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Spies E, Andreu T, Hartung M, Park J, Kamudoni P. Exploring the Perspectives of Patients Living With Lupus: Retrospective Social Listening Study. JMIR Form Res 2024; 8:e52768. [PMID: 38306157 PMCID: PMC10873798 DOI: 10.2196/52768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease affecting various organs with a wide range of clinical manifestations. Cutaneous lupus erythematosus (CLE) can manifest as a feature of SLE or an independent skin ailment. Health-related quality of life (HRQoL) is frequently compromised in individuals living with lupus. Understanding patients' perspectives when living with a disease is crucial for effectively meeting their unmet needs. Social listening is a promising new method that can provide insights into the experiences of patients living with their disease (lupus) and leverage these insights to inform drug development strategies for addressing their unmet needs. OBJECTIVE The objective of this study is to explore the experience of patients living with SLE and CLE, including their disease and treatment experiences, HRQoL, and unmet needs, as discussed in web-based social media platforms such as blogs and forums. METHODS A retrospective exploratory social listening study was conducted across 13 publicly available English-language social media platforms from October 2019 to January 2022. Data were processed using natural language processing and knowledge graph tagging technology to clean, format, anonymize, and annotate them algorithmically before feeding them to Pharos, a Semalytix proprietary data visualization and analysis platform, for further analysis. Pharos was used to generate descriptive data statistics, providing insights into the magnitude of individual patient experience variables, their differences in the magnitude of variables, and the associations between algorithmically tagged variables. RESULTS A total of 45,554 posts from 3834 individuals who were algorithmically identified as patients with lupus were included in this study. Among them, 1925 (authoring 5636 posts) and 106 (authoring 243 posts) patients were identified as having SLE and CLE, respectively. Patients frequently mentioned various symptoms in relation to SLE and CLE including pain, fatigue, and rashes; pain and fatigue were identified as the main drivers of HRQoL impairment. The most affected aspects of HRQoL included "mobility," "cognitive capabilities," "recreation and leisure," and "sleep and rest." Existing pharmacological interventions poorly managed the most burdensome symptoms of lupus. Conversely, nonpharmacological treatments, such as exercise and meditation, were frequently associated with HRQoL improvement. CONCLUSIONS Patients with lupus reported a complex interplay of symptoms and HRQoL aspects that negatively influenced one another. This study demonstrates that social listening is an effective method to gather insights into patients' experiences, preferences, and unmet needs, which can be considered during the drug development process to develop effective therapies and improve disease management.
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Affiliation(s)
| | | | | | | | - Paul Kamudoni
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
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Kawka L, Sarmiento-Monroy JC, Mertz P, Pijnenburg L, Rinagel M, Ugarte-Gil MF, Geneton S, Blaess J, Piga M, Arnaud L. Assessment and personalised advice for fatigue in systemic lupus erythematosus using an innovative digital tool: the Lupus Expert system for the Assessment of Fatigue (LEAF) study. RMD Open 2023; 9:e003476. [PMID: 38056917 PMCID: PMC10711918 DOI: 10.1136/rmdopen-2023-003476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Fatigue is reported as the most prevalent symptom by patients with systemic lupus erythematosus (SLE). Fatigue management is complex due to its multifactorial nature. The aim of the study was to assess the usefulness of an innovative digital tool to manage fatigue in SLE, in a completely automated manner. METHODS The «Lupus Expert System for Assessment of Fatigue» (LEAF) is free digital tool which measures the intensity and characteristics of fatigue and assesses disease activity, pain, insomnia, anxiety, depression, stress, fibromyalgia and physical activity using validated patient-reported instruments. Then, LEAF automatically provides personalised feedback and recommendations to cope with fatigue. RESULTS Between May and November 2022, 1250 participants with SLE were included (95.2% women, median age 43yo (IQR: 34-51)). Significant fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue <34) was reported by 78.9% of patients. In univariate analysis, SLE participants with fatigue were more likely to be women (p=0.01), perceived their disease as more active (p<0.0001), had higher levels of pain (p<0.0001), anxiety (p<0.0001), depression (p<0.0001), insomnia (p<0.0001), stress (p<0.0001) and were more likely to screen for fibromyalgia (p<0.0001), compared with patients without significant fatigue. In multivariable analysis, parameters independently associated with fatigue were insomnia (p=0.0003), pain (p=0.002), fibromyalgia (p=0.008), self-reported active SLE (p=0.02) and stress (p=0.045). 93.2% of the participants found LEAF helpful and 92.3% would recommend it to another patient with SLE. CONCLUSION Fatigue is commonly severe in SLE, and associated with insomnia, pain, fibromyalgia and active disease according to patients' perspective. Our study shows the usefulness of an automated digital tool to manage fatigue in SLE.
