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Lieber SB, Nahid M, Legge A, Rajan M, Lipschultz RA, Lin M, Reid MC, Mandl LA. Comparison of two frailty definitions in women with systemic lupus erythematosus. Rheumatology (Oxford) 2024; 63:1384-1390. [PMID: 37555816 PMCID: PMC11065438 DOI: 10.1093/rheumatology/kead393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES Frailty is a risk factor for adverse health in SLE. The Fried phenotype (FP) and the SLICC Frailty Index (SLICC-FI) are common frailty metrics reflecting distinct approaches to frailty assessment. We aimed to (1) compare frailty prevalence according to both metrics in women with SLE and describe differences between frail and non-frail participants using each method and (2) evaluate for cross-sectional associations between each metric and self-reported disability. METHODS Women aged 18-70 years with SLE were enrolled. FP and SLICC-FI were measured, and agreement calculated using a kappa statistic. Physician-reported disease activity and damage, Patient Reported Outcome Measurement Information System (PROMIS) computerized adaptive tests, and Valued Life Activities (VLA) self-reported disability were assessed. Differences between frail and non-frail participants were evaluated cross-sectionally, and the association of frailty with disability was determined for both metrics. RESULTS Of 67 participants, 17.9% (FP) and 26.9% (SLICC-FI) were frail according to each metric (kappa = 0.41, P < 0.01). Compared with non-frail women, frail women had greater disease damage, worse PROMIS scores, and greater disability (all P < 0.01 for FP and SLICC-FI). After age adjustment, frailty remained associated with a greater odds of disability [FP: odds ratio (OR) 4.7, 95% CI 1.2, 18.8; SLICC-FI: OR 4.6, 95% CI 1.3, 15.8]. CONCLUSION Frailty is present in 17.9-26.9% of women with SLE. These metrics identified a similar, but non-identical group of women as frail. Further studies are needed to explore which metric is most informative in this population.
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Affiliation(s)
- Sarah B Lieber
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Musarrat Nahid
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alexandra Legge
- Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mangala Rajan
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Myriam Lin
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - M Carrington Reid
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lisa A Mandl
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Chakravarty EF, Utset T, Kamen DL, Contreras G, McCune WJ, Aranow C, Kalunian K, Massarotti E, Clowse MEB, Rovin BH, Lim SS, Majithia V, Dall'Era M, Looney RJ, Erkan D, Saxena A, Olsen NJ, Ko K, Guthridge JM, Goldmuntz E, Springer J, D'Aveta C, Keyes-Elstein L, Barry B, Pinckney A, McNamara J, James JA. Mycophenolate mofetil withdrawal in patients with systemic lupus erythematosus: a multicentre, open-label, randomised controlled trial. THE LANCET. RHEUMATOLOGY 2024; 6:e168-e177. [PMID: 38301682 PMCID: PMC10922882 DOI: 10.1016/s2665-9913(23)00320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Mycophenolate mofetil is an immunosuppressant commonly used to treat systemic lupus erythematosus (SLE) and lupus nephritis. It is a known teratogen associated with significant toxicities, including an increased risk of infections and malignancies. Mycophenolate mofetil withdrawal is desirable once disease quiescence is reached, but the timing of when to do so and whether it provides a benefit has not been well-studied. We aimed to determine the effects of mycophenolate mofetil withdrawal on the risk of clinically significant disease reactivation in patients with quiescent SLE on long-term mycophenolate mofetil therapy. METHODS This multicenter, open-label, randomised trial was conducted in 19 centres in the USA. Eligible patients were aged between 18 and 70 years old, met the American College of Rheumatology (ACR) 1997 SLE criteria, and had a clinical SLEDAI score of less than 4 at screening. Mycophenolate mofetil therapy was required to be stable or decreasing for 2 years or more if initiated for renal indications, or for 1 year or more for non-renal indications. Participants were randomly allocated in a 1:1 ratio to a withdrawal group, who tapered off mycophenolate mofetil over 12 weeks, or a maintenance group who maintained their baseline dose (1-3g per day) for 60 weeks. Adaptive random allocation ensured groups were balanced for study site, renal versus non-renal disease, and baseline mycophenolate mofetil dose (≥2 g per day vs <2 g per day). Clinically significant disease reactivation by week 60 following random allocation, requiring increased doses or new immunosuppressive therapy was the primary endpoint, in the modified intention-to-treat population (all randomly allocated participants who began study-provided mycophenolate mofetil). Non-inferiority was evaluated using an estimation-based approach. The trial was registered at ClinicalTrials.gov (NCT01946880) and is completed. FINDINGS Between Nov 6, 2013, and April 27, 2018, 123 participants were screened, of whom 102 were randomly allocated to the maintenance group (n=50) or the withdrawal group (n=52). Of the 100 participants included in the modified intention-to-treat analysis (49 maintenance, 51 withdrawal), 84 (84%) were women, 16 (16%) were men, 40 (40%) were White, 41 (41%) were Black, and 76 (76%) had a history of lupus nephritis. The average age was 42 (SD 12·7). By week 60, nine (18%) of 51 participants in the withdrawal group had clinically significant disease reactivation, compared to five (10%) of 49 participants in the maintenance group. The risk of clinically significant disease reactivation was 11% (95% CI 5-24) in the maintenance group and 18% (10-32) in the withdrawal group. The estimated increase in the risk of clinically significant disease reactivation with mycophenolate mofetil withdrawal was 7% (one-sided upper 85% confidence limit 15%). Similar rates of adverse events were observed in the maintenance group (45 [90%] of 50 participants) and the withdrawal group (46 [88%] of 52 participants). Infections were more frequent in the mycophenolate mofetil maintenance group (32 [64%]) compared with the withdrawal group (24 [46%]). INTERPRETATIONS Mycophenolate mofetil withdrawal is not significantly inferior to mycophenolate mofetil maintenance. Estimates for the rates of disease reactivation and increases in risk with withdrawal can assist clinicians in making informed decisions on withdrawing mycophenolate mofetil in patients with stable SLE. FUNDING The National Institute of Allergy and Infectious Diseases and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
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Affiliation(s)
- Eliza F Chakravarty
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Tammy Utset
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Diane L Kamen
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - W Joseph McCune
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Cynthia Aranow
- Autoimmune and Musculoskeletal Disease, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Kenneth Kalunian
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, La Jolla, CA, USA
| | - Elena Massarotti
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Megan E B Clowse
- Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Brad H Rovin
- Division of Nephrology, Ohio State University, Columbus, OH, USA
| | - S Sam Lim
- School of Medicine, Emory University, Atlanta, GA, USA
| | - Vikas Majithia
- Division of Rheumatology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Maria Dall'Era
- Division of Rheumatology, Russell/Engleman Rheumatology Research Center, University of California, San Francisco, CA, USA
| | - R John Looney
- Allergy Immunology Rheumatology Division, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Amit Saxena
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Nancy J Olsen
- Division of Rheumatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Kichul Ko
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Joel M Guthridge
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ellen Goldmuntz
- Division of Allergy, Immunology, and Transplantation, NIH/NIAID, Bethesda, MD, USA
| | - Jessica Springer
- Division of Allergy, Immunology, and Transplantation, NIH/NIAID, Bethesda, MD, USA
| | | | | | - Bill Barry
- Rho Federal Systems Division, Durham, NC, USA
| | | | - James McNamara
- Division of Allergy, Immunology, and Transplantation, NIH/NIAID, Bethesda, MD, USA
| | - Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Kasturi S, Ahearn EL, Batterman A, Horton R, Kleinman J, Rose-Smith J, LeClair AM, Mandl LA. Measuring What Matters: A Qualitative Study of the Relevance and Clinical Utility of PROMIS Surveys in Systemic Lupus Erythematosus. J Rheumatol 2023; 51:jrheum.2023-0184. [PMID: 37399463 PMCID: PMC10757986 DOI: 10.3899/jrheum.2023-0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate the relevance and clinical utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) surveys in patients with systemic lupus erythematosus (SLE). METHODS Adults with SLE receiving routine outpatient care at a tertiary care academic medical center participated in a qualitative study. Patients completed PROMIS computerized adaptive tests (CATs) in 12 selected domains and rated the relevance of each domain to their experience with SLE. Focus groups and interviews were conducted to elucidate the relevance of the PROMIS surveys, identify additional domains of importance, and explore the utility of the surveys in clinical care. Focus group and interview transcripts were coded, and a thematic analysis was performed using an iterative inductive process. RESULTS Twenty-eight women and 4 men participated in 4 focus groups and 4 interviews, respectively. Participants endorsed the relevance and comprehensiveness of the selected PROMIS domains in capturing the effect of SLE on their lives. They ranked fatigue, pain interference, sleep disturbance, physical function, and applied cognition abilities as the most salient health-related quality of life (HRQOL) domains. They suggested that the disease-agnostic PROMIS questions holistically captured their lived experience of SLE and its common comorbidities. Participants were enthusiastic about using PROMIS surveys in clinical care and described potential benefits in enabling disease monitoring and management, facilitating communication, and empowering patients. CONCLUSION PROMIS includes the HRQOL domains that are of most importance to individuals with SLE. Patients suggest that these universal tools can holistically capture the impact of SLE and enhance routine clinical care.
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Affiliation(s)
- Shanthini Kasturi
- S. Kasturi, MD, MS, Division of Rheumatology, Tufts Medical Center, Boston, MA
| | - Emily L Ahearn
- E.L. Ahearn, BS, Tufts University School of Medicine, Boston, Massachusetts
| | - Adena Batterman
- A. Batterman, MSW, LCSW, Department of Social Work, Hospital for Special Surgery, New York, New York
| | - Roberta Horton
- R. Horton, LCSW, ACSW, Department of Social Work, Hospital for Special Surgery, New York, New York
| | - Juliette Kleinman
- J. Kleinman, LCSW, ACSW, Department of Social Work, Montefiore Health System, Bronx, New York
| | - Jillian Rose-Smith
- J. Rose-Smith, PhD, MPH, LCSW, Department of Social Work, Hospital for Special Surgery, New York, New York
| | - Amy M LeClair
- A.M. LeClair, PhD, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Lisa A Mandl
- L.A. Mandl, MD, MPH, Division of Rheumatology, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York, USA
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Ahmad Pouzi NA, Shaharir SS, Mohd Tamil A, Mustafar R, Ahmad Maulana S, Mageswaren E, Wan Ghazali WS. Validation and the associated factors of the Malay version of systemic lupus erythematosus-specific health-related quality of life questionnaires (SLEQoL and LupusQoL). PLoS One 2023; 18:e0285461. [PMID: 37186611 PMCID: PMC10184909 DOI: 10.1371/journal.pone.0285461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES To assess the reliability and validity of two disease-specific questionnaires that assess the quality of life (QoL) among patients with Systemic Lupus Erythematosus (SLE); SLEQoL and LupusQoL in Malay language. This study also identified the factors affecting each domain of the questionnaires. METHODS This cross-sectional study was conducted from June 2021 until April 2022, and SLE patients were recruited to complete the SLEQoL, LupusQoL and Short Form Health Survey (SF-36) in Malay language. Disease activity were recorded using the modified SLE Disease Activity Index (M- SLEDAI) and British Isles Lupus Assessment Group 2004 (BILAG-2004) index. Presence of organ damage was determined using the SLICC Damage index. Cronbach's alpha was calculated to determine internal consistency while exploratory factor analysis was done to determine the construct validity. Concurrent validity was evaluated using correlation with SF-36. Multiple linear regression analysis was deployed to determine the factors affecting each domain of SLEQoL and LupusQoL. RESULTS A total of 125 subjects were recruited. The Cronbach's α value for the Malay-SLEQoL (M-SLEQoL) and Malay-LupusQOL (M-LupusQoL) was 0.890 and 0.944 respectively. Exploratory factor analysis found formation of similar number of components with the original version of questionnaires and all items have good factor loading of >0.4. Both instruments also had good concurrent validity with SF-36. M-SLEQoL had good correlations with BILAG-2004 and M-SLEDAI scores. Musculoskeletal (MSK) involvement was independently associated with lower M-SLEQoL in physical function, activity and symptom domains. Meanwhile, MSK and NPSLE were associated with fatigue in M-LupusQoL. CONCLUSION Both M-SLEQoL and M-LupusQoL are reliable and valid as disease -specific QoL instruments for Malaysian patients. The M-Lupus QoL has better discriminative validity compared to the M-SLEQoL. SLE patients with MSK involvement are at risk of poor QoL in multiple domains including physical function, activity, symptoms and fatigue.
