodi Moghadam
- Department of Reproductive Health, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Tahereh Faezi
- Department of Rheumatology Research Center, Tehran University of Medical Sciences Tehran, Iran
| | - Armin Zareian
- Department of Public Health, Nursing Faculty, Aja University of Medical Sciences, Tehran, Iran
| | - Elham Rezaei
- Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Urmia University of Medical Sciences, Urmia, Iran
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9
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Gholizadeh S, Azizoddin DR, Mills SD, Zamora G, Potemra HMK, Hirz AE, Wallace DJ, Weisman MH, Nicassio PM. Body image mediates the impact of pain on depressive symptoms in patients with systemic lupus erythematosus. Lupus 2019; 28:1148-1153. [DOI: 10.1177/0961203319861675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with treatment manifestations that can cause changes in appearance, including skin rashes, alopecia, vitiligo, and scars. SLE has been shown to adversely impact body image outcomes, and previous research has identified that greater disease activity is associated with worse body image outcomes which, in turn, are associated with greater depressive symptoms. For patients with SLE who also experience significant pain, poor body image outcomes may further compromise wellbeing and lead to greater depressive symptoms. The role of pain in body image has not been explored in SLE. Thus, the present study examined whether body image (specifically, body image-related quality of life) serves as a mediator of the relationship between pain and depressive symptoms among patients with SLE. Methods Multiple mediation analysis was used to examine the hypothesis that body image-related quality of life mediates the relationship between pain and depressive symptoms in a sample of patients with SLE ( N = 135) from an urban region in Los Angeles, California. Results The sample was predominately female (92.6%) with a mean disease duration of approximately 17 years. Approximately one-quarter of the sample had elevated depressive symptoms. Body image-related quality of life was a significant mediator in the relationship between pain and depressive symptoms. The model accounted for 51% of the total variance in depressive symptoms ( R2 = 0.51). Conclusion This cross-sectional study suggested that body image-related quality of life may mediate the effects of pain on depressive symptoms among patients with SLE.
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Affiliation(s)
- S Gholizadeh
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
- Stanford University School of Medicine, Stanford, USA
| | - D R Azizoddin
- Stanford University School of Medicine, Stanford, USA
| | - S D Mills
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA
| | - G Zamora
- Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | | | - A E Hirz
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - D J Wallace
- Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, USA
| | - M H Weisman
- Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, USA
| | - P M Nicassio
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, USA
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10
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Mills SD, Azizoddin D, Gholizadeh S, Racaza GZ, Nicassio PM. The mediational role of helplessness in psychological outcomes in systemic lupus erythematosus. Lupus 2018; 27:1185-1189. [PMID: 29320976 DOI: 10.1177/0961203317751046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can result in disability and psychological distress. Although pain has been associated with depressive symptomatology and stress in SLE, a paucity of theoretical models have been used to explain the relationship between pain and psychological distress in this population. Thus, the present study examined helplessness as a mediator of the relationship between pain and psychological distress among patients with SLE. Methods Multiple mediation analysis was used to examine the hypothesis that learned helplessness mediates the relationship between pain and symptoms of anxiety, depression, and stress in a sample of patients with SLE ( N = 136) receiving medical care at Cedars Sinai Medical Center. Results The mean score on the Helplessness subscale was 14.5 ( SD = 5.4). Helplessness fully mediated the relationship between pain vitality and symptoms of anxiety (BCa 95% CI (-0.073, -0.015)), depression (BCa 95% CI (-0.502, -0.212)), and stress (BCa 95% CI (-0.063, -0.027)). Conclusion Participants reported a high level of perceived inability to control one's disease. Helplessness fully mediated the relationship between pain and measures of anxiety, depression, and perceived stress among patients with SLE.
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Affiliation(s)
- S D Mills
- 1 464916 San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology , San Diego, CA, USA
| | - D Azizoddin
- 2 Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - S Gholizadeh
- 1 464916 San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology , San Diego, CA, USA
| | - G Z Racaza
- 3 University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - P M Nicassio
- 4 Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
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11
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Williams EM, Hyer JM, Viswanathan R, Faith TD, Egede L, Oates JC, Marshall GD. Cytokine balance and behavioral intervention; findings from the Peer Approaches to Lupus Self-Management (PALS) project. Hum Immunol 2017; 78:574-581. [PMID: 28716698 PMCID: PMC6013837 DOI: 10.1016/j.humimm.2017.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/26/2017] [Accepted: 07/10/2017] [Indexed: 12/22/2022]
Abstract
The Peer Approaches to Lupus Self-Management program sought to address the disparate impact of systemic lupus erythematosus (SLE) on African American women through a peer mentoring intervention with aims of reducing stress, anxiety, and depression. Given the association between psychological health and immune function this study examines the relationship between patient reported outcomes (PROs) in these domains and immunologic indicators of disease activity. Twenty-three African American women with SLE served as mentees in the intervention from whom PRO measures were collected at the outset, midpoint, and end of the 12week pilot study. Blood samples were collected pre- and post-intervention. Plasma was collected from the samples and cryopreserved for subsequent analyses. The strongest correlations were between the Generalized Anxiety Disorder measure and Th1/Th2 cytokine balance. Weaker correlations existed between depression and the Th1/Th2 cytokine balance. Assessment of fresh versus cryopreserved samples revealed that changes in Th1/Th2 cytokine balance within the intervention were generally equivalent, regardless of sample type. The PALS intervention resulted in significant improvements to anxiety and depression levels which were significantly associated with positive changes in Th1/Th2 cytokine balance indicating a possible underlying mechanism of action. The nature of this relationship warrants further study.
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Affiliation(s)
- Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - J Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - Ramakrishnan Viswanathan
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Clinical Cancer Center Building, 5th Floor, Suite C5400, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA.
| | - Jim C Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas St, Suite 8, Charleston, SC 29425, USA; Rheumatology Section, Medial Service, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
| | - Gailen D Marshall
- Division of Clinical Immunology and Allergy, University of Mississippi Medical Center, 2500 North State Street, N416, Jackson, MS 39216, USA.
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12
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Williams EM, Egede L, Faith T, Oates J. Effective Self-Management Interventions for Patients With Lupus: Potential Impact of Peer Mentoring. Am J Med Sci 2017; 353:580-592. [PMID: 28641721 PMCID: PMC6249683 DOI: 10.1016/j.amjms.2017.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/28/2016] [Accepted: 01/20/2017] [Indexed: 01/22/2023]
Abstract
Systemic lupus erythematosus (SLE) is associated with significant mortality, morbidity and cost for the individual patient and society. In the United States, African Americans (AAs) have 3-4 times greater prevalence of lupus, risk of developing lupus at an earlier age and lupus-related disease activity, organ damage and mortality compared with whites. Evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function and delayed disability among patients with lupus. However, AAs and women are still disproportionately affected by lupus. This article presents the argument that peer mentoring may be an especially effective intervention approach for AA women with SLE. SLE peers with a track record of success in lupus management and have a personal perspective that clinicians often lack. This commonality and credibility can establish trust, increase communication and, in turn, decrease disparities in healthcare outcomes.
