2
|
Elera-Fitzcarrald C, Reátegui-Sokolova C, Gamboa-Cárdenas RV, Medina M, Zevallos F, Pimentel-Quiroz VR, Zeña-Huancas PA, Pastor-Asurza CA, Perich-Campos RA, Rodríguez-Bellido ZJ, Alarcón GS, Ugarte-Gil MF. Age at diagnosis and health-related quality of life are associated with fatigue in systemic lupus erythematosus patients: Data from the Almenara Lupus Cohort. Lupus 2020; 29:1644-1649. [PMID: 32741305 DOI: 10.1177/0961203320947472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To define the factors associated with fatigue in Mestizo patients with Systemic Lupus Erythematosus (SLE). METHODS This is a cross-sectional study of SLE patients from a single center cohort. Visits were performed every six months. For these analyses, the first visit between October 2017 and December 2018 was included. Demographic and clinical characteristics as well as treatment were recorded at every visit. Fatigue was ascertained with the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-FT), Health-Related Quality of Life (HRQoL) with the LupusQoL, disease activity with the Systemic Lupus Erythematosus Disease Activity Index -2 K (SLEDAI-2K), and damage with the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology damage index (SDI). Prednisone use was recorded as current daily dose. Immunosuppressive drugs and antimalarial use were recorded as current, past or never. Univariable and multivariable analyses were performed using linear regression models. For the multivariable analyses, model selection followed a backward elimination procedure. RESULTS Two hundred and twenty-six patients were evaluated. The mean (SD) age at diagnosis was 35.6 (13.1) years, 211 (93.4%) were female; and disease duration was 11.0 (7.3) years. The mean SLEDAI and SDI were 2.4 (3.5) and 1.3 (1.5), respectively. The mean FACIT-FT was 33.1 (10.8). On the multivariable analysis, age at diagnosis and some domains of HRQoL (physical health, emotional health and fatigue) remained associated. CONCLUSIONS Age at diagnosis is negatively associated with fatigue whereas HRQoL domains like physical health, emotional health and fatigue are positively associated with fatigue.
Collapse
Affiliation(s)
- Claudia Elera-Fitzcarrald
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,School of Medicine, Universidad Científica del Sur, Lima, Perú
| | - Cristina Reátegui-Sokolova
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Rocío V Gamboa-Cárdenas
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Mariela Medina
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Francisco Zevallos
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | | | - Paola A Zeña-Huancas
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - César A Pastor-Asurza
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Risto A Perich-Campos
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Zoila J Rodríguez-Bellido
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Graciela S Alarcón
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Manuel F Ugarte-Gil
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,School of Medicine, Universidad Científica del Sur, Lima, Perú
| |
Collapse
|
3
|
Barbacki A, Petri M, Aviña-Zubieta A, Alarcón GS, Bernatsky S. Fatigue Measurements in Systemic Lupus Erythematosus. J Rheumatol 2019; 46:1470-1477. [PMID: 30709953 DOI: 10.3899/jrheum.180831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Fatigue is a frequent, disabling issue in systemic lupus erythematosus (SLE). It is, however, difficult to quantify. The Ad Hoc Committee on SLE Response Criteria for Fatigue in 2007 recommended using the Krupp Fatigue Severity Scale (FSS). Since then, the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale has also been validated in SLE. We performed a review of instruments used to measure fatigue in adult SLE patients from 2007 onward. METHODS We searched PubMed, Medline, and Embase (January 2008-October 2017), identifying clinical trials and observational studies in adult SLE, where fatigue was a specifically measured outcome. All English and French studies were reviewed to determine fatigue measures and results. RESULTS Thirty-seven studies met inclusion criteria. Eight scales were used. The visual analog scale (VAS), FSS, and FACIT-Fatigue Scale were most frequent. FSS was the most often used instrument in both clinical trials and observational studies. Twenty-five of the 37 studies demonstrated a difference in fatigue that was statistically significant and clinically meaningful. Of the 12 studies that did not, 6 used FSS, 3 used VAS, 2 used the Multidimensional Assessment of Fatigue, and 1 used the Brief Fatigue Index. All 6 studies using the FACIT-Fatigue Scale detected clinically meaningful and statistically significant differences. CONCLUSION VAS, FSS, and FACIT-Fatigue Scale were the most frequently used instruments in adult SLE studies from 2008 to 2017. Many studies detected clinically important changes in fatigue. Fatigue remains a key measure in both clinical trials and observational SLE studies.