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Affiliation(s)
- Nur Aqeelah Ahmad Pouzi
- Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Cheras, Kuala Lumpur, Malaysia
| | - Syahrul Sazliyana Shaharir
- Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Cheras, Kuala Lumpur, Malaysia
| | - Azmi Mohd Tamil
- Department of Public Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Cheras, Kuala Lumpur, Malaysia
| | - Ruslinda Mustafar
- Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Cheras, Kuala Lumpur, Malaysia
| | | | - Eashwary Mageswaren
- Medical Department, Hospital Tengku Ampuan Rahimah, Klang, Selangor, Malaysia
| | - Wan Syamimee Wan Ghazali
- Department of Internal Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Kasturi S, Price LL, LeClair A, Patel N, Shetty S, Sheira D, Weber S, Curtis D, Nowell WB, Salmon J, Terrin N, McAlindon TE, Mandl LA. Clinical integration of patient-reported outcome measures to enhance the care of patients with SLE: a multi-centre prospective cohort study. Rheumatology (Oxford) 2022; 61:4763-4774. [PMID: 35357445 PMCID: PMC9707322 DOI: 10.1093/rheumatology/keac200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/17/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To assess the feasibility and impact of integrating electronic patient-reported outcome measures (PROMs) into the routine outpatient care of patients with SLE. METHODS We conducted a prospective cohort study, utilizing a mixed-methods sequential explanatory design, of SLE outpatients receiving rheumatology care at two academic medical centres. Participants completed electronic PROMs at enrolment and then prior to their next two routine rheumatology visits. PROM score reports were shared with patients and rheumatologists before visits. Patients and rheumatologists completed post-visit surveys evaluating the utility of PROMs in the clinical encounters. Focus groups of patients and interviews with treating rheumatologists were conducted to further explore their experience utilizing PROMs. RESULTS A total of 105 SLE patients and 17 rheumatologists participated in the study. Patients completed PROMs in 159 of 184 encounters (86%), with 93% of surveys completed remotely. Patients reported that PROMs were 'quite a bit' or 'very' useful (55% of encounters) and beneficial to communication (55% of encounters). In contrast, physicians found PROMs useful (20%) and beneficial to communication (17%) less frequently. There was no significant change in visit length, health-related quality of life or disease activity after implementation of PROMs; however, patient satisfaction improved slightly. Qualitative analyses revealed that patients felt PROMs provided utility primarily by facilitating communication, particularly when physicians discussed the surveys. CONCLUSION The remote capture and integration of electronic PROMs into clinical care was feasible in a diverse cohort of SLE outpatients. PROMs were useful to patients and enhanced their clinical experience primarily by facilitating communication.
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Affiliation(s)
- Shanthini Kasturi
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University
- Institute for Clinical Research and Health Policy Studies
| | - Amy LeClair
- Department of Medicine, Tufts Medical Center, Boston, MA
| | - Neena Patel
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Shreya Shetty
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Dina Sheira
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
| | - Serena Weber
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | | | | | - Jane Salmon
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
- Division of Rheumatology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Norma Terrin
- Tufts Clinical and Translational Science Institute, Tufts University
| | | | - Lisa A Mandl
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
- Division of Rheumatology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Sada KE, Katayama Y, Asano Y, Hayashi K, Miyawaki Y, Ohashi K, Katsuyama E, Katsuyama T, Takano-Narazaki M, Matsumoto Y, Yoshimi R, Shimojima Y, Ohno S, Kajiyama H, Ichinose K, Sato S, Fujiwara M, Yajima N. Association of one-point glucocorticoid-free status with chronic damage and disease duration in systemic lupus erythematosus: a cross-sectional study. Lupus Sci Med 2022; 9:9/1/e000772. [PMID: 36167483 PMCID: PMC9516281 DOI: 10.1136/lupus-2022-000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/18/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE It is still unclear how glucocorticoids (GCs) affect the long-term clinical course of patients with SLE. The objective of this study is to explore the factors associated with GC-free treatment status. METHODS Using data from the lupus registry of nationwide institutions, GC dose at registration was compared between short, middle and long disease durations of <5, 5-20 and ≥20 years, respectively. After excluding patients who never used GC, we evaluated the relationship between GC-free status and chronic damage using Systemic Lupus International Collaborating Clinics Damage Index. RESULTS GC doses at enrolment of the 1019 patients were as follows: GC-free in 101 (10%); 0<prednisolone (PSL) ≤5 mg/day in 411 (40%); 5<PSL ≤7.5 in 169 (17%); 7.5<PSL ≤10 in 194 (19%) and PSL≥10 in 144 (14%) patients. Of the patients who were not currently using GCs, patients who never used GC more frequently had short disease duration (66% with short, 23% with middle and 17% with long disease duration, p=0.00029). Univariate analysis of patients who underwent GC treatment showed that patients without GCs exhibited older age, lower disease activity, less immunosuppressant and hydroxychloroquine use and higher C3 levels. Among patients with a disease duration of ≥20 years, GC-free status was more frequent in patients without chronic damage (11% vs 4%, p=0.023). After adjusting for age, sex and disease activity, no chronic damage accrual was associated with GC-free status (OR 3.6, 95% CI 1.1 to 11.3). CONCLUSION Even in the patients with long disease duration, one-point GC-free treatment status might be related to no chronic damage accrual.
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Affiliation(s)
- Ken-Ei Sada
- Department of Clinical Epidemiology, Kochi Medical School, Nankoku, Japan .,Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yu Katayama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Asano
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keigo Hayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshia Miyawaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiji Ohashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Eri Katsuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Katsuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mariko Takano-Narazaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshinori Matsumoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeru Ohno
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Kajiyama
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Michio Fujiwara
- Department of Rheumatology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.,Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Majercak KR, Perfetto EM, Villalonga-Olives E. Capturing the patient experience in systemic lupus erythematosus: Are widely used measures fit-for-purpose and adherent to FDA PRO guidance recommendations? J Patient Rep Outcomes 2022; 6:7. [PMID: 35061149 PMCID: PMC8777546 DOI: 10.1186/s41687-022-00411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The 2009 Food and Drug Administration (FDA) patient-reported outcome (PRO) guidance outlines characteristics of rigorous PRO-measure development. There are a number of widely used PRO measures for Systemic Lupus Erythematosus (SLE), but it is unknown how well the development processes of SLE PRO measures align with FDA guidance; including updated versions. The objective of this study was to assess how well the LupusQoL and LupusPRO, and corresponding updated versions, LupusQoL-US and LupusPROv1.8, align with Food and Drug Administration (FDA) 2009 patient-reported outcome (PRO) guidance.
Methods
LupusQoL and LupusPRO were selected as the most widely studied and used Lupus PROs in the UK and US. Original (LupusQoL (2007) and LupusQoL-US (2010)) and revised (LupusPROVv1.7 (2012) and LupusPROv1.8 (2018)) versions were reviewed. We used FDA PRO guidance to create evaluation criteria for key components: target population, concepts measured, measurement properties, documentation across the phases of content validity (item-generation and cognitive interviewing, separately) and other psychometric-property testing. Two reviewers abstracted data independently, compared results, and resolved discrepancies.
Results
For all measures, the target population was unclear as population characteristics (e.g., ethnicity, education, disease severity) varied, and/or were not consistently reported or not considered across the three phases (e.g., LupusQoL item-generation lacked male involvement, LupusPRO cognitive-interviewing population characteristics were not reported). The item-generation phase for both original measures was conducted with concepts elicited via patient-engagement interviews and item derivation from experts. Cognitive interviewing was conducted via patient feedback with limited item-tracking for original measures. In contrast, the revised measures assumed content validity. Other psychometric testing recommendations (reliability, construct validity, ability to detect change) were reported for both original and revised measures, except for ability to detect change for revised measures.
Conclusions
The SLE PRO measures adhere to some but not all FDA PRO guidance recommendations. Limitations in processes and documentation of the study population, make it unclear for which target population(s) the current Lupus measures are fit-for-purpose.
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Lieber SB, Nahid M, Paget S, Berman JR, Barbhaiya M, Sammaritano LR, Kirou K, Carrino JA, Rajan M, Sheira D, Mandl LA. Evaluation of a Patient-reported Frailty Tool in Women With Systemic Lupus Erythematosus. J Rheumatol 2021; 49:60-67. [PMID: 34470795 DOI: 10.3899/jrheum.201466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Frailty is associated with mortality in systemic lupus erythematosus (SLE), but how best to measure frailty is unclear. We aimed to compare 2 frailty metrics, the self-reported Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale (FS) and the Fried phenotype (FP), in SLE to evaluate differences between frail and nonfrail women and whether frailty is associated with self-reported disability. METHODS Adult women aged < 70 years with validated SLE and mild/moderate disease enrolled in this cross-sectional study between August 2018 and October 2019. Correlation and agreement between the FS and the FP were determined. Differences in sociodemographic and disease characteristics, patient-reported outcome measures (PROMs), and biomarkers between frail and nonfrail participants were evaluated, as well as the association of frailty with Valued Life Activities disability. RESULTS Of 67 participants, 27% and 18% were frail according to the FS and the FP, respectively. Correlation (r = 0.51; P < 0.0001) and agreement (κ = 0.46; P = 0.0004) between the FS and the FP were significant. Frail women had greater disease damage, high-sensitivity C-reactive protein, and interleukin 6, and worse PROMs according to both frailty definitions. Both frailty measures were associated with self-reported disability after adjustment for age, comorbidity, and disease activity and damage; this relationship was attenuated for the FP. CONCLUSION Frailty prevalence was high in this cohort of women with SLE using both frailty definitions, suggesting that frailty may be accelerated in women with SLE, particularly when based exclusively on self-report. Frailty remained associated with self-reported disability in adjusted analyses. The FS may be an informative point-of-care tool to identify frail women with SLE.
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Affiliation(s)
- Sarah B Lieber
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Musarrat Nahid
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Stephen Paget
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Jessica R Berman
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Medha Barbhaiya
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Lisa R Sammaritano
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Kyriakos Kirou
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - John A Carrino
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Mangala Rajan
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Dina Sheira
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Lisa A Mandl
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
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Nguyen MH, Huang FF, O’Neill SG. Patient-Reported Outcomes for Quality of Life in SLE: Essential in Clinical Trials and Ready for Routine Care. J Clin Med 2021; 10:jcm10163754. [PMID: 34442047 PMCID: PMC8396817 DOI: 10.3390/jcm10163754] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Patient-reported outcome (PRO) instruments are widely used to assess quality of life in Systemic Lupus Erythematosus (SLE) research, and there is growing evidence for their use in clinical care. In this review, we evaluate the current evidence for their use in assessing quality of life in SLE in both research and clinical settings and examine the different characteristics of the commonly used PRO tools. There are now several well-validated generic and SLE-specific tools that have demonstrated utility in clinical trials and several tools that complement activity and damage measures in the clinical setting. PRO tools may help overcome physician–patient discordance in SLE and are valuable in the assessment of fibromyalgia and type 2 symptoms such as widespread pain and fatigue. Future work will identify optimal PRO tools for different settings but, despite current limitations, they are ready to be incorporated into patient care.