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Affiliation(s)
- Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Trevor Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - James Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina; Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Georgopoulou S, Efraimidou S, MacLennan SJ, Ibrahim F, Cox T. The relationship between social support and health-related quality of life in patients with antiphospholipid (hughes) syndrome. Mod Rheumatol 2017; 28:147-155. [DOI: 10.1080/14397595.2017.1317319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sofia Georgopoulou
- Academic Department of Rheumatology, King’s College London, School of Medicine, London, United Kingdom
| | - Sofia Efraimidou
- Centre for Sustainable Working Life, Birkbeck University of London, United Kingdom
| | | | - Fowzia Ibrahim
- Academic Department of Rheumatology, King’s College London, School of Medicine, London, United Kingdom
| | - Thomas Cox
- Centre for Sustainable Working Life, Birkbeck University of London, United Kingdom
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14
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Moraleda V, Prados G, Martínez MP, Sánchez AI, Sabio JM, Miró E. Sleep quality, clinical and psychological manifestations in women with systemic lupus erythematosus. Int J Rheum Dis 2017; 20:1541-1550. [DOI: 10.1111/1756-185x.13081] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Virginia Moraleda
- Department of Personality, Assessment and Psychological Treatment; Faculty of Psychology; University of Granada; Granada Spain
| | - Germán Prados
- Department of Nursing; Health Science Faculty; University of Granada; Granada Spain
| | - María P. Martínez
- Department of Personality, Assessment and Psychological Treatment; Faculty of Psychology; University of Granada; Granada Spain
| | - Ana I. Sánchez
- Department of Personality, Assessment and Psychological Treatment; Faculty of Psychology; University of Granada; Granada Spain
| | - José M. Sabio
- Internal Medicine Department; Virgen de las Nieves University Hospital; Granada Spain
| | - Elena Miró
- Department of Personality, Assessment and Psychological Treatment; Faculty of Psychology; University of Granada; Granada Spain
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Mills SD, Azizoddin D, Racaza GZ, Wallace DJ, Weisman MH, Nicassio PM. The psychometric properties of the Perceived Stress Scale-10 among patients with systemic lupus erythematosus. Lupus 2017; 26:1218-1223. [PMID: 28406052 DOI: 10.1177/0961203317701844] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease characterized by periods of remission and recurrent flares, which have been associated with stress. Despite the significance of stress in this disease, the Perceived Stress Scale-10 has yet to be psychometrically evaluated in patients with SLE. Methods Exploratory factor analysis was used to examine the structural validity of the Perceived Stress Scale-10 among patients with SLE ( N = 138) receiving medical care at Cedars Sinai Medical Center. Cronbach's coefficient alpha was used to examine internal consistency reliability, and Pearson product-moment correlations were used to examine convergent validity with measures of anxiety, depression, helplessness, and disease activity. Results Exploratory factor analysis provided support for a two-factor structure (comparative fit index = .95; standardized root mean residual = .04; root mean square error of approximation = .08). Internal consistency reliability was good for both factors (α = .84 and .86). Convergent validity was evidenced via significant correlations with measures of anxiety, depression, and helplessness. There were no significant correlations with the measure of disease activity. Conclusion The Perceived Stress Scale-10 can be used to examine perceived stress among patients with SLE.
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Affiliation(s)
- S D Mills
- 1 San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - D Azizoddin
- 2 Department of Psychology, Loma Linda University, Loma Linda, USA
| | - G Z Racaza
- 3 Section of Rheumatology, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - D J Wallace
- 4 Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, USA
| | - M H Weisman
- 4 Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, USA
| | - P M Nicassio
- 5 Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, USA
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16
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Agarwal N, Kumar V. An invisible student population: Accommodating and serving college students with lupus. Work 2017; 56:165-173. [DOI: 10.3233/wor-162477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Neelam Agarwal
- Center for Accommodations and Support Services (CASS), The University of Texas at El Paso, TX, USA
| | - Vinod Kumar
- Department of Mechanical Engineering, University of Texas at El Paso, TX, USA
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17
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Mazzoni D, Cicognani E, Prati G. Health-related quality of life in systemic lupus erythematosus: a longitudinal study on the impact of problematic support and self-efficacy. Lupus 2016; 26:125-131. [DOI: 10.1177/0961203316646459] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which can affect any organ in the body, reducing patients' health-related quality of life (HR-QOL). Psychosocial research on SLE is quite recent and is mostly based on qualitative and cross-sectional evidence. Some studies suggest that a protective role is played by perceived self-efficacy in the management of the disease, while a detrimental role is played by problematic social interactions. Methods: In a longitudinal study, we tested the independent contribution of self-efficacy and problematic social support, in predicting patients' HR-QOL after 11 months. An online questionnaire was completed by 162 participants with SLE, the second questionnaire after 11 months. Results: Controlling for corticosteroids and hydroxychloroquine use, self-efficacy in the management of the disease at Time 1 showed a significant and positive effect on HR-QOL at Time 2, while problematic social support (denying/uninformed) showed a negative effect. Conclusions: HR-QOL of SLE patients is influenced by self-efficacy in the management of the disease and problematic support. Specific attention should be paid to the quality of patients' social relationships and their perceived efficacy in the management of the disease in focused interventions as in daily clinical practice.
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Affiliation(s)
- D Mazzoni
- Department of Psychology, University of Bologna, Italy
| | - E Cicognani
- Department of Psychology, University of Bologna, Italy
| | - G Prati
- Department of Psychology, University of Bologna, Italy
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López-Pina JA, Meseguer-Henarejos AB, Gascón-Cánovas JJ, Navarro-Villalba DJ, Sinclair VG, Wallston KA. Measurement properties of the brief resilient coping scale in patients with systemic lupus erythematosus using rasch analysis. Health Qual Life Outcomes 2016; 14:128. [PMID: 27619635 PMCID: PMC5020451 DOI: 10.1186/s12955-016-0534-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 09/08/2016] [Indexed: 12/02/2022] Open
Abstract
Bacground Resilience has been defined as the capacity or the ability to rebound from and positively adapt to significant stressors, despite experiences of significant adversity or trauma. To capture to what extent an individual copes with stress in a resilient fashion the Brief Resilient Coping Scale (BRCS) was developed. This tool was validated in people with chronic disease, such as rheumatoid arthritis using standard psychometric techniques of classical test theory, but not yet in patients with Systemic lupus erythematosus (SLE). The aim of this study was to explore the psychometric properties of the Brief Resilient Coping Scale in patients with SLE using Rasch analysis. Method This study used cross-sectional data. The BRCS was administered to 232 patients with systemic lupus erythematosus. The aspects analyzed were unidimensionality, local independence and differential item functioning (DIF) to construct an interpretative scale of scores with the Rasch model. Results Rating scale mode (RSM) showed that the four categories used in the items of the BRCS are properly ordered. The four items provided a good fit to the polytomous Rasch model. Moreover, the parameters were sufficiently separated to measure resilience in patients with SLE. BRCS is a unidimensional scale (eigenvalue = 1.843) of resilience and the items were locally independent. There was no DIF between males and females in the sample. Only marginally significant differences depending on the level of education were found. The BRCS showed adequate discriminant validity between groups of scores. Conclusions BRCS is a suitable scale for measuring resilience in patients with SLE. This scale might be useful for clinicians to obtain information concerning the degree of resilience that each patient has, allowing individuals with low resilience to be identified who need interventions aimed at developing coping skills.
