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Ross E, Abulaban K, Kessler E, Cunningham N. Non-pharmacologic therapies in treatment of childhood-onset systemic lupus erythematosus: A systematic review. Lupus 2022; 31:864-879. [PMID: 35442103 DOI: 10.1177/09612033221094704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood-onset systemic lupus erythematosus (cSLE) is a complex multisystem autoimmune disease often associated with pain, fatigue, and mood-related disturbances. cSLE is associated with increased disease severity and higher rates of mortality as compared to adult onset SLE. Therefore, a multi-faceted approach to care, including the use of non-pharmacologic therapies, is essential to ensure optimal patient outcomes. The use of non-pharmacologic therapies as adjunctive treatments has been shown to be beneficial in adults with SLE, yet, their use and effect is less well understood in cSLE. This is the first systematic review to explore the use and quality of evidence of non-pharmacologic approaches to treat cSLE. METHODS A literature review was performed using PRISMA guidelines. Studies until March 2021 with participants diagnosed with cSLE were included. The quality of the evidence was graded via OCEBM levels of evidence guidelines and bias assessed using Cochrane guidelines. Completed clinical trials (via clinicaltrials.gov) were also searched to identify unpublished results. RESULTS Eleven published studies consisting of 1152 patients met inclusion criteria for this review, as well as three additional studies with unpublished data on clinicaltrial.gov. Of the published trials, four studies used patient education/support, three studies used dietary supplementation, three used forms of psychotherapy (e.g., Cognitive behavioral therapy), and 1 used aerobic exercise to target the following issues: treatment adherence (n = 3), quality of life (n = 3), fatigue (n = 2), pain (n = 2), depressive symptoms (n = 1), anxiety (n = 1), and health-related outcomes including disease severity (n = 3), cardiovascular disease risk (Cardiovascular disease; n = 3), and muscle function (n = 1). Across investigations, the quality of the evidence based on study design was moderate/low. In terms of potential outcomes, dietary supplementation methods were successful in 2 of 3 studies and were associated with improvements in disease activity and fatigue. Aerobic exercise was effective in decreasing resting heart rate and increasing cardiorespiratory capacity. Patient education/support was related to significantly increased treatment adherence and decreased cardiovascular risk markers. Two of the three studies examining the impact of psychotherapy showed improvements (e.g., in treatment adherence, depression and fatigue). CONCLUSION This review identifies several promising non-pharmacologic therapies to use as adjunctive treatments to traditional pharmacologic regimens in health and mental health-related outcomes in patients with cSLE. Future well controlled clinical trials would be beneficial to more rigorously evaluate the effects of non-pharmacologic therapies in pediatric populations.
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Affiliation(s)
- Elizabeth Ross
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Khalid Abulaban
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA.,24319Helen DeVos Children's Hospital (Rheumatology), Grand Rapids, MI, USA
| | - Elizabeth Kessler
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA.,24319Helen DeVos Children's Hospital (Rheumatology), Grand Rapids, MI, USA
| | - Natoshia Cunningham
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA.,Department of Family Medicine, 12268Michigan State University, East Lansing, MI, USA
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do Prado R, Aires PP, Suano-Souza FI, Affonso Fonseca FL, Terreri MT, Sarni ROS. Selenium nutritional status and its association with SLEDAI-2K, HOMA-IR and lipid profile in Juvenile Systemic Lupus Erythematosus patients. Lupus 2022; 31:155-162. [PMID: 35077255 DOI: 10.1177/09612033211067982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess nutritional status regarding selenium in adolescents with Juvenile Systemic Lupus Erythematosus (jSLE) and analyze possible associations with disease activity, insulin resistance and lipid profile. METHODS This was an observational, cross-sectional study of 31 female adolescents with jSLE and 31 healthy female volunteers as a comparison group. We obtained demographic, anthropometric (weight, stature, waist, and neck circumferences), and clinical data (disease activity measured by SLEDAI-2K) from both groups; laboratory data including: lipid profile, plasma selenium, erythrocyte glutathione peroxidase activity (GPx), plasma malondialdehyde (MDA), ultrasensitive C-reactive protein (usCRP), insulin levels, and glycemia (Homeostasis Model Assessment for Insulin Resistance-HOMA-IR). RESULTS Mean age at diagnosis of jSLE group was 15.9±1.7 years, with mean disease duration of 3.6±2.6 years. 48% of patients and controls had below-reference Se levels (≤46mcg/L). GPx was more frequently below reference levels (<4.171U/L) in the jSLE group, compared to controls. A ROC curve was used to assess the power of the variables to discriminate between both groups; insulin (AUC = 0.712; CI 95% 0.584-0.840), waist-to-height ratio (AUC = 0.704; CI 95% 0.572-0.837), and HOMA-IR (AUC = 0.689; CI 95% 0.556-0.822) were the variables with the greatest discriminatory power. Linear regression showed an independent inverse association between Se levels and c-LDL; no such correlation was found for GPx activity. SLEDAI-2 K and HOMA-IR showed no association with levels of Se and GPx activity. CONCLUSIONS Approximately, 50% of jSLE adolescents had below reference Se levels. The frequency of inadequate GPx values was higher in patients, compared to controls. There was an independent inverse association between Se and c-LDL levels in both groups; this was not the case for HOMA-IR and SLEDAI-2K. The data show the importance of assessing Se nutritional status in jSLE patients.