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Affiliation(s)
- Matthew H. Nguyen
- Liverpool Hospital, Liverpool, NSW 2170, Australia;
- Pathology Department, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Frank F. Huang
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia;
| | - Sean G. O’Neill
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia;
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Correspondence: ; Tel.: +61-02-94631890
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10
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Carrión-Nessi FS, Marcano-Rojas MV, Freitas-DeNobrega DC, Romero Arocha SR, Antuarez-Magallanes AW, Fuentes-Silva YJ. Validation of the LupusQoL in Venezuela: A specific measurement of quality of life in patients with systemic lupus erythematosus. ACTA ACUST UNITED AC 2021; 18:355-360. [PMID: 34373232 DOI: 10.1016/j.reumae.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Traditionally, the health-related quality of life (HRQoL) of patients with systemic lupus erythematosus (SLE) has been assessed using instruments that neglect the specific characteristics of the disease. This study determines the validity of the Lupus Quality of Life (LupusQoL) questionnaire as a psychometrically stable instrument to measure the HRQoL of patients with SLE in Venezuela and establishes the cutoff points of the questionnaire for the Venezuelan population. PATIENTS AND METHODS A cross-sectional study was conducted that included patients with SLE from April to July 2018. Patients completed the LupusQoL and the "Generalitat de Catalunya" (GENCAT) scale; sociodemographic data, activity index (SLEDAI) and accumulated damage (SLICC), were obtained. Reliability was evaluated by internal consistency and the convergent validity of the LupusQoL was determined with the GENCAT scale. RESULTS Of the 100 patients, 93% were women, the mean age was 42 years old (SD: 13) and the mean duration of the disease was 11 years (SD: 9); the mean of SLEDAI and SLICC was 3 and 1, respectively. The cutoff point that defined a "better" or "worse" HRQoL for LupusQoL was 64.55 points. A moderate convergence was found after grouping, according to the cutoff points, of the LupusQoL with the GENCAT scale (Cohen's kappa coefficient = .556; p = .000). CONCLUSIONS The LupusQoL is a valid psychometrically stable instrument to measure the HRQoL of patients with SLE in Venezuela. Cutoff points were established to stratify the HRQoL in the Venezuelan population with LES, being useful to complement a comprehensive evaluation.
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Affiliation(s)
- Fhabián S Carrión-Nessi
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela.
| | - María V Marcano-Rojas
- Programa de Enfermedades Endocrino-Metabólicas, Instituto de Salud Pública, Ciudad Bolívar, Venezuela
| | - Diana C Freitas-DeNobrega
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela
| | - Sinibaldo R Romero Arocha
- Programa de Formación de Científicos Médicos (MD/PhD), Facultad de Medicina, Universidad de Minnesota, MN, United States
| | - Allen W Antuarez-Magallanes
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela
| | - Yurilís J Fuentes-Silva
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela; Centro Clínico Universitario de Oriente, Ciudad Bolívar, Venezuela
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11
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Annapureddy N, Jolly M. Patient-Reported Outcomes in Lupus. Rheum Dis Clin North Am 2021; 47:351-378. [PMID: 34215368 DOI: 10.1016/j.rdc.2021.04.004] [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: 10/21/2022]
Abstract
Patient-reported outcome (PRO) was identified as a core systemic lupus erythematosus (SLE) outcome in 1999. More than 20 years later, however, generic PRO measures evaluating impact in SLE are used mainly for research. Generic and disease-targeted PRO tools have unique advantages. Significant progress in identification of patient disease-relevant PRO concepts and development of new PRO tools for SLE has occurred over the past 20 years. Further research needs to focus on responsiveness and minimally important differences of existing, promising PRO tools to facilitate their use in SLE patient care and research.
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Affiliation(s)
- Narender Annapureddy
- Department of Medicine, Vanderbilt University, 1160 21st Avenue, Suite T3113 MCN, Nashville, TN 37232, USA
| | - Meenakshi Jolly
- Department of Medicine, Rush University, 1611 West Harrison Street, Suite 510, Chicago, IL 60615, USA.
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Lai NS, Lu MC, Chang HH, Lo HC, Hsu CW, Huang KY, Tung CH, Hsu BB, Wu CH, Koo M. A Comparison of the Correlation of Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and Systemic Lupus Erythematosus Disease Activity Score (SLE-DAS) with Health-Related Quality of Life. J Clin Med 2021; 10:jcm10102137. [PMID: 34063379 PMCID: PMC8157030 DOI: 10.3390/jcm10102137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: The aim of this study was to compare the correlation of a recently developed systemic lupus erythematosus disease activity score (SLE-DAS) with the SLE disease activity index 2000 (SLEDAI-2K) with the Lupus Quality of Life questionnaire (LupusQoL) in Taiwanese patients with SLE. Methods: A cross-sectional study was conducted in a regional teaching hospital in Taiwan from April to August 2019. Adult patients with a clinician-confirmed diagnosis of SLE based on the 1997 American College of Rheumatology revised criteria or the 2012 Systemic Lupus International Collaborating Clinics Classification Criteria were recruited. SLE disease activity was measured with both SLEDAI-2K and SLE-DAS. Disease-specific quality of life was assessed using the LupusQoL. Results: Of the 333 patients with SLE in this study, 90.4% were female and 40% were between the ages of 20 and 39 years. The median SLEDAI-2K score was 4.00 (interquartile range [IQR] 2.00–7.50) and the median SLE-DAS score was 2.08 (IQR 1.12–8.24) in our patients with SLE. After adjusting for sex and age intervals, both SLEDAI-2k and SLE-DAS were significantly and inversely associated with all eight domains of LupusQoL. The magnitudes of the mean absolute error, root mean square error, Akaike Information Criterion, Bayesian Information Criterion, and coefficient of determination were comparable between SLEDAI-2K and SLE-DAS. Conclusions: There were no clear differences in the use of SLE-DAS over SLEDAI-2K in assessing HRQoL in patients with SLE. We suggest that, in this aspect, both SLEDAI-2K and SLE-DAS are effective tools for measuring disease activity in patients with SLE.
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Affiliation(s)
- Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan; (N.-S.L.); (M.-C.L.); (K.-Y.H.); (C.-H.T.); (B.-B.H.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien City, Hualien 97004, Taiwan
| | - Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan; (N.-S.L.); (M.-C.L.); (K.-Y.H.); (C.-H.T.); (B.-B.H.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien City, Hualien 97004, Taiwan
| | - Hsiu-Hua Chang
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan; (H.-H.C.); (H.-C.L.); (C.-W.H.)
| | - Hui-Chin Lo
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan; (H.-H.C.); (H.-C.L.); (C.-W.H.)
| | - Chia-Wen Hsu
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan; (H.-H.C.); (H.-C.L.); (C.-W.H.)
| | - Kuang-Yung Huang
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan; (N.-S.L.); (M.-C.L.); (K.-Y.H.); (C.-H.T.); (B.-B.H.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien City, Hualien 97004, Taiwan
| | - Chien-Hsueh Tung
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan; (N.-S.L.); (M.-C.L.); (K.-Y.H.); (C.-H.T.); (B.-B.H.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien City, Hualien 97004, Taiwan
| | - Bao-Bao Hsu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan; (N.-S.L.); (M.-C.L.); (K.-Y.H.); (C.-H.T.); (B.-B.H.); (C.-H.W.)
| | - Cheng-Han Wu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan; (N.-S.L.); (M.-C.L.); (K.-Y.H.); (C.-H.T.); (B.-B.H.); (C.-H.W.)
| | - Malcolm Koo
- Graduate Institute of Long-Term Care, Tzu Chi University of Science and Technology, Hualien City, Hualien 973302, Taiwan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Correspondence:
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Strand V, Simon LS, Meara AS, Touma Z. Measurement properties of selected patient-reported outcome measures for use in randomised controlled trials in patients with systemic lupus erythematosus: a systematic review. Lupus Sci Med 2021; 7:7/1/e000373. [PMID: 32591423 PMCID: PMC7319706 DOI: 10.1136/lupus-2019-000373] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/17/2020] [Accepted: 05/24/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The heterogeneous multisystem manifestations of SLE include fatigue, pain, depression, sleep disturbance and cognitive dysfunction, and underscore the importance of a multidimensional approach when assessing health-related quality of life. The US Food and Drug Administration has emphasised the importance of patient-reported outcomes (PROs) for approval of new medications and Outcome Measures in Rheumatology has mandated demonstration of appropriate measurement properties of selected PRO instruments. METHODS Published information regarding psychometric properties of the Medical Outcomes Survey Short Form 36 (SF-36), Lupus Quality of Life Questionnaire (LupusQoL) and Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F), and their suitability as end points in randomised controlled trials (RCTs) and longitudinal observational studies (LOS) were assessed. A search of English-language literature using MEDLINE and EMBASE identified studies related to development and validation of these instruments. Evidence addressed content validity, reliability (internal consistency and test-retest reliability), construct validity (convergent and divergent) and longitudinal responsiveness, including thresholds of meaning and discrimination. RESULTS All instruments demonstrated strong internal consistency, reliability and appropriate face/content validity, indicating items within each instrument that measure the intended concept. SF-36 and LupusQoL demonstrated test-retest reliability; although not published with FACIT-F in SLE supported by evidence from other rheumatic diseases. All instruments demonstrated convergent validity with other comparable PROs and responsivity to treatment. CONCLUSION The measurement properties of PRO instruments with published data from RCTs including: SF-36, LupusQoL and FACIT-F indicate their value as secondary end points to support labelling claims in RCTs and LOS evaluating the efficacy of SLE treatments.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
| | | | | | - Zahi Touma
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Carrión-Nessi FS, Marcano-Rojas MV, Freitas-DeNobrega DC, Romero Arocha SR, Antuarez-Magallanes AW, Fuentes-Silva YJ. Validation of the LupusQoL in Venezuela: A Specific Measurement of Quality of Life in Patients with Systemic Lupus Erythematosus. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00061-9. [PMID: 33931336 DOI: 10.1016/j.reuma.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/02/2020] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Traditionally, the health-related quality of life (HRQoL) of patients with systemic lupus erythematosus (SLE) has been assessed using instruments that neglect the specific characteristics of the disease. This study determines the validity of the Lupus Quality of Life (LupusQoL) questionnaire as a psychometrically stable instrument to measure the HRQoL of patients with SLE in Venezuela and establishes the cutoff points of the questionnaire for the Venezuelan population. PATIENTS AND METHODS A cross-sectional study was conducted that included patients with SLE from April to July 2018. Patients completed the LupusQoL and the Generalitat de Catalunya (GENCAT) scale; sociodemographic data, activity index (SLEDAI) and accumulated damage (SLICC), were obtained. Reliability was evaluated by internal consistency and the convergent validity of the LupusQoL was determined with the GENCAT scale. RESULTS Of the 100 patients, 93% were women, the mean age was 42years old (SD: 13) and the mean duration of the disease was 11years (SD: 9); the mean of SLEDAI and SLICC was 3 and 1, respectively. The cutoff point that defined a "better" or "worse" HRQoL for LupusQoL was 64.55 points. A moderate convergence was found after grouping, according to the cutoff points, of the LupusQoL with the GENCAT scale (Cohen's kappa coefficient=.556; p=.000). CONCLUSIONS The LupusQoL is a valid psychometrically stable instrument to measure the HRQoL of patients with SLE in Venezuela. Cutoff points were established to stratify the HRQoL in the Venezuelan population with LES, being useful to complement a comprehensive evaluation.