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Affiliation(s)
- José-Antonio López-Pina
- Department of Basic Psychology and Methodology, Faculty of Psychology, Campus of Espinardo, University of Murcia, 30100, Murcia, Spain.
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Williams EM, Lorig K, Glover S, Kamen D, Back S, Merchant A, Zhang J, Oates JC. Intervention to Improve Quality of life for African-AmericaN lupus patients (IQAN): study protocol for a randomized controlled trial of a unique a la carte intervention approach to self-management of lupus in African Americans. BMC Health Serv Res 2016; 16:339. [PMID: 27485509 PMCID: PMC4971708 DOI: 10.1186/s12913-016-1580-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic Lupus Erythematosus (lupus) is a chronic autoimmune disease that can impact any organ system and result in life-threatening complications. African-Americans are at increased risk for morbidity and mortality from lupus. Self-management programs have demonstrated significant improvements in health distress, self-reported global health, and activity limitation among people with lupus. Despite benefits, arthritis self-management education has reached only a limited number of people. Self-selection of program could improve such trends. The aim of the current study is to test a novel intervention to improve quality of life, decrease indicators of depression, and reduce perceived and biological indicators of stress in African-American lupus patients in South Carolina. METHODS/DESIGN In a three armed randomized, wait list controlled trial, we will evaluate the effectiveness of a patient-centered 'a-la-carte' approach that offers subjects a variety of modes of interaction from which they can choose as many or few as they wish, compared to a 'set menu' approach and usual care. This unique 'a-la-carte' self-management program will be offered to 50 African-American lupus patients participating in a longitudinal observational web-based SLE Database at the Medical University of South Carolina. Each individualized intervention plan will include 1-4 options, including a mail-delivered arthritis kit, addition and access to an online message board, participation in a support group, and enrollment in a local self-management program. A 'set menu' control group of 50 lupus patients will be offered a standardized chronic disease self-management program only, and a control group of 50 lupus patients will receive usual care. Outcomes will include changes in (a) health behaviors, (b) health status, (c) health care utilization, and (d) biological markers (urinary catecholamines). DISCUSSION Such a culturally sensitive educational intervention which includes self-selection of program components has the potential to improve disparate trends in quality of life, disease activity, depression, and stress among African-American lupus patients, as better outcomes have been documented when participants are able to choose/dictate the content and/or pace of the respective treatment/intervention program. Since there is currently no "gold standard" self-management program specifically for lupus, this project may have a considerable impact on future research and policy decisions. TRIAL REGISTRATION NCT01837875 ; April 18, 2013.
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Affiliation(s)
- Edith M. Williams
- Department of Public Health Sciences, Department of Medicine, Division of Rheumatology, Core Investigator, MUSC Center for Health Disparities Research, Medical University of South Carolina, 135 Cannon Street, Suite 303, MSC835, Charleston, SC 29425 USA
| | - Kate Lorig
- Department of Medicine, Stanford University, 291 Campus Drive, Room LK3C02, Stanford, CA 94305 USA
| | - Saundra Glover
- Institute of Health Disparities, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210 USA
| | - Diane Kamen
- Department of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 912, Charleston, SC 29425 USA
| | - Sudie Back
- Department of Psychiatry/Behavioral Science, Division of Clinical Neuroscience, Medical University of South Carolina, 67 President Street, Charleston, SC 29425 USA
| | - Anwar Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, 800 Sumter Street, Room 211, Columbia, SC 29208 USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208 USA
| | - James C. Oates
- Department of Medicine, Division of Rheumatology, Medical University of South Carolina, 114 Doughty Street, Room 425-C, Charleston, SC 29414 USA
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Abstract
Health-related quality of life (HRQoL) is an important outcome measure in patients with systemic lupus erythematosus (SLE). A review was undertaken of the literature relating to HRQoL in SLE. MEDLINE, EMBASE, CINAHL, Allied and Complimentary Medicine were searched to locate full papers in the English language reporting on HRQoL in adult SLE patients published between 1990 and 2005. In total 53 papers were included and the review was subdivided into: 1) description of HRQoL in SLE patients; 2) HRQoL and disease activity and/or damage; 3) the impact of other variables on HRQoL; and 4) HRQoL measures used in clinical trials in SLE patients. The findings were as follows: HRQoL is reduced in SLE patients; HRQoL is not correlated to disease activity or damage; age appears to have a negative impact on HRQoL especially physical health but the effect of disease duration is unclear; other potentially modifiable variables such as fatigue and psychosocial factors impact on HRQoL in a complex manner; and HRQoL measures which are sensitive to change should be an essential outcome measure in all clinical trials on SLE patients.
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Affiliation(s)
- K McElhone
- Department of Rheumatology, Royal Blackburn Hospital, Blackburn, UK
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21
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Mazzoni D, Cicognani E. Positive and problematic support, stress and quality of life in patients with systemic lupus erythematosus. ANXIETY STRESS AND COPING 2016; 29:542-51. [DOI: 10.1080/10615806.2015.1134785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Davide Mazzoni
- Department of Psychology, University of Bologna, Bologna, Italy
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Postal M, Lapa AT, Sinicato NA, de Oliveira Peliçari K, Peres FA, Costallat LTL, Fernandes PT, Marini R, Appenzeller S. Depressive symptoms are associated with tumor necrosis factor alpha in systemic lupus erythematosus. J Neuroinflammation 2016; 13:5. [PMID: 26732584 PMCID: PMC4702302 DOI: 10.1186/s12974-015-0471-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tumor necrosis factor alpha (TNF-α) is deeply related to pathogenesis of neurodevelopmental disorders, especially depression. The aim of this study was to explore potential relationships between sera TNF-α levels and mood and anxiety disorders in systemic lupus erythematosus (SLE) patients. METHODS We included 153 consecutive SLE patients (women 148; median age 30; range 10-62) and 40 (women 37; mean age 28.5; range 12-59) age- and sex-matched healthy controls. Mood and anxiety disorders were determined through Beck Depression and Beck Anxiety Inventory. SLE patients were further assessed for clinical and laboratory SLE manifestations. TNF-α levels were measured by enzyme-linked immunosorbent assay using commercial kits. RESULTS Depressive symptoms were identified in 70 (45.7 %) SLE patients and in 10 (25 %) healthy controls (p < 0.001). Anxiety symptoms were identified in 93 (60.7 %) SLE patients and in 16 controls (40 %) (p < 0.001). Sera TNF-α levels were increased in SLE patients with depressive symptoms (p < 0.001) and with anxiety symptoms (p = 0.014). A direct correlation between the severity of depressive symptoms and sera TNF-α levels (r = 0.22; p = 0.003) was observed. TNF-α levels were significantly increased in patients with active disease (p = 0.012). In addition, we observed a correlation between sera TNF-α levels and disease activity (r = 0.28; p = 0.008). In the multivariate analysis, sera TNF-α levels were independently associated with depressive symptoms (t = 3.28; 95 % CI 1.08-2.2; p = 0.002). CONCLUSIONS Sera TNF-α levels are increased in SLE patients with mood and anxiety disorders. In SLE, sera TNF-α levels are independently associated with mood disorders. The etiology of mood disorders is still debated in SLE, but our findings suggest the presence of immunological basis for depression in SLE.