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Affiliation(s)
- Rogério do Prado
- Rheumatology Unit of Department of Pediatrics,28105Federal University of São Paulo, Sao Paulo, Brazil
| | - Patricia P Aires
- Rheumatology Unit of Department of Pediatrics,28105Federal University of São Paulo, Sao Paulo, Brazil
| | | | | | - Maria Teresa Terreri
- Rheumatology Unit of Department of Pediatrics,28105Federal University of São Paulo, Sao Paulo, Brazil
| | - Roseli O S Sarni
- Department of Pediatrics, 28105Federal University of São Paulo, Sao Paulo, Brazil
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Abstract
Despite an incomplete overall understanding, nutrition plays an important role in connective tissue disease. Assessment of patients with connective tissue disease for nutritional status and metabolic disturbances may significantly contribute to patient outcomes. Several studies have indicated the multifactorial role of macronutrients, micronutrients, and supplements in the setting of connective tissue disease. There is additional evidence regarding the roles of weight, obesity, and malnutrition. This contribution reviews a growing body of data regarding nutrition in the development and treatment of various connective tissue diseases, including systemic lupus erythematosus, dermatomyositis, and systemic sclerosis.
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Affiliation(s)
- Alexa Lisevick
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Jette Hooper
- Department of Dermatology, University of Connecticut Medical Center, Farmington, Connecticut, USA
| | - Neda Shahriari
- Department of Dermatology, University of Connecticut Medical Center, Farmington, Connecticut, USA
| | - Jun Lu
- Department of Dermatology, University of Connecticut Medical Center, Farmington, Connecticut, USA.
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Medeiros PBS, Salomão RG, Teixeira SR, Rassi DM, Rodrigues L, Aragon DC, Fassini PG, Ued FV, Tostes RC, Monteiro JP, Ferriani VPL, de Carvalho LM. Disease activity index is associated with subclinical atherosclerosis in childhood-onset systemic lupus erythematosus. Pediatr Rheumatol Online J 2021; 19:35. [PMID: 33743717 PMCID: PMC7981852 DOI: 10.1186/s12969-021-00513-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular events. The present study determined the prevalence of subclinical atherosclerosis in childhood-onset SLE using the carotid intima-media thickness (CIMT) measurement and investigated associations between traditional and nontraditional risk factors for atherosclerosis, such as medications, SLE Disease Activity Index - SLEDAI-2 K and SLICC-ACR damage index and CIMT. METHODS Cross-sectional prospective study between 2017 and 2018. CIMT was assessed by ultrasonography. Data were collected by chart review, nutritional evaluation and laboratory tests and analyzed by Fisher, Wilcoxon-Mann-Whitney tests, multiple linear and log binomial regression. RESULTS Twenty-eight patients (mean age 13.9 years, SD 3) were enrolled. The prevalence of subclinical atherosclerosis was 32% (95% CI 14.8, 49.4). The mean CIMT was 0.43 ± 0.035 mm. The most common traditional risk factors observed were dyslipidemia (82.1%), uncontrolled hypertension (14.2%), obesity (14.3%), and poor diet (78.6%). Uncontrolled hypertension (p = 0.04), proteinuria (p = 0.02), estimated glomerular filtration rate < 75 ml /min/1.73 m2 (p = 0.02) and SLEDAI-2 K > 5 (P = 0.04) were associated with subclinical atherosclerosis. SLEDAI-2 K > 5 maintained association with CIMT after adjusting for control variables. CONCLUSION Subclinical atherosclerosis is frequently observed in cSLE, mainly in patients with moderate to severe disease activity.
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Affiliation(s)
- Priscila B. S. Medeiros
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil ,grid.11899.380000 0004 1937 0722Division of Pediatric Rheumatology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Roberta G. Salomão
- grid.11899.380000 0004 1937 0722Division of Nutrition and Metabolism, Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Sara R. Teixeira
- grid.11899.380000 0004 1937 0722Department of Medical Imaging, Oncology and Hematology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Diane M. Rassi
- grid.11899.380000 0004 1937 0722Department of Pharmacology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Luciana Rodrigues
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil
| | - Davi C. Aragon
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil
| | - Priscila G. Fassini
- grid.11899.380000 0004 1937 0722Department of Internal Medicine, Division of Nutrology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Fábio V. Ued
- grid.11899.380000 0004 1937 0722Division of Nutrition and Metabolism, Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Rita C. Tostes
- grid.11899.380000 0004 1937 0722Department of Pharmacology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Jacqueline P. Monteiro
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil ,grid.11899.380000 0004 1937 0722Division of Nutrition and Metabolism, Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Virgínia P. L. Ferriani
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil ,grid.11899.380000 0004 1937 0722Division of Pediatric Rheumatology, University of São Paulo, Ribeirão Preto, São Paulo Brazil
| | - Luciana M. de Carvalho
- grid.11899.380000 0004 1937 0722Department of Pediatrics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900 Brazil ,grid.11899.380000 0004 1937 0722Division of Pediatric Rheumatology, University of São Paulo, Ribeirão Preto, São Paulo Brazil ,grid.11899.380000 0004 1937 0722Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900 Brazil
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