Collapse
Affiliation(s)
- Ariane Barbacki
- From the Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia; Arthritis Research Centre of Canada, Richmond, British Columbia; Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,A. Barbacki, MD, Department of Medicine, Division of Rheumatology, McGill University Health Centre; M. Petri, MD, MPH, Division of Rheumatology, Johns Hopkins University School of Medicine; A. Aviña-Zubieta, MD, MSc, PhD, Division of Rheumatology, Department of Medicine, and Department of Experimental Medicine, University of British Columbia Faculty of Medicine, and Arthritis Research Centre of Canada; G.S. Alarcón, MD, MPH, Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham; S. Bernatsky, MD, PhD, Department of Medicine, Division of Rheumatology, McGill University Health Centre
| | - Michelle Petri
- From the Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia; Arthritis Research Centre of Canada, Richmond, British Columbia; Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,A. Barbacki, MD, Department of Medicine, Division of Rheumatology, McGill University Health Centre; M. Petri, MD, MPH, Division of Rheumatology, Johns Hopkins University School of Medicine; A. Aviña-Zubieta, MD, MSc, PhD, Division of Rheumatology, Department of Medicine, and Department of Experimental Medicine, University of British Columbia Faculty of Medicine, and Arthritis Research Centre of Canada; G.S. Alarcón, MD, MPH, Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham; S. Bernatsky, MD, PhD, Department of Medicine, Division of Rheumatology, McGill University Health Centre
| | - Antonio Aviña-Zubieta
- From the Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia; Arthritis Research Centre of Canada, Richmond, British Columbia; Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,A. Barbacki, MD, Department of Medicine, Division of Rheumatology, McGill University Health Centre; M. Petri, MD, MPH, Division of Rheumatology, Johns Hopkins University School of Medicine; A. Aviña-Zubieta, MD, MSc, PhD, Division of Rheumatology, Department of Medicine, and Department of Experimental Medicine, University of British Columbia Faculty of Medicine, and Arthritis Research Centre of Canada; G.S. Alarcón, MD, MPH, Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham; S. Bernatsky, MD, PhD, Department of Medicine, Division of Rheumatology, McGill University Health Centre
| | - Graciela S Alarcón
- From the Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia; Arthritis Research Centre of Canada, Richmond, British Columbia; Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,A. Barbacki, MD, Department of Medicine, Division of Rheumatology, McGill University Health Centre; M. Petri, MD, MPH, Division of Rheumatology, Johns Hopkins University School of Medicine; A. Aviña-Zubieta, MD, MSc, PhD, Division of Rheumatology, Department of Medicine, and Department of Experimental Medicine, University of British Columbia Faculty of Medicine, and Arthritis Research Centre of Canada; G.S. Alarcón, MD, MPH, Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham; S. Bernatsky, MD, PhD, Department of Medicine, Division of Rheumatology, McGill University Health Centre
| | - Sasha Bernatsky
- From the Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia; Arthritis Research Centre of Canada, Richmond, British Columbia; Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. .,A. Barbacki, MD, Department of Medicine, Division of Rheumatology, McGill University Health Centre; M. Petri, MD, MPH, Division of Rheumatology, Johns Hopkins University School of Medicine; A. Aviña-Zubieta, MD, MSc, PhD, Division of Rheumatology, Department of Medicine, and Department of Experimental Medicine, University of British Columbia Faculty of Medicine, and Arthritis Research Centre of Canada; G.S. Alarcón, MD, MPH, Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Alabama at Birmingham; S. Bernatsky, MD, PhD, Department of Medicine, Division of Rheumatology, McGill University Health Centre.
| |
Collapse
|
4
|
Alves VBF, Basso PJ, Nardini V, Silva A, Chica JEL, Cardoso CRDB. Dehydroepiandrosterone (DHEA) restrains intestinal inflammation by rendering leukocytes hyporesponsive and balancing colitogenic inflammatory responses. Immunobiology 2016; 221:934-43. [PMID: 27263829 DOI: 10.1016/j.imbio.2016.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/06/2016] [Accepted: 05/23/2016] [Indexed: 01/28/2023]
Abstract
Dehydroepiandrosterone (DHEA) is a hormone that plays an important role in the modulation of inflammatory responses. However, the precise mechanisms that link the actions of this androgen with protection or susceptibility to inflammatory bowel diseases (IBD) remain uknown. Here we showed that low dose DHEA inhibited proliferation of spleen cells and IFN-у production. The hormone was not toxic to myeloid lineage cells, although it caused necrosis of spleen cells at the intermediate and highest doses in vitro (50 and 100μM). The treatment of C57BL/6 mice with DHEA during colitis induction by dextran sodium sulfate (DSS) led to a reduction in weight loss and clinical signs of disease. There were decreased peripheral blood monocytes on day 6 of DSS exposure and treatment, besides increase in circulating neutrophils in the tissue repair phase. DHEA also led to reduced lamina propria cellularity and restoration of normal colon length. These results were accompanied by decreased expression of IL-6 and TGF-β mRNA, while IL-13 was augmented in the colon on day 6, which was probably related to attenuation of inflammation. There was retention of CD4(+) cells in the spleen after use of DHEA, along with augmented frequency of CD4(+)IL-4(+) cells, decreased CD4(+)IFN-ɣ(+) in spleen and constrained CD4(+)IL-17(+) population in the mesenteric lymph nodes. Moreover, splenocytes of mice treated with DHEA became hyporesponsive, as observed by reduced proliferation after re-stimulation ex-vivo. In conclusion, DHEA modifyies leukocyte activity and balances the exacerbated immune responses which drive local and systemic damages in IBD.
Collapse
Affiliation(s)
- Vanessa Beatriz Freitas Alves
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Paulo José Basso
- Departamento de Imunologia e Bioquímica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Viviani Nardini
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Angélica Silva
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Cristina Ribeiro de Barros Cardoso
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.
| |
Collapse
|