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Affiliation(s)
- Mariana Postal
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Aline Tamires Lapa
- Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Nailú Angélica Sinicato
- Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Karina de Oliveira Peliçari
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Fernando Augusto Peres
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Lilian Tereza Lavras Costallat
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Paula Teixeira Fernandes
- Department of Sport Sciences, Faculty of Physical Education State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil
| | - Roberto Marini
- Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Simone Appenzeller
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil. .,Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
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Barbasio C, Vagelli R, Marengo D, Querci F, Settanni M, Tani C, Mosca M, Granieri A. Illness perception in systemic lupus erythematosus patients: The roles of alexithymia and depression. Compr Psychiatry 2015; 63:88-95. [PMID: 26555496 DOI: 10.1016/j.comppsych.2015.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Alexithymia and depressive mood have been described as important dimensions of several medical diseases. Systemic lupus erythematosus is a chronic condition characterized by unpredictable clinical manifestations. The relationships between alexithymia, depression, and illness perception were examined in systemic lupus erythematosus patients. The interrelationships between psychological factors, such as alexithymia and depressive mood, were explored in systemic lupus erythematosus patients, and associations between these factors and illness perception in SLE were examined. We hypothesized that alexithymia and negative perceptions of illness would be associated in SLE patients, and depression would mediate this relationship. METHODS Subjects were 100 consecutive systemic lupus erythematosus patients attending the outpatient clinic at the University of Pisa rheumatology unit. They completed the Toronto Alexithymia Scale, Beck Depression Inventory, and Revised Illness Perceptions Questionnaire. Clinical variables were measured, disease activity was evaluated using the European Consensus Lupus Activity Measure, and damage was assessed using the Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index. RESULTS There were no associations between clinical variables, alexithymia, and depression. The results highlight the existence of significant links between alexithymia and illness perception for systemic lupus erythematosus patients. Moreover, our data suggest that some of these links are mediated by depression, which is the direct predictor of different aspects of perceived health. CONCLUSION Our findings suggest that studying the role of psychological factors, such as alexithymia and depression, may contribute to a more comprehensive perspective of systemic lupus erythematosus, including their impact on patients' beliefs about treatment effectiveness and emotional adaptation to chronic disease.
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Affiliation(s)
| | - Roberta Vagelli
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
| | - Davide Marengo
- Department of Psychology, University of Turin, Italy; Department of social sciences and humanities, University of Aosta Valley, Italy.
| | - Francesca Querci
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
| | | | - Chiara Tani
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
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Beckerman NL, Auerbach C, Kim SJ, Salmon J, Horton R. Lupus (SLE): Existence and Impact of Depressive Symptomatology. SOCIAL WORK IN HEALTH CARE 2015; 54:499-517. [PMID: 26186422 DOI: 10.1080/00981389.2015.1045575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this cross-sectional study (N = 84) is to: (1) further identify the unique psychosocial challenges facing those living with Systemic Lupus Erythematosus (SLE) and (2) discern the validity of the depression dimension of the System Lupus Erythematosus Needs Questionnaire (SLENQ) (by including the Beck Depression Inventory [BDI-II]). Utilizing the BDI-II, this study replicates and confirms the validity of studies that employed the SLENQ, establishing that those who have manifested signs of depression in the SLENQ, are equally likely to show signs of depression in the BDI-II. Authors identify and confirm that patients who experience SLE-related depression are significantly more likely to forget taking or stop taking their SLE medications. The authors review relevant research, discuss findings, and provide evidence-based recommendations for social workers providing mental health care to patients living with Lupus.
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25
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Williams EM, Bruner L, Penfield M, Kamen D, Oates JC. Stress and Depression in Relation to Functional Health Behaviors in African American Patients with Systemic Lupus Erythematosus. RHEUMATOLOGY (SUNNYVALE, CALIF.) 2014; 2014:005. [PMID: 26618072 PMCID: PMC4662575 DOI: 10.4172/2161-1149.s4-005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE While increased psychological distress in SLE has been clinically and empirically reported, the relationship between emotional distress, treatment adherence, and disease activity are complex and even more unclear in African American lupus patients. In an effort to elucidate this phenomenon in these patients, this exploratory study aimed to investigate relationships between stress, depression, and various health behaviors in this group. METHODS Thirty patients invited to participate in this study were African American systemic lupus erythematosus (SLE) patients attending rheumatology clinics at the Medical University of South Carolina (MUSC). This study was part of a larger interventional pilot study, the Balancing Lupus Experiences with Stress Strategies (BLESS) study, that included a comprehensive battery of psychosocial, quality of life, and behavior change measures. RESULTS When looking at the association between anxiety/stress and functionality, levels of reported stress had strong effects upon functionality, especially between health distress and functionality. When looking at the association between depressive symptoms and functionality, depressive symptoms had moderate effects upon social/role limitations and nights spent in the hospital. CONCLUSION Not only did the larger pilot project demonstrate significant reductions in stress and depression as a result of workshop participation; this nested study also showed that those improvements were positively associated with improved health behaviors. These results could have implications for developing interventions to improve disease experience and quality of life in SLE patients with stress and depression.
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Affiliation(s)
- Edith M. Williams
- Institute for Partnerships to Eliminate Health Disparities, University of South Carolina; Columbia, SC, USA
| | - Larisa Bruner
- Office of Public Health Practice, University of South Carolina; Columbia, SC, USA
| | - Megan Penfield
- Institutional Assessment and Compliance, University of South Carolina; Columbia, SC, USA
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
| | - James C. Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
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Rutter S, Kiemle G. Exploring the social and interpersonal experiences of South Asian women with a diagnosis of Systemic Lupus Erythematosus. Psychol Health 2014; 30:318-35. [DOI: 10.1080/08870446.2014.972397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S.J. Rutter
- Department of Clinical Psychology, North Manchester General Hospital, Manchester, UK
| | - G. Kiemle
- Doctorate in Clinical Psychology, The University of Liverpool, Liverpool, UK
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27
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Williams EM, Kamen D, Penfield M, Oates JC. Stress Intervention and Disease in African American Lupus Patients: The Balancing Lupus Experiences with Stress Strategies (BLESS) Study. Health (London) 2014; 6:71-79. [PMID: 24932382 PMCID: PMC4052946 DOI: 10.4236/health.2014.61011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Edith M Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425
| | - Megan Penfield
- Institutional Assessment and Compliance, University of South Carolina, 1710 College Street, Suite 205, Columbia, SC 29208
| | - James C Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425 and Medical Service, Ralph H. Johnson VA Medical Center, Charleston, SC
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Sterling K, Gallop K, Swinburn P, Flood E, French A, Al Sawah S, Iikuni N, Naegeli A, Nixon A. Patient-reported fatigue and its impact on patients with systemic lupus erythematosus. Lupus 2013; 23:124-32. [PMID: 24197552 DOI: 10.1177/0961203313511554] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fatigue is a hallmark symptom of systemic lupus erythematosus (SLE), often associated with flares, side effects of treatment, and extensive organ damage and may have a significant impact on health-related quality of life (HrQoL). To date, the experience of fatigue in patients with SLE is underexplored. This study explored the experience of fatigue in patients with SLE and its impact on their lives through qualitative interviews. This cross-sectional qualitative study was conducted with 22 adult patients with SLE, recruited from two clinical sites in the United States. In-person semi-structured interviews were conducted and thematic analysis was performed focusing on the experience of fatigue in SLE. Results indicated that 21 out of 22 patients experienced fatigue due to SLE. Patients reported that fatigue was variable in nature in terms of both severity and frequency. Fatigue was described as having an impact on multiple aspects of a patient's life: emotions, cognition, work, activities of daily living, leisure activities, social activities, and family activities. Understanding how patients with SLE describe the symptom of fatigue and how it impacts their lives is the key to better understanding how to measure fatigue in clinical studies evaluating new treatments for SLE.