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Affiliation(s)
- Fhabián S Carrión-Nessi
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela.
| | - María V Marcano-Rojas
- Programa de Enfermedades Endocrino-Metabólicas, Instituto de Salud Pública, Ciudad Bolívar, Venezuela
| | - Diana C Freitas-DeNobrega
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela
| | - Sinibaldo R Romero Arocha
- Programa de Formación de Científicos Médicos (MD/PhD), Facultad de Medicina, Universidad de Minnesota, Minnesota, Estados Unidos
| | - Allen W Antuarez-Magallanes
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela
| | - Yurilís J Fuentes-Silva
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela; Centro Clínico Universitario de Oriente, Ciudad Bolívar, Venezuela
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Kernder A, Elefante E, Chehab G, Tani C, Mosca M, Schneider M. The patient's perspective: are quality of life and disease burden a possible treatment target in systemic lupus erythematosus? Rheumatology (Oxford) 2020; 59:v63-v68. [PMID: 33280017 PMCID: PMC7719037 DOI: 10.1093/rheumatology/keaa427] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
A few decades ago, the therapy goal of patients with systemic lupus erythematosus (SLE) was survival and the prevention of organ failure. Today, clinical remission and low disease activity are believed to be the optimal therapeutic targets. These aims are difficult to reach for many patients, but they still do not address the health-related quality of life (QoL) that is significantly impaired in SLE patients. Even in the state of remission, QoL and fatigue are insufficient controlled. Thus, patient-oriented research is essential to design new strategies for the management of lupus patients. The INTEGRATE project analyses the patients' and physicians' perspectives to pave the way to design an innovative therapeutic strategy for lupus and focuses on the multifaceted dimensions of the disease burden. Shared decision making (SDM) could include the patient's perspective of SLE to treatment strategy and consider QoL and the burden of lupus into the process of therapy decision.
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Affiliation(s)
- Anna Kernder
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gamal Chehab
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matthias Schneider
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
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Carvajal Bedoya G, Davis LA, Hirsh JM. Patient-Reported Outcomes in Rheumatology Patients With Limited English Proficiency and Limited Health Literacy. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:738-749. [PMID: 33091257 DOI: 10.1002/acr.24243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
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17
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Izadi Z. Health‐Related Quality of Life Measures in Adult Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:577-592. [DOI: 10.1002/acr.24245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/28/2020] [Indexed: 12/31/2022]
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Okamoto Y, Katsumata Y, Baba S, Kawaguchi Y, Harigai M. Validation of the Japanese version of the Lupus Damage Index Questionnaire in a large observational cohort: A two-year prospective study. Mod Rheumatol 2020; 31:834-842. [PMID: 32990111 DOI: 10.1080/14397595.2020.1829341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The Lupus Damage Index Questionnaire (LDIQ) is a validated patient-reported outcome measure to assess accumulated damage in systemic lupus erythematosus (SLE). We aimed to translate it into Japanese and further investigate its validity and reliability. METHODS The English version of the LDIQ was translated into Japanese and administered to Japanese patients with SLE (n = 259) at our university clinic. Physicians simultaneously completed the Systemic Lupus International Collaborating Clinics Damage Index (SDI) and SLE Disease Activity Index 2000 (SLEDAI-2K). Patients were prospectively followed for a repeat assessment the following year. RESULTS The median LDIQ score was 2.0. The LDIQ demonstrated substantial correlation with the SDI but poor correlation with the SLEDAI-2K (Spearman's ρ = 0.75 and -0.08, respectively). These results suggested its convergent and discriminant validity. The LDIQ demonstrated good test-retest reliability (intraclass correlation coefficient = 0.85). When the effect size and standardized response mean for the LDIQ were assessed only in patients who had a change ≥1 in the SDI, they demonstrated a small to moderate responsiveness: 0.43 and 0.59, respectively. CONCLUSION The Japanese version of the LDIQ had acceptable reliability and validity and its performance was comparable with the original version.
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Affiliation(s)
- Yuko Okamoto
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuhiro Katsumata
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Sayumi Baba
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasushi Kawaguchi
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Azizoddin DR, Jolly M, Arora S, Yelin E, Katz P. Longitudinal Study of Fatigue, Stress, and Depression: Role of Reduction in Stress Toward Improvement in Fatigue. Arthritis Care Res (Hoboken) 2020; 72:1440-1448. [PMID: 31421030 PMCID: PMC7024647 DOI: 10.1002/acr.24052] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/13/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Fatigue is common among individuals with systemic lupus erythematosus (SLE), but the causes are not well understood. Our objective was to examine perceived stress and depressive symptoms as predictors of fatigue in SLE. METHODS Data from 2 years of the Lupus Outcomes Study (n = 650 patients), obtained through annual structured interviews, were used. Fatigue was measured with the Short Form 36 (SF-36) vitality scale along with a variety of self-report measures of disease, depression, and stress. Multivariate linear regression models examined predictors of changes in fatigue. Model 1 tested the association of time 1 (T1) depression with time 2 (T2) fatigue; model 2 added T1 perceived stress to model 1, and final models added T1-to-T2 decrease in stress. All analyses controlled for T1 fatigue, age, sex, self-report of fibromyalgia, pain, and SLE duration, activity, and damage. RESULTS Mean ± SD age was 51 ± 12 years, 92% of participants were women, and 68% were white. The mean ± SD SF-36 fatigue score was 55 ± 24. T1 depression significantly predicted T2 fatigue. When T1 stress was added, stress (β = 1.7 [95% confidence interval (95% CI) 1.1, 2.2]; P < 0.0001) significantly predicted T2 fatigue, but depression was no longer significant. The addition of T1-to-T2 decrease in stress was associated with a clinically meaningful decline in fatigue (β = -11.8 [95% CI -15.6, -8.9]; P < 0.0001). CONCLUSION While depressive symptoms initially predicted subsequent fatigue, the effects were mediated by stress. A decrease in stress, in addition, was associated with a clinically meaningful decrease in fatigue. These results suggest that perceived stress plays an important role in SLE fatigue and may be an important focus of interventions for fatigue.
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Affiliation(s)
| | | | | | - Edward Yelin
- Russell/Engleman Research Center in Arthritis and Philip R Lee Institute for Health Policy Studies, University of San Francisco California, San Francisco, CA
| | - Patricia Katz
- Russell/Engleman Research Center in Arthritis and Philip R Lee Institute for Health Policy Studies, University of San Francisco California, San Francisco, CA
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Abstract
Background and PurposeSystemic Lupus Erythematosus negatively affects health related quality of life (HRQOL). The purpose of this review is to synthesize and evaluate findings related to the psychometric properties of the LupusQoL and its variations.MethodsA search of CINAHL, PubMed, and Medline for the timeframe of 2007–2019 for English-language articles using any form of the LupusQoL was completed. Thirty-five studies were reviewed to determine psychometric soundness.ResultsCronbach alpha results supported the internal consistency with test–retest data supporting stability. Factor structure and Scree plots varied. Content, construct, criterion, convergent, and discriminate validity were supported. Ceiling and floor effects occurred.ConclusionsThe LupusQoL and its variations offer a disease-specific measure with supported reliability and validity for use in culturally disparate populations. Factor structure and ceiling/floor effects need further edification.
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Morishita M, Sada KE, Ohashi K, Miyawaki Y, Asano Y, Hayashi K, Asano SH, Yamamura Y, Watanabe H, Narazaki M, Matsumoto Y, Kawabata T, Yajima N, Wada J. Damage accrual related to pregnancies before and after diagnosis of systemic lupus erythematosus: a cross-sectional and nested case-control analysis from a lupus registry. Lupus 2020; 29:176-181. [PMID: 31924143 DOI: 10.1177/0961203319898766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the chronic damage associated with pregnancies before and after the diagnosis of systemic lupus erythematosus (SLE). METHODS Using childbearing-aged female SLE patient data registered at the Okayama and Showa University Hospitals, a nested case-control analysis was performed to investigate the relationship between pregnancy and chronic damage using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). RESULTS Pregnancy occurred in 22 patients before and 13 patients after the diagnosis of SLE in 104 eligible patients. Live births occurred in 82% (33/40) and 50% (9/18) of the pregnancies before and after the diagnosis of SLE, respectively. After matching age and disease duration, 33 case patients with chronic damage (SDI ≥ 1) and 33 control patients without chronic damage (SDI = 0) were selected. Hypertension was more frequent in cases than in controls (48% vs. 24%, p = 0.041). Pregnancies before and after the diagnosis of SLE were comparable between cases and controls (before the diagnosis: nine case patients and eight control patients; after the diagnosis: three case patients and five control patients; p = 1.00). Even after adjusting for hypertension using multivariate analysis, the pregnancies before and after the diagnosis were not significant predictors for chronic damage (odds ratio = 1.48 (95% confidence interval 0.33-6.65)), p = 0.60 of the pregnancy before the diagnosis; odds ratio = 0.78 (95% confidence interval 0.13-4.74), p = 0.78 of the pregnancy after the diagnosis). CONCLUSION Pregnancies, either before or after the diagnosis of SLE, did not show any differences in chronic damage. Our results help alleviate fears regarding childbearing in female patients with SLE and their families.
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Affiliation(s)
- M Morishita
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K-E Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Ohashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Miyawaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Asano
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Hayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - S Hiramatsu Asano
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Yamamura
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - H Watanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - M Narazaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Matsumoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - T Kawabata
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - N Yajima
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - J Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Raymond WD, Eilertsen GØ, Shanmugakumar S, Nossent JC. The Impact of Cytokines on the Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus. J Clin Med 2019; 8:jcm8060857. [PMID: 31208069 PMCID: PMC6617124 DOI: 10.3390/jcm8060857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction: Systemic lupus erythematosus (SLE) reduces the health-related quality of life (HRQoL), even during periods of disease quiescence. We investigated whether subclinical inflammation as reflected by cytokine levels is linked with reduced HRQoL. Methods: A cross-sectional study of SLE patients (n = 52, mean age 47.3, 86.5% female) who completed a Short Form Health Survey-36 (SF-36) questionnaire. The clinical and demographic data, scores for the disease activity (SLEDAI-2K), organ damage (SDI), and laboratory data were collected simultaneously. The autoantibody and cytokine levels (IFN-γ, IL-1β, IL-4, IL-6, IL-10, IL-12, IL-17, BAFF, TNF-α, TGF-β1, MIP-1α, MIP-1β and MCP-1 (levels in pg/mL) were quantified by sandwich ELISA. The comparisons and associations were assessed non-parametrically, and a multiple regression determined the effect sizes (ES) of the variables on the SF-36 domain and summary scores. Results: The SF-36 summary and domain scores for SLE patients were significantly (20–40%) lower than in a comparable control group, with the exception of the Mental Health scores (p = 0.06). SLE patients had a normal body mass index (BMI) (median, 24.2 kg/m2), a high rate of smoking (69.2%), and usage of social security benefits (90.4%). TGF-β1 (ES 0.06), IL-12 (ES −0.11), IFN-γ (ES 0.07) and MCP-1 (ES 0.06) influenced the SF-36 domain scores; and MCP-1 (ES 0.04) influenced the Mental Health Summary Score (MCS). Obvious manifestations, including patient visual analogue scale (VAS) (ES −2.84 to −6.29), alopecia (ES −14.89), malar rash (ES −14.26), and analgesic requirement (ES −19.38), independently influenced the SF-36 items; however, the SF-36 scores were not reflected by the physician VAS or disease activity (SLEDAI-2K). Conclusions: Cytokines had a minimal impact on HRQoL in SLE patients, especially compared to visible skin manifestations, central nervous system (CNS) damage, and pain. Better tools are needed to capture HRQoL in measures of disease activity.
