Health-related quality of life, remission and low lupus disease activity state in patients with systemic lupus erythematosus

OBJECTIVES

To measure the association between SLE remission and scores of patients-reported outcome (PRO) measures.

METHODS

We performed a prospective cohort study of SLE patients with a 2-year follow-up, using Lupus Patient-Reported Outcome (LupusPRO), Lupus Quality of Life (LupusQoL), Systemic Lupus Erythematosus Quality of Life (SLEQOL) and 36-item Short Form (SF-36) questionnaires. Remission was defined as remission off treatment (ROFT) and remission on treatment (RONT) according to the definitions of remission in SLE consensus. Mixed models accounting for repeated measures were used to compare groups as follow: ROFT and RONT vs no remission and lupus low disease activity state (LLDAS) vs no LLDAS.

RESULTS

A total of 1478 medical visits and 2547 PRO questionnaires were collected during the follow-up from the 336 recruited patients. A between-group difference in PRO scores reaching at least 5 points on a 0-100 scale was obtained in the following domains: lupus symptoms (LLDAS: +5 points on the 0-100 scale, RONT: +9, ROFT: +5), lupus medication (LLDAS: +5, RONT: +8, ROFT: +9), pain vitality (LLDAS: +6, RONT: +9, ROFT: +6) of LupusPRO; role emotional (LLDAS: +5, RONT: +8), role physical (RONT: +7 and ROFT: +7), bodily pain (RONT: +6), mental health (RONT: +5) and social functioning (RONT: +6) of SF-36. In contrast, a between-group difference reaching at least 5 points was not achieved for any of the LupusQoL and SLEQOL domains.

CONCLUSIONS

RONT, ROFT and LLDAS were associated with significant and clinically relevant higher QoL in most PRO domains of the LupusPRO (disease specific) and SF-36 (generic) questionnaires, but not with LupusQoL and SLEQOL disease-specific questionnaires.

Disease-specific quality of life following a flare in systemic lupus erythematosus: an item response theory analysis of the French EQUAL cohort

OBJECTIVE

To explore, at an item-level, the effect of disease activity (DA) on specific health-related quality of life (HRQoL) in SLE patients using an item response theory longitudinal model.

METHODS

This prospective longitudinal multicentre French cohort EQUAL followed SLE patients over 2 years. Specific HRQoL according to LupusQoL and SLEQOL was collected every 3 months. DA according to SELENA-SLEDAI flare index (SFI) and revised SELENA-SLEDAI flare index (SFI-R) was evaluated every 6 months. Regarding DA according to SFI and each SFI-R type of flare, specific HRQoL of remitting patients was compared with non-flaring patients fitting a linear logistic model with relaxed assumptions for each domain of the questionnaires.

RESULTS

Between December 2011 and July 2015, 336 patients were included (89.9% female). LupusQoL and SLEQOL items related to physical HRQoL (physical health, physical functioning, pain) were most affected by musculoskeletal and cutaneous flares. Cutaneous flares had significant influence on self-image. Neurological or psychiatric flares had a more severe impact on specific HRQoL. Patient HRQoL was impacted up to 18 months after a flare.

CONCLUSION

Item response theory analysis is able to pinpoint items that are influenced by a given patient group in terms of a latent trait change. Item-level analysis provides a new way of interpreting HRQoL variation in SLE patients, permitting a better understanding of DA impact on HRQoL. This kind of analysis could be easily implemented for the comparison of groups in a clinical trial.

TRIAL REGISTRATION

ClinicalTrials.gov, http://clinicaltrials.gov, NCT01904812.

Factors promoting health empowerment of young people: a qualitative pre-interventional study

Background

Angata, an intervention research project led by the regional instance of health education and promotion (Ireps) of Burgundy-Franche-Comté, aims to strengthening the autonomy and decision-making ability of vulnerable youth regarding their health. It is implemented in several facilities. The goal is to improve well-being and quality of life of young people benefiting from socio-educational measures by working with them and the professionals in their living environments. The objective of the study presented was to analyze the factors promoting health empowerment of young people, prior to this intervention, in the Employment Integration Facility (Epide) of Belfort.

Methods

Interviews were conducted with 8 young people and 13 professionals to explore their representations regarding well-being, nutritional health (eating habits, nutrition, physical activity), self-esteem and physical appearance. The determinants of health, lifestyles and organization in the living environment as well as the biographical pathways of young people were also collected.

Results

The Epide, structured on a military model, welcomes young people out-of-school, without qualifications and with complex life courses. The Epide can be seen as a functional community whose whole effort is dedicated to the goal of young volunteers leaving for a job or professional training. The support provided by educators (professional social or former military) is focused on building skills and restoration of self-esteem. Critical consciousness develops over time spent within the structure. The factors promoting empowerment within this strict framework are numerous, but young people’s participation in the decisions taken within the structure remains at the solicitation stage.

Conclusions

The framework provided at the Epide allows an environment conducive to the process of individual empowerment. These leverage can be mobilized to reinforce health empowerment of youth during the Angata project.

Key messages

An empowering educational environment, even strict, can foster the health empowerment of young people subject to vulnerabilities. The allowed level of participation remains an important factor to consider in order to fully promote health empowerment of young people.

[Study of algorithms to identify schizophrenia in the SNIIRAM database conducted by the REDSIAM network]

BACKGROUND

The aim of the REDSIAM network is to foster communication between users of French medico-administrative databases and to validate and promote analysis methods suitable for the data. Within this network, the working group "Mental and behavioral disorders" took an interest in algorithms to identify adult schizophrenia in the SNIIRAM database and inventoried identification criteria for patients with schizophrenia in these databases.

METHODS

The methodology was based on interviews with nine experts in schizophrenia concerning the procedures they use to identify patients with schizophrenia disorders in databases. The interviews were based on a questionnaire and conducted by telephone.

RESULTS

The synthesis of the interviews showed that the SNIIRAM contains various tables which allow coders to identify patients suffering from schizophrenia: chronic disease status, drugs and hospitalizations. Taken separately, these criteria were not sufficient to recognize patients with schizophrenia, an algorithm should be based on all of them. Apparently, only one-third of people living with schizophrenia benefit from the longstanding disease status. Not all patients are hospitalized, and coding for diagnoses at the hospitalization, notably for short stays in medicine, surgery or obstetrics departments, is not exhaustive. As for treatment with antipsychotics, it is not specific enough as such treatments are also prescribed to patients with bipolar disorders, or even other disorders. It seems appropriate to combine these complementary criteria, while keeping in mind out-patient care (every year 80,000 patients are seen exclusively in an outpatient setting), even if these data are difficult to link with other information. Finally, the experts made three propositions for selection algorithms of patients with schizophrenia.

CONCLUSION

Patients with schizophrenia can be relatively accurately identified using SNIIRAM data. Different combinations of the selected criteria must be used depending on the objectives and they must be related to an appropriate length of time.