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Affiliation(s)
- Kl Sterling
- 1Eli Lilly and Company, Indianapolis, IN, USA
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29
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Sutanto B, Singh-Grewal D, McNeil HP, O'Neill S, Craig JC, Jones J, Tong A. Experiences and Perspectives of Adults Living With Systemic Lupus Erythematosus: Thematic Synthesis of Qualitative Studies. Arthritis Care Res (Hoboken) 2013; 65:1752-65. [DOI: 10.1002/acr.22032] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/03/2013] [Accepted: 04/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Bernadet Sutanto
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
| | - Davinder Singh-Grewal
- University of Sydney, The Children's Hospital at Westmead, University of New South Wales, and Liverpool Hospital; Sydney, New South Wales Australia
| | - H. Patrick McNeil
- University of New South Wales and Liverpool Hospital; Sydney, New South Wales Australia
| | - Sean O'Neill
- University of New South Wales and Liverpool Hospital; Sydney, New South Wales Australia
| | - Jonathan C. Craig
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
| | - Julie Jones
- University of Sydney; Sydney, New South Wales Australia
| | - Allison Tong
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
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30
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Staud R. Peripheral and central mechanisms of fatigue in inflammatory and noninflammatory rheumatic diseases. Curr Rheumatol Rep 2013; 14:539-48. [PMID: 22802155 DOI: 10.1007/s11926-012-0277-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fatigue is a common symptom in a large number of medical and psychological disorders, including many rheumatologic illnesses. A frequent question for health care providers is related to whether reported fatigue is "in the mind" or "in the body"-that is, central or peripheral. If fatigue occurs at rest without any exertion, this suggests psychological or central origins. If patients relate their fatigue mostly to physical activities, including exercise, their symptoms can be considered peripheral. However, most syndromes of fatigue seem to depend on both peripheral and central mechanisms. Sometimes, muscle biopsy with histochemistry may be necessary for the appropriate tissue diagnosis, whereas serological tests generally provide little reliable information about the origin of muscle fatigue. Muscle function and peripheral fatigue can be quantified by contractile force and action potential measurements, whereas validated questionnaires are frequently used for assessment of mental fatigue. Fatigue is a hallmark of many rheumatologic conditions, including fibromyalgia, myalgic encephalitis/chronic fatigue syndrome, rheumatoid arthritis, systemic lupus, Sjogren's syndrome, and ankylosing spondylitis. Whereas many studies have focused on disease activity as a correlate to these patients' fatigue, it has become apparent that other factors, including negative affect and pain, are some of the most powerful predictors for fatigue. Conversely, sleep problems, including insomnia, seem to be less important for fatigue. There are several effective treatment strategies available for fatigued patients with rheumatologic disorders, including pharmacological and nonpharmacological therapies.
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Affiliation(s)
- Roland Staud
- Division of Rheumatology and Clinical Immunology, University of Florida, PO Box 100221, Gainesville, FL 32610-0221, USA.
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31
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Mazzoni D, Cicognani E. Sharing experiences and social support requests in an Internet forum for patients with systemic lupus erythematosus. J Health Psychol 2013; 19:689-96. [PMID: 23479300 DOI: 10.1177/1359105313477674] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Internet forums represent a useful but understudied resource to understand psychosocial aspects of living with systemic lupus erythematosus. This study was aimed to describe the demand/supply of social support through the Internet in relation with the description of personal illness experiences. All the posts (118) from an Italian forum for systemic lupus erythematosus patients were collected and analyzed combining qualitative content analysis with statistical textual analysis. The results showed different purposes for posts: starting new relationships, seeking information, receiving emotional support, and giving a contribution. Lexical analysis identified three ways of describing patients' experiences. Discussion focuses on the relationship between the requested/offered support and systemic lupus erythematosus experiences.
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32
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Castelino M, Abbott J, McElhone K, Teh LS. Comparison of the psychometric properties of health-related quality of life measures used in adults with systemic lupus erythematosus: a review of the literature. Rheumatology (Oxford) 2012; 52:684-96. [PMID: 23264550 DOI: 10.1093/rheumatology/kes370] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE A review of the literature was undertaken to evaluate the development and psychometric properties of health-related quality of life (HRQoL) measures used in adults with SLE. This information will help clinicians make an informed choice about the measures most appropriate for research and clinical practice. METHODS Using the key words lupus and quality of life, full original papers in English were identified from six databases: OVID MEDLINE, EMBASE, Allied and Complementary Medicine, Psychinfo, Web of Science and Health and Psychosocial Instruments. Only studies describing the validation of HRQoL measures in adult SLE patients were retrieved. RESULTS Thirteen papers were relevant; five evaluated generic instruments [QOLS-S (n = 1), EQ-5D/SF-6D (n = 1), SF-36 (n = 3)] and eight evaluated disease-specific measures [L-QOL (n = 1), LupusQoL (UK) (n = 1), LupusQoL (US) (n = 1), SSC (n = 2), SLEQOL (n = 3)]. For the generic measures, there is moderate evidence of good content validity and internal consistency, whereas there is strong evidence for both these psychometric properties in disease-specific measures. There is limited to moderate evidence to support the construct validity and test-retest reliability for the disease-specific measures. Responsiveness and floor/ceiling effects have not been adequately investigated in any of the measures. CONCLUSIONS Direct comparison of the psychometric properties was difficult because of the different methodologies employed in the development and evaluation of the different HRQoL measures. However, there is supportive evidence that multidimensional disease-specific measures are the most suitable in terms of content and internal reliability for use in studies of adult patients with SLE.
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33
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Waldron N, Brown SJ, Hewlett S, Elliott B, McHugh N, McCabe CS. 'To suddenly have a name for this thing… was wonderful': the patient's experience of receiving a diagnosis of systemic lupus erythematosus. Musculoskeletal Care 2012; 10:135-141. [PMID: 22514146 DOI: 10.1002/msc.1010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The aim of this study was to explore the patient's perception of receiving a diagnosis of systemic lupus erythematosus (lupus) and reports on their experience of the period between onset of symptoms and receiving a definitive diagnosis. METHODS Focus groups were conducted in seven rheumatology centres. Forty-three participants were purposively selected and data were subjected to thematic deductive analysis. RESULTS Focus group data generated three major themes. 'Diagnostic uncertainty and misdiagnosis' describes the frustration for many of experiencing years of often debilitating symptoms that have gone unacknowledged by health professionals and misunderstood by themselves. Some experienced the trauma of being misdiagnosed, which impacted on how they adjusted to their final diagnosis of lupus. 'Consequences of receiving a diagnosis' highlights the feelings of relief for participants at finally having a diagnosis, despite its implications. However, the manner in which this knowledge was delivered was often inappropriate and unsupported, affecting how they adjusted to future management of their condition. 'Impact on individuals' lives' explores how many felt empowered by finally receiving recognition for their symptoms, but the diagnosis of a relatively unknown condition with often invisible symptoms impacted on the response and support they received from those around them. CONCLUSION It is essential health professionals have a greater understanding of the patient experience prior to receiving a diagnosis of lupus. The individual experience from symptom onset to diagnosis has a direct impact on the patient's subsequent acceptance of their diagnosis and response to management and therefore justifies the need for further research in this field.