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Affiliation(s)
- Warren David Raymond
- Rheumatology Group, School of Medicine, The University of Western Australia, Perth 6009, Australia.
| | - Gro Østli Eilertsen
- Molecular Inflammation Research Group, Department of Clinical Medicine, Arctic University, 9037 Tromsø, Norway.
| | - Sharanyaa Shanmugakumar
- Rheumatology Group, School of Medicine, The University of Western Australia, Perth 6009, Australia.
| | - Johannes Cornelis Nossent
- Rheumatology Group, School of Medicine, The University of Western Australia, Perth 6009, Australia.
- Molecular Inflammation Research Group, Department of Clinical Medicine, Arctic University, 9037 Tromsø, Norway.
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth 6009, Australia.
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Clinical characteristics and health related quality of life (HRQoL) in Egyptian patients with systemic lupus erythematosus. THE EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Elera-Fitzcarrald C, Fuentes A, González LA, Burgos PI, Alarcón GS, Ugarte-Gil MF. Factors affecting quality of life in patients with systemic lupus erythematosus: important considerations and potential interventions. Expert Rev Clin Immunol 2018; 14:915-931. [DOI: 10.1080/1744666x.2018.1529566] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Claudia Elera-Fitzcarrald
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
| | - Alejandro Fuentes
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Alonso González
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Paula I. Burgos
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Graciela S. Alarcón
- The University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Manuel F. Ugarte-Gil
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
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Izadi Z, Gandrup J, Katz PP, Yazdany J. Patient-reported outcome measures for use in clinical trials of SLE: a review. Lupus Sci Med 2018; 5:e000279. [PMID: 30167315 PMCID: PMC6109821 DOI: 10.1136/lupus-2018-000279] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 12/16/2022]
Abstract
Inclusion of patient-reported outcomes is important in SLE clinical trials as they allow capture of the benefits of a proposed intervention in areas deemed pertinent by patients. We aimed to compare the measurement properties of health-related quality of life (HRQoL) measures used in adults with SLE and to evaluate their responsiveness to interventions in randomised controlled trials (RCTs). A systematic review was undertaken using full original papers in English identified from three databases: MEDLINE, EMBASE and PubMed. Studies describing the validation of HRQoL measures in English-speaking adult patients with SLE and SLE drug RCTs that used an HRQoL measure were retrieved. Twenty-five validation papers and 26 RCTs were included in the indepth review evaluating the measurement properties of 4 generic (Medical Outcomes Study Short-Form 36 (SF36), Patient Reported Outcomes Measurement Information System (PROMIS) item-bank, EuroQol-5D, and Functional Assessment of Chronic Illness Therapy-Fatigue) and 3 disease-specific (Lupus Quality of Life (LupusQoL), Lupus Patient Reported Outcomes, Lupus Impact Tracker (LIT)) instruments. All measures had good convergent and discriminant validity. PROMIS provided the strongest evidence for known-group validity and reliability among generic instruments; however, data on its responsiveness have not been published. Across measures, standardised response means were generally indicative of poor-moderate sensitivity to longitudinal change. In RCTs, clinically important improvements were reported in SF36 scores from baseline; however, between-arm differences were frequently non-significant and non-important. SF36, PROMIS, LupusQoL and LIT had the strongest evidence for acceptable measurement properties, but few measures aside from the SF36 have been incorporated into clinical trials. This review highlights the importance of incorporating a broader range of SLE-specific HRQoL measures in RCTs and warrants further research that focuses on longitudinal responsiveness of newer instruments.
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Affiliation(s)
- Zara Izadi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Julie Gandrup
- Division of Rheumatology, University of California, San Francisco, California, USA
| | - Patricia P Katz
- Division of Rheumatology, University of California, San Francisco, California, USA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, California, USA
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Kasturi S, Burket JC, Berman JR, Kirou KA, Levine AB, Sammaritano LR, Mandl LA. Feasibility of Patient-Reported Outcomes Measurement Information System (PROMIS®) computerized adaptive tests in systemic lupus erythematosus outpatients. Lupus 2018; 27:1591-1599. [DOI: 10.1177/0961203318778372] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The aims of this study were to assess the feasibility of administering Patient-Reported Outcomes Measurement Information System (PROMIS®) computerized adaptive tests (CATs) to outpatients with systemic lupus erythematosus (SLE). Methods Adults with SLE were recruited during routine outpatient visits at an SLE Center of Excellence. Participants completed 14 PROMIS CATs and provided feedback on their experience. Differences in socio-demographic and clinical characteristics between participants and non-participants were evaluated. Results A total of 204 (86%) of 238 socioeconomically and racially diverse SLE patients completed PROMIS CATs. There were no significant differences between participants and non-participants. Time constraints were cited most frequently as reasons for non-participation. More than 75% of individuals submitted positive comments, including approval of the content and format of questions, and the survey’s promotion of self-reflection. A minority of participants cited challenges, most often related to question phrasing (8%) and technical difficulties (6%). Conclusions The administration of PROMIS CATs was feasible and positively received in a diverse cohort of SLE outpatients. Neither socio-demographic nor disease characteristics were significant barriers to successful completion of PROMIS CATs. PROMIS CATs have great potential for efficiently measuring important patient-centered outcomes in routine clinical care of a wide range of SLE patients.
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Affiliation(s)
- S Kasturi
- Department of Medicine/Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - J C Burket
- Hospital for Special Surgery, Healthcare Research Institute, New York, NY, USA
| | - J R Berman
- Department of Medicine/Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - K A Kirou
- Department of Medicine/Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - A B Levine
- Department of Medicine/Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - L R Sammaritano
- Department of Medicine/Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - L A Mandl
- Department of Medicine/Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
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Kasturi S, Szymonifka J, Burket JC, Berman JR, Kirou KA, Levine AB, Sammaritano LR, Mandl LA. Feasibility, Validity, and Reliability of the 10-item Patient Reported Outcomes Measurement Information System Global Health Short Form in Outpatients with Systemic Lupus Erythematosus. J Rheumatol 2018; 45:397-404. [PMID: 29419473 DOI: 10.3899/jrheum.170590] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the feasibility, validity, and reliability of the Patient Reported Outcomes Measurement Information System Global Health Short Form (PROMIS10) in outpatients with systemic lupus erythematosus (SLE). METHODS SLE outpatients completed PROMIS10, Medical Outcomes Study Short Form-36 (SF-36), LupusQoL-US, and selected PROMIS computerized adaptive tests (CAT) at routine visits at an SLE Center of Excellence. Construct validity was evaluated by correlating PROMIS10 physical and mental health scores with PROMIS CAT, legacy instruments, and physician-derived measures of disease activity and damage. Test-retest reliability was determined among subjects reporting stable SLE activity at 2 assessments 1 week apart using intraclass correlation coefficients (ICC). RESULTS A diverse cohort of 204 out of 238 patients with SLE (86%) completed survey instruments. PROMIS10 physical health scores strongly correlated with physical function, pain, and social health domains in PROMIS CAT, SF-36, and LupusQoL, while mental health scores strongly correlated with PROMIS depression CAT, SF-36, and LupusQoL mental health domains (Spearman correlations ≥ 0.70). Active arthritis, comorbid fibromyalgia (FM), and anxiety were associated with worse PROMIS10 scores, but sociodemographic factors and physician-assessed flare status were not. Test-retest reliability for PROMIS10 physical and mental health scores was high (ICC ≥ 0.85). PROMIS10 required < 2 minutes to complete. CONCLUSION PROMIS10 is valid and reliable, and can efficiently screen for impaired physical function, pain, and emotional distress in outpatients with SLE. With strong correlations to LupusQoL and SF-36 but significantly reduced responder burden, PROMIS10 is a promising tool for measuring patient-reported outcomes in routine SLE clinical care and value-based healthcare initiatives.
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Affiliation(s)
- Shanthini Kasturi
- From the Division of Rheumatology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York, USA. .,S. Kasturi, MD, MS, Division of Rheumatology, Department of Medicine, Tufts Medical Center; J. Szymonifka, MA, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; J.C. Burket, PhD, Healthcare Research Institute, Hospital for Special Surgery; J.R. Berman MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; K.A. Kirou, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; A.B. Levine, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; L.R. Sammaritano, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; and L.A. Mandl, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine.
| | - Jackie Szymonifka
- From the Division of Rheumatology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York, USA.,S. Kasturi, MD, MS, Division of Rheumatology, Department of Medicine, Tufts Medical Center; J. Szymonifka, MA, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; J.C. Burket, PhD, Healthcare Research Institute, Hospital for Special Surgery; J.R. Berman MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; K.A. Kirou, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; A.B. Levine, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; L.R. Sammaritano, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; and L.A. Mandl, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine
| | - Jayme C Burket
- From the Division of Rheumatology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York, USA.,S. Kasturi, MD, MS, Division of Rheumatology, Department of Medicine, Tufts Medical Center; J. Szymonifka, MA, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; J.C. Burket, PhD, Healthcare Research Institute, Hospital for Special Surgery; J.R. Berman MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; K.A. Kirou, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; A.B. Levine, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; L.R. Sammaritano, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; and L.A. Mandl, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine
| | - Jessica R Berman
- From the Division of Rheumatology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York, USA.,S. Kasturi, MD, MS, Division of Rheumatology, Department of Medicine, Tufts Medical Center; J. Szymonifka, MA, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; J.C. Burket, PhD, Healthcare Research Institute, Hospital for Special Surgery; J.R. Berman MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; K.A. Kirou, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; A.B. Levine, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; L.R. Sammaritano, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; and L.A. Mandl, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine
| | - Kyriakos A Kirou
- From the Division of Rheumatology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York, USA.,S. Kasturi, MD, MS, Division of Rheumatology, Department of Medicine, Tufts Medical Center; J. Szymonifka, MA, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; J.C. Burket, PhD, Healthcare Research Institute, Hospital for Special Surgery; J.R. Berman MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; K.A. Kirou, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; A.B. Levine, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; L.R. Sammaritano, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; and L.A. Mandl, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine
| | - Alana B Levine
- From the Division of Rheumatology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York, USA.,S. Kasturi, MD, MS, Division of Rheumatology, Department of Medicine, Tufts Medical Center; J. Szymonifka, MA, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; J.C. Burket, PhD, Healthcare Research Institute, Hospital for Special Surgery; J.R. Berman MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; K.A. Kirou, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; A.B. Levine, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; L.R. Sammaritano, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; and L.A. Mandl, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine
| | - Lisa R Sammaritano
- From the Division of Rheumatology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York, USA.,S. Kasturi, MD, MS, Division of Rheumatology, Department of Medicine, Tufts Medical Center; J. Szymonifka, MA, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; J.C. Burket, PhD, Healthcare Research Institute, Hospital for Special Surgery; J.R. Berman MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; K.A. Kirou, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; A.B. Levine, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; L.R. Sammaritano, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; and L.A. Mandl, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine
| | - Lisa A Mandl
- From the Division of Rheumatology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York, USA.,S. Kasturi, MD, MS, Division of Rheumatology, Department of Medicine, Tufts Medical Center; J. Szymonifka, MA, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; J.C. Burket, PhD, Healthcare Research Institute, Hospital for Special Surgery; J.R. Berman MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; K.A. Kirou, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; A.B. Levine, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; L.R. Sammaritano, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine; and L.A. Mandl, MD, MPH, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine
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Baba S, Katsumata Y, Okamoto Y, Kawaguchi Y, Hanaoka M, Kawasumi H, Yamanaka H. Reliability of the SF-36 in Japanese patients with systemic lupus erythematosus and its associations with disease activity and damage: a two-consecutive year prospective study. Lupus 2017; 27:407-416. [DOI: 10.1177/0961203317725586] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to validate the reliability of the Medical Outcomes Study Short Form-36 (SF-36) among Japanese patients with systemic lupus erythematosus (SLE). Japanese patients with SLE ( n = 233) completed the SF-36 and other related demographic questionnaires, and physicians simultaneously completed the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics Damage Index (SDI). Patients were prospectively followed for a repeat assessment the following year. The SF-36 subscales demonstrated acceptable internal consistency (Cronbach’s α of 0.85–0.89), and an overall good test–retest reliability (intraclass correlation coefficient >0.70). The average baseline SF-36 subscale/summary scores except for “bodily pain” were significantly lower than those of the Japanese general population ( p < 0.05). The SDI showed an inverse correlation with the SF-36 subscale/summary scores except for “vitality” and “mental component summary” at baseline, whereas the SLEDAI-2K did not. In the second year, “social functioning” and “mental component summary” of the SF-36 deteriorated among patients whose SDI or SLEDAI-2K score increased (effect sizes < −0.20). In conclusion, the SF-36 demonstrated acceptable reliability among Japanese patients with SLE. Health-related quality of life measured by the SF-36 was reduced in Japanese patients with SLE and associated with disease damage, rather than disease activity.