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Affiliation(s)
- Nicola Waldron
- The Royal National Hospital for Rheumatic Diseases, Bath, UK.
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34
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Gallop K, Nixon A, Swinburn P, Sterling KL, Naegeli AN, Silk MET. Development of a conceptual model of health-related quality of life for systemic lupus erythematosus from the patient's perspective. Lupus 2012; 21:934-43. [DOI: 10.1177/0961203312441980] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: The aim of this study was to evaluate the impact of systemic lupus erythematosus (SLE) on the lives of patients in order to inform the development of a conceptual model. Methods: Twenty-two participants with SLE (defined as meeting four of the 11 ACR criteria) were recruited for this study. Semi-structured, in-person interviews were conducted with each participant, exploring the symptoms experienced and the impact on the patient's life. Thematic analysis of interview transcripts was conducted in ATLAS.ti software to identify areas of impact and explore the interrelationships between concepts to inform the development of a conceptual model. Results: Almost all participants were female (95%); the sample was diverse in terms of age (mean age of 45.5 years; age range of 20–60 years), ethnicity (59% black/African American) and disease duration. Commonly reported symptoms were pain, fatigue/tiredness and skin problems. Qualitative analysis revealed seven themes relating to the impact of SLE symptoms on patient's Health Related Quality of Life (HRQL): emotions, social, family and leisure activities, daily activities, cognition, appearance, employment activities and independence. The interrelationships between symptoms, impacts and symptom triggers are illustrated in a conceptual model. Conclusions: The conceptual model illustrates the wide-reaching impact of SLE symptoms on a patient’s HRQL, and the potential broad impact of a treatment that improves SLE symptoms.
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Affiliation(s)
- K Gallop
- Oxford Outcomes, an ICON plc company, Oxford, UK
| | - A Nixon
- Oxford Outcomes, an ICON plc company, Oxford, UK
| | - P Swinburn
- Oxford Outcomes, an ICON plc company, Oxford, UK
| | | | | | - MET Silk
- Eli Lilly and Company, Indiana, USA
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35
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Beckerman NL, Sarracco M. Listening to lupus patients and families: fine tuning the assessment. SOCIAL WORK IN HEALTH CARE 2012; 51:597-612. [PMID: 22905976 DOI: 10.1080/00981389.2012.683679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Given the chronicity and uncertainty of lupus, patients and their family members will face physical, financial, social, and emotional challenges that can be overwhelming. This article records the experiences of three different families affected by lupus. Although these patients and families are very different, their perspectives identify common emotional challenges. Understanding these experiences from their perspectives can help facilitate an assessment that is highly attuned to the potential psychosocial impact of lupus on the patient and the family.
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Affiliation(s)
- N L Beckerman
- Wurzweiler School of Social Work, Yeshiva University, New York, New York 10033, USA.
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36
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Auerbach C, Beckerman NL. Locus of control and lupus: patients' beliefs, perspectives, and disease activity. SOCIAL WORK IN HEALTH CARE 2012; 51:613-626. [PMID: 22905977 DOI: 10.1080/00981389.2012.683685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patients with lupus often experience a high degree of psychological symptoms such as anxiety, depression, and mood disorders that can influence their beliefs and perceptions of their illness. The purpose of the study was to examine how a patient's self-reported psychosocial needs (depression and anxiety) and beliefs about how much control they have over their health (health locus of control) influences their perception of disease chronicity and acuity. The study findings were based on a survey of 378 patients self-diagnosed with lupus.
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Affiliation(s)
- Charles Auerbach
- Wurzweiler School of Social Work, Yeshiva University, New York, New York 10033, USA.
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37
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Postal M, Costallat LTL, Appenzeller S. Neuropsychiatric manifestations in systemic lupus erythematosus: epidemiology, pathophysiology and management. CNS Drugs 2011; 25:721-36. [PMID: 21870886 DOI: 10.2165/11591670-000000000-00000] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Systemic lupus erythematosus (SLE) is a relapsing-remitting autoimmune disease with CNS involvement occurring in up to 75% of patients. However, the frequency of neuropsychiatric manifestations in SLE studies varies widely, depending on the type of manifestations included and the method used for evaluation. CNS involvement may be considered primary if directly related to SLE activity in the CNS or secondary when related to treatment, infections, metabolic abnormalities or other systemic manifestations such as uraemia and hypertension. The pathogenesis of neuropsychiatric SLE is as yet unknown, though numerous autoantibodies and cytokines have been suggested as possible mediators. However, independent of the aetiology of the insult, the final common pathway in neuropsychiatric SLE is the involvement of the cerebral microvasculature. The diagnosis of primary CNS involvement by SLE is often difficult, as both focal and diffuse manifestations may occur and there is no gold standard for diagnosis. A high index of clinical suspicion, in addition to laboratory and neuroimaging findings may support the diagnosis. Treatment is mostly empirical, although one randomized controlled trial has shown that cyclophosphamide in addition to methylprednisolone is superior to methylprednisolone alone in severe neuropsychiatric SLE.
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Affiliation(s)
- Mariana Postal
- Department of Medicine, Rheumatology Unit, State University of Campinas, Brazil
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38
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Mazzoni D, Cicognani E. Social support and health in patients with systemic lupus erythematosus: A literature review. Lupus 2011; 20:1117-25. [DOI: 10.1177/0961203311412994] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the last decades, with the improvement of life expectancies for systemic lupus erythematosus (SLE) patients, the relationship between social support and health in this population has received a considerable amount of attention in behavioural medicine and health psychology. This paper is the first to review research studies which specifically investigated perceived social support in relation to SLE patients’ health outcomes (quality of life, disease activity and damage). Starting with a descriptive approach to social support perceived by patients with SLE, the research evidence on the impact of social support on health is presented. These studies demonstrate that the consideration of social support is critical in predicting disease activity, damage and quality of life (both physical and psychological components) although the precise ways in which social support contributes to health are not yet completely understood. Discussing the results, the authors offer some suggestions which could guide further research in this field. Finally, clinical and non-clinical implications of the findings are discussed.
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Affiliation(s)
- D Mazzoni
- Department of Education Sciences, University of Bologna, Italy
| | - E Cicognani
- Department of Education Sciences, University of Bologna, Italy
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39
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Moldovan I, Katsaros E, Carr FN, Cooray D, Torralba K, Shinada S, Ishimori ML, Jolly M, Wallace DJ, Weisman MH, Nicassio PM. The Patient Reported Outcomes in Lupus (PATROL) study: role of depression in health-related quality of life in a Southern California lupus cohort. Lupus 2011; 20:1285-92. [DOI: 10.1177/0961203311412097] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - FN Carr
- Alliant International University, School of Professional Psychology, California, USA
| | - D Cooray
- Harbor-UCLA Medical Center, California, USA
| | - K Torralba
- University of Southern California Keck School of Medicine, California, USA
| | - S Shinada
- University of Southern California Keck School of Medicine, California, USA
| | - ML Ishimori
- Cedars-Sinai Medical Center, California, USA
| | - M Jolly
- Rush University Medical Center, Chicago, USA
| | - DJ Wallace
- Cedars-Sinai Medical Center, California, USA
| | - MH Weisman
- Cedars-Sinai Medical Center, California, USA
| | - PM Nicassio
- David Geffen School of Medicine, UCLA, California, USA
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40
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Nicassio PM, Kay MA, Custodio MK, Irwin MR, Olmstead R, Weisman MH. An evaluation of a biopsychosocial framework for health-related quality of life and disability in rheumatoid arthritis. J Psychosom Res 2011; 71:79-85. [PMID: 21767687 PMCID: PMC3139906 DOI: 10.1016/j.jpsychores.2011.01.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 01/07/2011] [Accepted: 01/10/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the relationships between physical, psychological, and social factors and health-related quality of life (HRQOL) and disability in rheumatoid arthritis (RA). METHODS A sample of 106 patients with rheumatoid arthritis (RA) completed measures of self-reported disease activity and psychosocial functioning, including coping, personal mastery, social network, perceived stress, illness beliefs, the SF-36 and Health Assessment Questionnaire Disability Index (HAQ-DI). In addition, physician-based assessment of disease activity using the Disease Activity Scale (DAS-28) was obtained. Hierarchical multiple regression analyses were used to evaluate the relationships between psychosocial factors and scores on the SF-36 and HAQ-DI. RESULTS Lower self-reported disease activity was associated with higher SF-36 physical functioning scores, while the contribution of active coping, passive coping, and helplessness was significant only as a block. Lower self-reported disease activity, higher personal mastery, and lower perceived stress contributed to higher SF-36 mental health functioning, and higher self-reported disease activity and lower helplessness were associated with greater disability, as indexed by the HAQ-DI. The DAS-28, an objective of measure of disease activity, was unrelated to any of these outcomes. CONCLUSIONS The findings highlight the importance of targeting psychological factors to enhance HRQOL and disability in the clinical management of RA patients.
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Affiliation(s)
- Perry M Nicassio
- University of California, Los Angeles, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, USA.
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41
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Hyphantis T, Palieraki K, Voulgari PV, Tsifetaki N, Drosos AA. Coping with health-stressors and defence styles associated with health-related quality of life in patients with systemic lupus erythematosus. Lupus 2011; 20:893-903. [PMID: 21562019 DOI: 10.1177/0961203311398264] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study aimed to assess the association of coping with health-stressors and defence styles with health-related quality of life (HRQOL) in systemic lupus erythematosus (SLE). In 56 SLE patients we assessed disease activity (SLEDAI), functional limitations (HAQ), psychological distress (SCL-90-R), defence styles (Defence Style Questionnaire), hostility (HDHQ), coping with health-stressors (Sense of Coherence scale) and HRQOL (WHOQOL-BREF). Two hundred and eight rheumatologic patients (168 with rheumatoid arthritis [RA] and 40 with primary Sjögren's syndrome [SS]) served as disease controls. SLE patients' HRQOL was similar to that of patients with RA and primary SS after adjusting for demographic and disease variables. Psychological distress was significantly associated with most aspects of HRQOL, but sense of coherence mediated the relationship of psychological distress with Physical HRQOL; this mediation effect was unique to SLE, as mediation analyses showed. Maladaptive action defence style was also significantly associated with Environment HRQOL independently of psychological distress (p < 0.024). These findings indicate that, apart from the early assessment and treatment of psychological distress, clinicians and consultation-liaison psychiatrists should bear in mind the SLE patients' psychological resources and coping capacities to deal with the stress of the disease, since such traits, although usually underestimated, are strongly independently associated with HRQOL.
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Affiliation(s)
- T Hyphantis
- Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.
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42
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Beckerman NL, Auerbach C, Blanco I. Psychosocial dimensions of SLE: implications for the health care team. J Multidiscip Healthc 2011; 4:63-72. [PMID: 21594059 PMCID: PMC3093952 DOI: 10.2147/jmdh.s19303] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Indexed: 11/23/2022] Open
Abstract
Background: The purpose of this exploratory study was threefold, ie, to clarify the unique psychosocial challenges facing those living with systemic lupus erythematosus (SLE), to distinguish which sociodemographic variables impact the lives of SLE patients, and generate knowledge regarding the way patients perceive SLE medication regimens. Methods: This was a cross-sectional exploratory study in 378 patients diagnosed with SLE and receiving services from the SLE Lupus Foundation in New York City. In addition to sociodemographic variables, the instrument used consisted of two scales, ie, the Systemic Lupus Erythematosus Needs Questionnaire (SLENQ) and the Multidimensional Health Locus of Control Scale, as well as questions regarding subjective perceptions of side effects from SLE medication. Results: The highest general cause of self-reported depressive and anxious feelings was changes in appearance due to SLE, and limitations in physical abilities due to SLE (primarily from muscle and joint pain). The higher the sense of control over SLE, the less likely respondents were to report feeling depressed and anxious. African-American and Hispanic SLE patients reported a higher level of unmet psychological needs due to SLE than did their other ethnic counterparts. Weight gain and hair loss were the most likely medication side effects and also the most likely causes of SLE-related depression and anxiety. Conclusion: Those living with SLE are at risk for feelings of depression and anxiety. African-American and Hispanic women are at higher risk for these emotional states. Comprehensive assessment across the disciplines should screen this group of patients for depression and anxiety, and be prepared to refer them to patient education and social work counseling as indicated.
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43
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Thumboo J, Fong KY. Health-related quality of life of patients with systemic lupus erythematosus in Asia: how can this be improved? Lupus 2011; 19:1430-5. [PMID: 20947553 DOI: 10.1177/0961203310374309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The multicultural and multilinguistic landscape in Asia poses interesting challenges in the assessment and improvement of Health-Related Quality of Life (HRQoL) in Asian patients with systemic lupus erythematosus (SLE). This article highlights some of these challenges and addresses the issue of how to improve HRQoL of these patients by: (1) framing important concepts in HRQoL in relation to the chronic relapsing nature and multisystem involvement in this condition; (2) discussing ways to improve measurement of HRQoL of SLE patients in Asia by reviewing existing HRQoL instruments (both generic (i.e. the SF-36) and disease-specific (i.e. the L-QoL, LupusQoL, SLEQoL and SLE Symptom Checklist)) and item banking; and (3) discussing approaches to improving HRQoL in SLE.