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Affiliation(s)
- S Baba
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Y Katsumata
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Y Okamoto
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Y Kawaguchi
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - M Hanaoka
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - H Kawasumi
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - H Yamanaka
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
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Jolly M, Kosinski M, Garris CP, Oglesby AK. Prospective Validation of the Lupus Impact Tracker: A Patient-Completed Tool for Clinical Practice to Evaluate the Impact of Systemic Lupus Erythematosus. Arthritis Rheumatol 2017; 68:1422-31. [PMID: 26814452 DOI: 10.1002/art.39601] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 01/14/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the reliability, validity, responsiveness, and utility of the Lupus Impact Tracker (LIT). METHODS This was a prospective longitudinal study with 20 North American sites participating. Consenting patients completed the LIT, Medical Outcomes Study Short Form 36 (version 2), Patient Health Questionnaire 9 (PHQ-9), LupusQoL, and patient LIT feedback questionnaire. Rheumatologists completed the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) version of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and physician LIT feedback questionnaire. The reliability, convergent validity, construct validity, and responsiveness of the LIT were evaluated. RESULTS Of the 325 SLE patients enrolled, 90% were female, 53% were white, and 33% were African American. Their mean age was 42 years. The mean ± SD baseline physician's global assessment and total SELENA-SLEDAI scores were 1.04 ± 0.8 and 4.28 ± 3.8, respectively, while 3-month scores were 0.94 ± 0.73 and 4.09 ± 3.79, respectively. Internal consistency reliability was high (>0.9) at both visits. LIT scores correlated highly with other measures of patient-reported outcomes, and construct validity was established against clinical measures. The LIT was highly responsive to patient-reported changes in SLE health status; however, LIT scores were not as responsive to changes in the SELENA-SLEDAI score. The majority of patients and physicians found LIT to be acceptable and feasible to administer in a clinical setting. CONCLUSION The LIT is a reliable and valid instrument for assessing the impact of SLE on patients and captures unique and important information not included in physician assessments of disease. It may be useful in clinical practice to facilitate communication between the physician and the patient and enable efficient incorporation of the patient's perspective in disease management.
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Affiliation(s)
| | | | - Cindy P Garris
- GlaxoSmithKline R&D, Research Triangle Park, North Carolina
| | - Alan K Oglesby
- GlaxoSmithKline R&D, Research Triangle Park, North Carolina
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Duruöz MT, Unal C, Toprak CS, Sezer İ, Yilmaz F, Ulutatar F, Atagündüz P, Baklacioglu HS. The validity and reliability of Systemic Lupus Erythematosus Quality of Life Questionnaire (L-QoL) in a Turkish population. Lupus 2017; 26:1528-1533. [DOI: 10.1177/0961203317707063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Systemic lupus erythematosus (SLE) may have a profound impact on quality of life. There is increasing interest in measuring quality of life in lupus patients. The purpose of this study was to investigate the validity and reliability of SLE Quality of Life Questionnaire (L-QoL) in Turkish SLE patients. Methods SLE according to 2012 Systemic Lupus International Collaborating Clinics Classification Criteria were recruited into the study. Demographic data, clinical parameters and disease activity measured with the Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K); were noted. Nottingham Health Profile and Health Assessment Questionnaire were filled out in addition to the Turkish L-QoL (LQoL-TR). Internal consistency, test–retest reliability, and convergent and discriminant validity were evaluated. Results The mean age of participants was 43.55 ± 14.33 years and the mean disease duration was 89.8 ± 92.1 months. The patients filled out LQoL-TR in 2.5 min. Strong correlation of LQoL-TR with all subgroups of the Nottingham Health Profile and the Health Assessment Questionnaire were established showing the convergent validity. The highest correlation was demonstrated with emotional reactions (rho = 0.72) and sleep component (rho = 0.65) of the Nottingham Health Profile scale ( p < 0.0001). Its poor and not significant correlation with nonfunctional parameters (age, disease duration, perceived general health, SLEDAI-2K) showed its discriminative properties. LQoL-TR demonstrated good internal reliability with a Cronbach’s α of 0.93 and test–retest reliability with intraclass correlation coefficient of 0.87. Conclusion The LQoL-TR is a practical and useful tool which demonstrates good validity and reliability.
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Affiliation(s)
- M T Duruöz
- Marmara University, School of Medicine, PMR Department, Rheumatology Division, Istanbul, Turkey
| | - C Unal
- Marmara University, School of Medicine, PMR Department, Istanbul, Turkey
| | - C Sanal Toprak
- Marmara University, School of Medicine, PMR Department, Istanbul, Turkey
| | - İ Sezer
- Antalya Education and Research Hospital, Rheumatology Department, Antalya, Turkey
| | - F Yilmaz
- University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, PMR Department, Istanbul, Turkey
| | - F Ulutatar
- Marmara University, School of Medicine, PMR Department, Istanbul, Turkey
| | - P Atagündüz
- Marmara University, School of Medicine, Internal Medicine Department, Rheumatology Division, Istanbul, Turkey
| | - H S Baklacioglu
- Marmara University, School of Medicine, PMR Department, Rheumatology Division, Istanbul, Turkey
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Meseguer-Henarejos AB, Gascón-Cánovas JJ, López-Pina JA. Components of quality of life in a sample of patients with lupus: a confirmatory factor analysis and Rasch modeling of the LupusQoL. Clin Rheumatol 2017; 36:1789-1795. [DOI: 10.1007/s10067-017-3649-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 03/20/2017] [Accepted: 04/18/2017] [Indexed: 01/31/2023]
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Agarwal N, Kumar V. Burden of lupus on work: Issues in the employment of individuals with lupus. Work 2017; 55:429-439. [PMID: 27689581 DOI: 10.3233/wor-162398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) or Lupus is one of the leading causes of work disability in the United States, accounting for about 20% of the more than estimated 1.5 million Americans with a work disability. The symptoms of lupus can have a profound impact on the person's employment. Impacts of lupus are more pronounced among young and middle-adulthood. Studies have shown that loss in work hours cost the nation nearly $13 billion annually. The loss also impacts the individual's work, quality of life, self-management, and self-efficacy. OBJECTIVE In this article, the author describes the financial burden of lupus. The article also describes the substantial impact of lupus on employment outcomes for individuals living with the condition. The author also reviews major signs and symptoms of disease and their impact on employment. RESULTS Findings from this research can be used to identify various accommodations and strategies for individuals to prevent flare-ups. CONCLUSIONS The paper presents innovative strategies that include early interventions and how employers andco-workers can provide helpful support that includes job accommodations to individuals with lupus.
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Affiliation(s)
- Neelam Agarwal
- Center for Accommodations and Support Services (CASS), University of Texas at El Paso, El Paso, TX, USA
| | - Vinod Kumar
- Department of Mechanical Engineering, University of Texas at El Paso, El Paso, TX, USA
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Kasturi S, Szymonifka J, Burket JC, Berman JR, Kirou KA, Levine AB, Sammaritano LR, Mandl LA. Validity and Reliability of Patient Reported Outcomes Measurement Information System Computerized Adaptive Tests in Systemic Lupus Erythematosus. J Rheumatol 2017; 44:1024-1031. [DOI: 10.3899/jrheum.161202] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/11/2022]
Abstract
Objective.The aims of this study were to assess the construct validity and the test-retest reliability of Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests (CAT) in patients with systemic lupus erythematosus (SLE).Methods.Adults with SLE completed the Medical Outcomes Study Short Form-36, LupusQoL-US version (“legacy instruments”), and 14 selected PROMIS CAT. Using Spearman correlations, PROMIS CAT were compared with similar domains measured with legacy instruments. CAT were also correlated with the Safety of Estrogens in Lupus Erythematosus National Assessment–Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) disease activity and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) scores. Test-retest reliability was evaluated using ICC.Results.There were 204 outpatients with SLE enrolled in the study and 162 completed a retest. PROMIS CAT showed good performance characteristics and moderate to strong correlations with similar domains in the 2 legacy instruments (r = −0.49 to 0.86, p < 0.001). However, correlations between PROMIS CAT and the SELENA-SLEDAI disease activity and SDI were generally weak and statistically insignificant. PROMIS CAT test-retest ICC were good to excellent, ranging from 0.72 to 0.88.Conclusion.To our knowledge, these data are the first to show that PROMIS CAT are valid and reliable for many SLE-relevant domains. Importantly, PROMIS scores did not correlate well with physician-derived measures. This disconnect between objective signs and symptoms and the subjective patient disease experience underscores the crucial need to integrate patient-reported outcomes into clinical care to ensure optimal disease management.
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T-helper signals restore B-cell receptor signaling in autoreactive anergic B cells by upregulating CD45 phosphatase activity. J Allergy Clin Immunol 2016; 138:839-851.e8. [DOI: 10.1016/j.jaci.2016.01.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/08/2015] [Accepted: 01/29/2016] [Indexed: 12/25/2022]
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Machado Escobar MA, Yacuzzi MS, Martinez RN, González Lucero L, Bellomio VI, Santana M, Galindo L, Mayer MM, Barreira JC, Sarano J, Gomez G, Collado MV, Martinez A, Orozco MC, Betancur G, Dal Pra F, Sanchez A, Juarez V, Lucero EV. Validation of an Argentine version of Lupus Quality of Life questionnaire. Lupus 2016; 25:1615-1622. [PMID: 27444335 DOI: 10.1177/0961203316660202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/28/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine reproducibility and validity of an Argentine version of the Lupus Quality of Life questionnaire (LupusQoL) and to determine cut-off values in the questionnaire. MATERIALS AND METHODS One hundred and forty-seven systemic lupus erythematosus patients (American College of Rheumatology 1982/1997) were assessed from April 2014 to July 2014. Demographic and socioeconomic variables were collected, as well as SELENA/SLEDAI, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index Score, comorbidities and treatment data. Patients completed LupusQoL-Argentine version and European Quality of Life Questionnaire (EuroQoL-5D). Internal consistency and reliability were examined. Convergent validity with EuroQoL-5D was assessed through analysis of latent classes, which established homogeneous categories from the responses of each domain of LupusQoL and for the total. RESULTS Out of 147 patients, 93.2% were female, mean age 36.4 ± 11.1 years, mean disease duration 2.7 ± 9 years, mean SELENA/SLEDAI 2.7 ± 3 points. The cut-off point that defined good or bad quality of life was 0.739 for EuroQoL 5D and 63 for LupusQoL. Cut-off values for each LupusQoL domain were also defined, creating two classes in each of them. There was moderate to high concordance to classify quality of life (Kappa = 0.74, 95% confidence interval = 0.54, 0.95). CONCLUSION The Argentine version of LupusQoL is a valid, reliable and reproducible instrument to assess quality of life. In this study, cut-off points that allow the classification of patients regarding whether they have good or bad quality of life are established for the first time.
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Affiliation(s)
| | - M S Yacuzzi
- Hospital Ángel Cruz Padilla, Tucumán, Argentina
| | | | | | | | - M Santana
- Hospital Ángel Cruz Padilla, Tucumán, Argentina
| | - L Galindo
- Hospital Ángel Cruz Padilla, Tucumán, Argentina
| | - M M Mayer
- Hospital Británico de Buenos Aires, Argentina
| | | | - J Sarano
- Instituto Lanari, Buenos Aires, Argentina
| | - G Gomez
- Instituto Lanari, Buenos Aires, Argentina
| | | | - A Martinez
- Hospital de Agudos Dr E Tornú, Buenos Aires, Argentina
| | - M C Orozco
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - G Betancur
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - F Dal Pra
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | | | | | - E V Lucero
- Hospital Ángel Cruz Padilla, Tucumán, Argentina
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Abstract
Successful management of complex conditions such as systemic lupus erythematosus (SLE) and comorbid conditions benefit from patient-reported outcomes (PRO). Measuring health-related quality of life with PROs provides SLE patients with an opportunity to participate in their treatment and to facilitate better communication with the multidisciplinary team involved in their care. Health outcomes research has produced well-validated instruments that can be used across diseases; others have been specifically developed for SLE. The use of generic and SLE-specific PROs depends on needs, including population monitoring, treatment decision making, clinical trials research, and for evaluating and comparing the effect of therapies.
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Pamuk ON, Balci MA, Donmez S, Tsokos GC. The incidence and prevalence of systemic lupus erythematosus in Thrace, 2003–2014: A 12-year epidemiological study. Lupus 2015; 25:102-9. [DOI: 10.1177/0961203315603141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 08/05/2015] [Indexed: 02/01/2023]
Abstract
Background We estimated the prevalence and incidence, clinical features, treatment, and prognosis of systemic lupus erythematosus (SLE) patients in the Thrace region of Turkey. Methods We retrospectively evaluated 331 patients (307 female, 24 male, mean age 38.5 years) diagnosed with SLE between 2003 and 2014. Clinical features, treatments, and response to various treatment modalities were recorded. Our hospital has been the only tertiary referral center for rheumatological diseases for a mixed rural and urban population of 620,477 people (306,036 females, 314,411 males) for more than 16 years. Results The mean annual incidence of SLE was 4.44/100,000 (females, 8.4/100,000; males, 0.6/100,000). The overall prevalence of SLE was 51.7/100,000 (females, 97.7/100,000; males, 7/100,000). Major organ involvement was present in the following percentages: neurologic involvement: 20.1%; renal involvement: 28.2%; autoimmune hemolytic anemia: 9.6%; thrombocytopenia: 14.7%. Seventeeen SLE patients (13 females, four males) died at a median follow-up of 48 months. The five-year survival was 94.5%, and the ten-year survival was 89.9%. According to Kaplan–Meier survival analysis, poor prognostic factors were: male gender ( p = 0.015); smoking ( p = 0.02); pleural involvement ( p = 0.011); thrombocytopenia ( p = 0.021); myocarditis ( p = 0.028); renal involvement ( p = 0.037); treatment with cyclophosphamide ( p = 0.011); and an initial high SLEDAI score (>4) ( p = 0.02). Lymphopenia at the time of diagnosis appeared as a favorable prognostic factor ( p = 0.008). Cox regression analysis revealed myocarditis (OR: 20.4, p = 0.018) and age at diagnosis (OR: 1.11, p = 0.035) to be poor, and lymphopenia at the time of diagnosis to be good prognostic factors (OR:0.13, p = 0.031). Conclusions The annual incidence and prevalence of SLE in the Thrace region of Turkey is lower than those reported in North America, however they are similar to those reported for European countries. Clinical manifestations appear to be milder, whereas survival was similar to those recorded in Western countries.
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Affiliation(s)
- O N Pamuk
- Division of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey
| | - M A Balci
- Division of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey
| | - S Donmez
- Division of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey
| | - G C Tsokos
- Division of Rheumatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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Yilmaz-Oner S, Oner C, Dogukan FM, Moses TF, Demir K, Tekayev N, Atagunduz P, Tuglular S, Direskeneli H. Health-related quality of life assessed by LupusQoL questionnaire and SF-36 in Turkish patients with systemic lupus erythematosus. Clin Rheumatol 2015; 35:617-22. [DOI: 10.1007/s10067-015-2930-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 03/22/2015] [Accepted: 03/23/2015] [Indexed: 12/23/2022]
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Pamuk ON, Onat AM, Donmez S, Mengüs C, Kisacik B. Validity and reliability of the Lupus QoL index in Turkish systemic lupus erythematosus patients. Lupus 2014; 24:816-21. [PMID: 25542903 DOI: 10.1177/0961203314565412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/26/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) patients have seriously impaired quality of life (QoL). In addition to activity and damage indices used in the past, tools to evaluate QoL in SLE have been developed in recent years. In this study, we test the validity of the Turkish version of the Lupus-QoL (LupusQoL-TR) score, and investigate its association with clinical findings and activity indices. METHODS A total of 132 patients diagnosed with SLE according to ACR 1997 criteria were included. The clinical and demographic features, and biochemical data were retrieved from hospital records. SLE Disease Activity Index (SLEDAI) and damage score (SLICC-ACR) were determined at the time of administration of Lupus-QoL questionnaire. The Lupus-QoL includes 34 questions divided into eight domains. We reevaluated the LupusQoL-TR and pretested its understandability. SLE patients were concomitantly administered the LupusQoL-TR and generic SF-36. Internal consistency, test-retest reliability, convergent and discriminant validity were calculated. RESULTS The mean age of our SLE patients was 37.9 ± 12.8 years. Internal consistency reliability ranged from 0.88 to 0.93, and test-retest reliability from 0.84 to 0.94. LupusQoL-related domains in SF-36 were correlated (from 0.66 to 0.74). Most LupusQoL-TR domains, except planning, were able to discriminate between active and inactive SLE groups. Scores in all domains of the LupusQoL-TR were found to be discriminative for patients with and without damage according to SLICC-ACR score. CONCLUSION The LupusQoL-TR was found to be a valid patient-reported outcome measure method when evaluating QoL in Turkish SLE patients.
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Affiliation(s)
- O N Pamuk
- Department of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey
| | - A M Onat
- Department of Rheumatology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - S Donmez
- Department of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey
| | - C Mengüs
- Department of Internal Medicine, Trakya University Medical Faculty, Edirne, Turkey
| | - B Kisacik
- Department of Rheumatology, Gaziantep University Medical Faculty, Gaziantep, Turkey
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Linguistic Validation of the LupusQoL for the Assessment of Quality of Life in Iranian Patients with Systemic Lupus Erythematosus. Int J Rheumatol 2014; 2014:151530. [PMID: 25313310 PMCID: PMC4172886 DOI: 10.1155/2014/151530] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 08/31/2014] [Indexed: 01/29/2023] Open
Abstract
Objectives. We evaluated the psychometric properties of the Persian LupusQoL for the evaluation of quality of life in Iranian systemic lupus erythematosus (SLE) patients. Methods. The LupusQoL was translated to Persian language. Patients with SLE (n = 78) completed the LupusQoL and the Short-Form Health Survey (SF-36). Disease activity and cumulative disease damage were assessed with standard indices. The psychometric properties of the scale were evaluated. Results. The Cronbach's alpha was 0.97 for the total LupusQoL (above 0.8 for subscales). There were strong corrected item-total (r > 0.4), item-subscale (r ≥ 0.5), and subscale-total correlations (r > 0.6), as well as intersubscale correlations (r > 0.5). Patients with active disease and patients with disease damage index of ≥1 had lower scores in domains of planning, emotional health, burden to others, and body image than patients with inactive disease and those with no disease damage, respectively (P < 0.05). The LupusQoL and the SF-36 correlated well regarding comparable domains (r > 0.4). Conclusion. The psychometric characteristics of the Persian version of LupusQoL questionnaire are acceptable in Iranian population. This instrument can be used to evaluate quality of life in Iranian SLE patients.
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Holloway L, Humphrey L, Heron L, Pilling C, Kitchen H, Højbjerre L, Strandberg-Larsen M, Hansen BB. Patient-reported outcome measures for systemic lupus erythematosus clinical trials: a review of content validity, face validity and psychometric performance. Health Qual Life Outcomes 2014; 12:116. [PMID: 25048687 PMCID: PMC4223409 DOI: 10.1186/s12955-014-0116-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/08/2014] [Indexed: 01/30/2023] Open
Abstract
Background Despite overall progress in treatment of autoimmune diseases, patients with systemic lupus erythematosus (SLE) experience many inflammatory symptoms representing an unmet medical need. This study aimed to create a conceptual model of the humanistic and economic burden of SLE, and review the patient-reported outcomes (PROs) used to measure such concepts in SLE clinical trials. Methods A conceptual model for SLE was developed from structured review of published articles from 2007 to August 2013 identified from literature databases (MEDLINE, EMBASE, PsycINFO, EconLit) plus other sources (PROLabels, FDA/EMA websites, Clinicaltrials.gov). PROs targeting key symptoms/impacts were identified from the literature. They were reviewed in the context of available guidance and assessed for face and content validity and psychometric properties to determine appropriateness for use in SLE trials. Results The conceptual model identified fatigue, pain, cognition, daily activities, emotional well-being, physical/social functioning and work productivity as key SLE concepts. Of the 68 articles reviewed, 38 reported PRO data. From these and the other sources, 15 PROs were selected for review, including SLE-specific health-related quality of life (HRQoL) measures (n = 5), work productivity (n = 1), and generic measures of fatigue (n = 3), pain (n = 2), depression (n = 2) and HRQoL (n = 2). The Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-Fatigue), Brief Pain Inventory (BPI-SF) and LupusQoL demonstrated the strongest face validity, conceptual coverage and psychometric properties measuring key concepts in the conceptual model. All PROs reviewed, except for three Lupus-specific measures, lacked qualitative SLE patient involvement during development. The Hospital Anxiety and Depression Scale (HADS), Short Form [36 item] Health Survey version 2 (SF-36v2), EuroQoL 5-dimensions (EQ-5D-3L and EQ-5D-5L) and Work Productivity and Activity Impairment Questionnaire: Lupus (WPAI:Lupus) showed suitability for SLE economic models. Conclusions Based on the identification of key symptoms and impacts of SLE using a scientifically sound conceptual model, we conclude that SLE is a condition associated with high unmet need and considerable burden to patients. This review highlights the availability and need for disease-specific and generic patient-reported measures of relevant domains of disease signs and symptoms, HRQoL and work productivity, providing useful insight for SLE clinical trial design.
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Wang SL, Wu B, Zhu LA, Leng L, Bucala R, Lu LJ. Construct and criterion validity of the Euro Qol-5D in patients with systemic lupus erythematosus. PLoS One 2014; 9:e98883. [PMID: 24892282 PMCID: PMC4043925 DOI: 10.1371/journal.pone.0098883] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/08/2014] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the construct and criterion validity of the Euro Qol-5D (EQ-5D), which allows quality-adjusted life-years to be calculated, in patients with systemic lupus erythematosus (SLE). Methods Consecutive SLE patients who had been followed at the Renji Hospital, School of Medicine, Shanghai Jiao Tong University were recruited. Cross-sectional correlations of the EQ-5D with equivalent domains in disease-specific health-related quality of life (HRQoL), LupusQol, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) measures, the Systemic Lupus International Collaborating Clinics Damage Index (SDI), and patient characteristics were tested. Discriminant validity to assess the ability to distinguish between patients of different disease severity was assessed. There also were evaluations of ceiling and floor effects. Results 240 patients were recruited in total. The EQ-5D correlated moderately to strongly with all domains of the LupusQoL (r: 0.44–0.7) apart from intimate relationships (r = 0.25) and body image (r = 0.18). There was moderate negative correlation between EQ-5D and clinical assessment of disease, SLEDAI (r = −0.589) and SDI (r = −0.509). When compared with equivalent domains on LupusQoL, there was good construct validity in EQ-5D (r: 0.631–0.812). EQ-5D could also discriminate patients with varied disease severity (according SLEDAI and SDI). There was no floor effect in EQ-5D but the ceiling effect remains strong (34%). Conclusion Our results provide sufficient evidence that the EQ-5D displays construct and criterion validity for use in SLE patients. Disease-specific measures of HRQoL used alongside may be a better choice.