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Affiliation(s)
- J Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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44
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Abstract
This article reports on the findings of a qualitative study based on three focus-groups of individuals (N = 32) living with Systemic Lupus Erythematosus (SLE). The themes that emerged indicated a high vulnerability for self-reported feelings of depression. The four key challenges included: (1) feeling depressed that they are not who they used to be, (2) feelings of depression and anxiety related to coping with the uncertainty of the illness, (3) physical and emotional fatigue of living with a chronic illness, and (4) coping with the financial strain of the illness. These psychosocial challenges should be considered in screening, assessment, and treatment planning for social work service with this population.
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Affiliation(s)
- Nancy L Beckerman
- Wurweiler School of Social Work, Yeshiva University, New York, New York, USA.
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45
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Assessing disease activity and outcome in systemic lupus erythematosus. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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46
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Abstract
Epidemiologic, socioeconomic, and psychosocial factors play an important role in health care and handling of patients with the various clinical forms of lupus erythematosus (LE). Patients with LE are mostly young women; adolescents and some ethnic groups are especially prone to a severe course of disease. The unpredictable and fluctuating flares of disease, the need for longterm treatment, and the side effects and damage caused by the disease itself severely reduce quality of life. Problems arise, involving family members, adherence to medical advice and therapy, communication and self management. Socioeconomically, patients are often unable to take regular employment and to pay for health insurance. Stress factors that arise have a negative impact on the course of disease, increasing both fatigue and the basic burden of illness. Healthcare professionals must pay careful attention to all these items, as they attempt to treat flares, minimize drug side effects, provide pain relief, arrange communication and exercise programs along with behavioral and psychosocial interventions in multidisciplinary cooperation, and also involve and support family members.
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Affiliation(s)
- E Aberer
- Department of Dermatology and Venerology, Medical University of Graz, Auenbrugger Platz 8, A-8036 Graz, Austria.
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47
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Carr FN, Nicassio PM, Ishimori ML, Moldovan I, Katsaros E, Torralba K, Shinada S, Cooray D, Wallace DJ, Finck S, Jolly M, Wilson AL, Weisman MH. Depression predicts self-reported disease activity in systemic lupus erythematosus. Lupus 2010; 20:80-4. [DOI: 10.1177/0961203310378672] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that can significantly impact both physiological and psychological functioning. In order to examine the relationship between psychological functioning and disease activity in SLE, we administered instruments that collected sociodemographic information and measured indices of disease activity and psychosocial functioning from 125 adult Hispanic and White patients with SLE. Patients were recruited from four healthcare settings in the greater Southern California area. Both cross-sectional and longitudinal relationships between depression and disease activity were evaluated. Cross-sectional findings revealed that depression and ethnicity were independently correlated with self-reported disease activity. Longitudinally, depression alone predicted self-reported disease activity. These data suggest that depression may play a significant role in the health status of SLE patients and serve as an important target for clinical intervention.
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Affiliation(s)
- FN Carr
- California School of Professional Psychology, Alliant International University, Los Angeles, California, USA
| | - PM Nicassio
- University of California, Los Angeles, California, USA
| | - ML Ishimori
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - I Moldovan
- Loma Linda University, Loma Linda, California, USA
| | - E Katsaros
- Loma Linda University, Loma Linda, California, USA
| | - K Torralba
- University of Southern California, Los Angeles, California, USA
| | - S Shinada
- University of Southern California, Los Angeles, California, USA
| | - D Cooray
- Harbor-UCLA Medical Center, Torrance, California, USA
| | - DJ Wallace
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - S Finck
- University of California, Los Angeles, California, USA
| | - M Jolly
- Rush University Medical Center, Chicago, Illinois, USA
| | - AL Wilson
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - MH Weisman
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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Sliem H, Tawfik G, Khalil KA, Ibrahim N. Pattern of systemic lupus erythematosus in Egyptian patients: the impact of disease activity on the quality of life. Pan Afr Med J 2010; 6:14. [PMID: 21734922 PMCID: PMC3120985 DOI: 10.4314/pamj.v6i1.69084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 08/06/2010] [Indexed: 11/25/2022] Open
Abstract
Introduction Systemic lupus erythematosus (SLE) afflicts young people disproportionately, often at a crucial time in their lives when they are trying to establish relationships, start families and launch careers. As a result, persons with SLE may experience a wide range of physical and
psychosocial problems that are not always fully captured by descriptions of the disease’s physiological consequences alone. Methods In order to characterize the spectrum of the effects of SLE with regards to disease activity and its impact on the quality of life (QoL), a case control study involving 59 SLE Egyptian patients (mean age 28.6 years, 94.9% females) and 20 healthy controls was undertaken. Disease activity was measured by SLE Disease Activity Index (SLEDAI), and quality of life was measured by Short Form–36 health questionnaire (SF-36). Results Mucocutaneous and hematological manifestations were present in most of the patients and arthralgia in half of them. All domains of SF-36 including general health, physical functions, physical limitations, energy/fatigue, emotional well-being, pain, social functions, and health changes were significantly lower in SLE patients compared to controls. Except for emotional limitations, all domains were correlated with disease activity and low in class IV-V lupus nephritis. Conclusion Physicians should focus on QoL and how to improve it; health education regarding the negative impact of disease activity on the patients should be given attention. The results of QoL studies help physicians to understand and provide better support to SLE patients beside rapid meticulous control of disease activity.
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Affiliation(s)
- Hamdy Sliem
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Egypt
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Nicassio PM. Arthritis and psychiatric disorders: disentangling the relationship. J Psychosom Res 2010; 68:183-5. [PMID: 20105701 PMCID: PMC3234995 DOI: 10.1016/j.jpsychores.2009.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 09/15/2009] [Accepted: 09/15/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Perry M. Nicassio
- Clinical Professor, Department of Psychiatry School of Medicine University of California, Los Angeles
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Taïeb O, Bricou O, Baubet T, Gaboulaud V, Gal B, Mouthon L, Dhote R, Guillevin L, Rose Moro M. Patients' beliefs about the causes of systemic lupus erythematosus. Rheumatology (Oxford) 2009; 49:592-9. [PMID: 20040529 DOI: 10.1093/rheumatology/kep430] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Beliefs about the causes of SLE have rarely been investigated. The purpose of this study was to explore these beliefs. METHODS Face-to-face interviews were carried out with a total of 33 women with SLE, fulfilling the ACR criteria, with a median age of 40 (range 15-65) years. Data were analysed using interpretative phenomenological analysis. RESULTS Women attributed SLE to many causes, some of them being not congruent with biomedical models. The most frequent beliefs about the causes of SLE related to autoimmunity, psychological and familial causes, heredity, magico-religious causes (especially in first- and second-generation migrants) and infectious causes. Autoimmunity was often seen as a self-destructive process. CONCLUSIONS Being diagnosed with SLE prompted 'Why me?' and 'Why now?' questioning among these women, who attempted to reconstruct coherence in their life histories. For clinicians, analysis of the beliefs about the causes clarifies what is at stake for the patient. The objective is to allow patients to produce narrative to describe their chronic illness experience in order to facilitate a long-term treatment alliance. Further studies are required to understand relationships between beliefs about causes, psychological distress and SLE morbidity.
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Affiliation(s)
- Olivier Taïeb
- Department of Child and Adolescent Psychiatry and General Psychiatry, Avicenne Hospital, AP-HP, Université Paris 13, 93000 Bobigny, France.
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