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Affiliation(s)
- Su-li Wang
- Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Wu
- Clinical Outcomes and Economics Group, Department of pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-an Zhu
- Department of Medicine, Section of Rheumatology, Yale University School of Medicine, The Anlyan Center, New Haven, Connecticut, United States of America
| | - Lin Leng
- Department of Medicine, Section of Rheumatology, Yale University School of Medicine, The Anlyan Center, New Haven, Connecticut, United States of America
| | - Richard Bucala
- Department of Medicine, Section of Rheumatology, Yale University School of Medicine, The Anlyan Center, New Haven, Connecticut, United States of America
| | - Liang-jing Lu
- Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
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van Vollenhoven RF, Mosca M, Bertsias G, Isenberg D, Kuhn A, Lerstrøm K, Aringer M, Bootsma H, Boumpas D, Bruce IN, Cervera R, Clarke A, Costedoat-Chalumeau N, Czirják L, Derksen R, Dörner T, Gordon C, Graninger W, Houssiau F, Inanc M, Jacobsen S, Jayne D, Jedryka-Goral A, Levitsky A, Levy R, Mariette X, Morand E, Navarra S, Neumann I, Rahman A, Rovenský J, Smolen J, Vasconcelos C, Voskuyl A, Voss A, Zakharova H, Zoma A, Schneider M. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis 2014; 73:958-67. [DOI: 10.1136/annrheumdis-2013-205139] [Citation(s) in RCA: 446] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Conti F, Perricone C, Reboldi G, Gawlicki M, Bartosiewicz I, Pacucci VA, Massaro L, Miranda F, Truglia S, Alessandri C, Spinelli FR, Teh LS, Ceccarelli F, Valesini G. Validation of a disease-specific health-related quality of life measure in adult Italian patients with systemic lupus erythematosus: LupusQoL-IT. Lupus 2014; 23:743-51. [PMID: 24569393 DOI: 10.1177/0961203314524466] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/28/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this paper is to assess the validity of a linguistically validated version of the Lupus Quality of Life (LupusQoL(©)) in Italian patients affected by systemic lupus erythematosus (SLE). METHODS Consecutive SLE patients completed the Italian version of the LupusQoL(©) and the Short Form (SF)-36. Disease activity was evaluated by the SLE disease activity Index-2000 (SLEDAI-2 K), and chronic damage by the Systemic Lupus International Collaborating Clinics/American College Rheumatology (ACR) Damage Index score (SDI). Internal consistency and test-retest reliability, convergent and discriminant validity were examined. Factor analysis with varimax rotation was performed. RESULTS A total of 117 Italian SLE patients (M:F 13:104; mean age 40.6 ± 11.6 years, mean disease duration 127.5 ± 94.1 months) were recruited into the study. The Italian version of the LupusQoL(©) demonstrated substantial evidence of convergent validity in these patients when compared with equivalent items of the SF-36. In addition, the LupusQoL(©) discriminated between patients with different degrees of disease activity as measured by the SLEDAI-2 K. SLE patients with higher disease activity (SLEDAI-2K ≥4) showed poor QoL compared with those with lower disease activity (SLEDAI-2K <4), with significant differences in the domains of physical health, planning, burden to others and fatigue (p = 0.001, p = 0.04, p = 0.03, p = 0.04, respectively). The confirmatory factor analysis using the eight domain loadings of the 34 items showed a poor fit (χ(2)/degree of freedom (df) 2.26, χ(2 )= 1128.6 (p < 0.001), root mean square error of approximation (RMSEA) = 0.167; goodness-of-fit index (GFI) = 0.606, comparative fit index (CFI) = 0.649)). Screeplot analysis suggested a five-factor loading structure and confirmatory factor analysis result of which is similar to the eight-factor model. A good internal consistency was observed (Cronbach's α 0.89-0.91). Test-retest reliability was good to excellent between baseline and day 15 (intraclass correlation coefficient (ICC) 0.90-0.98). CONCLUSION The Italian version of the LupusQoL(©) is a valid tool for adult patients with SLE.
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Affiliation(s)
- F Conti
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - C Perricone
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - G Reboldi
- Department of Medicine, University of Perugia, Perugia, Italy
| | - M Gawlicki
- Corporate Translations, Inc., East Hartford, CT, USA
| | - I Bartosiewicz
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - V A Pacucci
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - L Massaro
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - F Miranda
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - S Truglia
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - C Alessandri
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - F R Spinelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - L-S Teh
- Department of Rheumatology, Royal Blackburn Hospital, Blackburn, UK
| | - F Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - G Valesini
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
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Dua AB, Touma Z, Toloza S, Jolly M. Top 10 Recent Developments in Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus. Curr Rheumatol Rep 2013; 15:380. [DOI: 10.1007/s11926-013-0380-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bourré-Tessier J, Clarke AE, Mikolaitis-Preuss RA, Kosinski M, Bernatsky S, Block JA, Jolly M. Cross-cultural Validation of a Disease-specific Patient-reported Outcome Measure for Systemic Lupus Erythematosus in Canada. J Rheumatol 2013; 40:1327-33. [DOI: 10.3899/jrheum.121129] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective.The LupusPRO, a disease-targeted patient-reported outcome measure, was developed and validated in US patients with systemic lupus erythematosus (SLE). We report the results of the cross-cultural validation study of the English version of the LupusPRO among patients in Canada with SLE.Method.The LupusPRO was administered to English-speaking Canadian patients with SLE. Demographic, clinical, and serological characteristics were obtained, and the Medical Outcomes Study Short Form-36 (SF-36) and LupusPRO were administered. Disease activity was ascertained using the Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and the Lupus Foundation of America definition of flare (Yes/No). Damage was assessed using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Physician disease activity and damage assessments were also ascertained using visual analog scales. A mail-back LupusPRO form was completed within 2–3 days of the index visit. Items tested were internal consistency reliability (ICR), test-retest reliability (TRT), convergent and discriminant validity (against corresponding domains of the SF-36), criterion validity (against disease activity or health status), and known-groups validity.Results.Participants were 123 Canadian patients with SLE (94% women); mean age was 47.7 (SD 14.8) years. The median (interquartile range) SELENA-SLEDAI and SDI were 4 (6) and 1 (3), respectively. The ICR of the LupusPRO domains ranged from 0.60 to 0.93, while the TRT range was 0.62–0.95. Measures observed were convergent and discriminant validity with corresponding domains of SF-36, criterion validity, and known-groups validity against disease activity, damage, and health status. Confirmatory factor analysis showed a good fit.Conclusion.The LupusPRO has fair psychometric properties among Canadian patients with SLE, and prospective studies to establish minimally important difference are continuing.
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Wang SL, Wu B, Leng L, Bucala R, Lu LJ. Validity of LupusQoL-China for the assessment of health related quality of life in Chinese patients with systemic lupus erythematosus. PLoS One 2013; 8:e63795. [PMID: 23717486 PMCID: PMC3662722 DOI: 10.1371/journal.pone.0063795] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 04/05/2013] [Indexed: 11/26/2022] Open
Abstract
Objectives To adapt and assess the validity and reliability of LupusQoL for use in Chinese patients with systemic lupus erythematosus (SLE). Methods Debriefing interviews of subjects with SLE guided the language modifications of the tool. The process of adaptation proceeded according to the guideline and pre-testing results of LupusQoL-China. 220 SLE patients completed LupusQoL-China and a generic preference-based measurement of health EuroQoL scale (EQ-5D), and 20 patients repeated them after 2 weeks. Internal consistency (ICR) and test-retest (TRT) reliability, convergent and discriminant validity were examined. Factor analysis and Rasch analysis were performed. Results The mean (SD) age of the 208 subjects with SLE was 33.93 (±9.19) years. ICR and TRT of the eight domains ranged from 0.811 to 0.965 and 0.836 to 0.974, respectively. The LupusQoL-China domains demonstrated substantial evidence of construct validity when compared with equivalent domains on the EQ-5D (physical health and usual activities r = −0.63, pain and pain/discomfort r = −0.778, emotional health and anxiety/depression r = −0.761, planning and usual activities r = −0.560). Most LupusQoL-China domains could discriminate patients with varied disease activities and end-organ damage (according to SELENA-SLEDAI and SLICC-DI). The principal component analysis revealed six factors, and confirmatory factor analysis result of which is similar to eight factors model. Conclusions These results provide evidence that the LupusQoL-China is valid as a disease-specific HRQoL assessment tool for Chinese patients with SLE.
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Affiliation(s)
- Su-li Wang
- Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Wu
- Clinical Outcomes and Economics Group, Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lin Leng
- Section of Rheumatology, Department of Medicine, Yale University School of Medicine, The Anlyan Center, New Haven, Connecticut, United States of America
| | - Richard Bucala
- Section of Rheumatology, Department of Medicine, Yale University School of Medicine, The Anlyan Center, New Haven, Connecticut, United States of America
| | - Liang-jing Lu
- Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
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Kasitanon N, Wangkaew S, Puntana S, Sukitawut W, Leong KP, Louthrenoo W. The reliability, validity and responsiveness of the Thai version of systemic lupus erythematosus quality of life (SLEQOL-TH) instrument. Lupus 2013; 22:289-96. [DOI: 10.1177/0961203312474702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The English version of the Systemic Lupus Erythematosus Quality of Life Questionnaire (SLEQOL) is a validated disease-specific quality of life instrument. The aim of this study was to evaluate the psychometric properties of the Thai version of the SLEQOL (SLEQOL-TH). Methods Two independent translators translated the SLEQOL into Thai. The back translation of this version was performed by two other independent translators. The final version, SLEQOL-TH, was completed after resolving the discrepancies revealed by the back translation. One hundred and nine patients with SLE were enrolled to test the reliability, construct validity, floor and ceiling effects, and sensitivity to the changes of the SLEQOL-TH at six months. The differential item functioning (DIF) between the Thai and English versions was analyzed using the partial gamma. Results The internal consistency of the SLEQOL-TH was satisfactory with the overall Cronbach’s alpha of 0.86. The test-retest reliability of the SLEQOL-TH was acceptable with the intra-class correlation coefficient of 0.86. Low correlations between the SLEQOL-TH and SLEDAI were observed. The total score of the SLEQOL-TH was moderately responsive to changes in quality of life, with a standardized response mean of 0.50. When comparing the SLEQOL-TH from Thai SLE patients with the original SLEQOL version obtained from Singapore SLE patients, 11 out of 40 items showed a moderate to large DIF. Conclusions The SLEQOL-TH has acceptable psychometric properties and shows construct validity. In comparison with the English version of SLEQOL, there are some items that showed DIF. The applicability of the SLEQOL-TH in real-life clinical practice and clinical trials needs to be determined.
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Affiliation(s)
- N Kasitanon
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - S Wangkaew
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - S Puntana
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - W Sukitawut
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - KP Leong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore and Health Promotion Board, Singapore
| | - W Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
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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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