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Affiliation(s)
- Lou Kawka
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Philippe Mertz
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Luc Pijnenburg
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marina Rinagel
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Manuel Francisco Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Sophie Geneton
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Blaess
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Matteo Piga
- Department of Medical Sciences and Public health, University of Cagliari, Cagliari, Italy
| | - Laurent Arnaud
- Department of Rheumatology, National Reference Center for Autoimmune Disease (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- INSERM UMR-S 1109, Immuno-rhumatologie moléculaire, Strasbourg, France
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Almalag HM, Almaghlouth I, Dabbagh R, Alsalem AR, Alrajban FN, Algarni SA, Alosaimi FN, Alassaf MI, Alshamrani MA, Alzomia S, Alanazi B, Alalwan T, Alkhalaf A, Bedaiwi M, Omair MA. Prevalence of fatigue functional and social impairment among patients with rheumatic diseases compared to patients without: A cross-sectional comparison. Medicine (Baltimore) 2023; 102:e33151. [PMID: 36862854 PMCID: PMC9981388 DOI: 10.1097/md.0000000000033151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Rheumatic diseases (RD) are chronic diseases that significantly affect the lives of patients. Assessing health outcomes through a patient-reported outcome measurement information system (PROMIS) is essential for RD management. Moreover, these tend to be less favorable among individuals than among the rest of the population. This study aimed to compare PROMIS between RD patients and other patients. This cross sectional study was conducted in the year 2021. Information about patients with RD was obtained from the RD registry at King Saud University Medical City. Patients without RD were recruited from family medicine clinics. Patients were contacted electronically through WhatsApp© to complete the PROMIS surveys. We compared the individual PROMIS scores between the 2 groups using linear regression, adjusting for sex, nationality, marital status, education level, employment, family history of RD, income, and chronic comorbidities. There were 1024 individuals (512 with RD and 512 without RD). The most common RD was systemic lupus erythematosus (51.6%), followed by rheumatoid arthritis (44.3%). Individuals with RD reported significantly higher PROMIS T-scores for pain [β = 6.2; 95% confidence interval (CI) = 4.76, 7.71] and fatigue (β = 2.9; 95% CI = 1.37, 4.38) compared to those without RD. Moreover, RD individuals reported lower physical functioning (β = -5.4; 95% CI = -6.50, -4.24) and social interaction (β = -4.5; 95% CI = -5.73, -3.20). Patients with RD in Saudi Arabia, particularly those with systemic lupus erythematosus and rheumatoid arthritis, have significantly greater impairment in physical functioning and social interaction and report higher levels of fatigue and pain. Addressing and ameliorating these negative outcomes is necessary to improve quality of life.
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Affiliation(s)
- Haya M. Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- * Correspondence: Haya M. Almalag, Department of Clinical Pharmacy, King Saud University, College of Pharmacy, Riyadh 11149, Saudi Arabia (e-mail: )
| | - Ibrahim Almaghlouth
- Rheumatology Unit, Department of medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rufaidah Dabbagh
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | | | | | | | | - Boshra Alanazi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tareq Alalwan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alkhalaf
- Rheumatology Unit, Department of medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Bedaiwi
- Rheumatology Unit, Department of medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A. Omair
- Rheumatology Unit, Department of medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Petrocchi V, Visintini E, De Marchi G, Quartuccio L, Palese A. Patient Experiences of Systemic Lupus Erythematosus: Findings From a Systematic Review, Meta-Summary, and Meta-Synthesis. Arthritis Care Res (Hoboken) 2022; 74:1813-1821. [PMID: 34133081 PMCID: PMC9796081 DOI: 10.1002/acr.24639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/01/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore the experience of patients with systemic lupus erythematosus (SLE). METHODS A systematic review of qualitative studies published in English in the past 10 years and identified through the PubMed, CINAHL, Scopus, and Web of Science databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The methodologic quality of each included study was assessed using the Critical Appraisal Screening Programme tool. Study findings were then subjected to a meta-summary and meta-synthesis. RESULTS Twenty-six studies with a good overall methodologic quality were included, documenting the experience of 565 adult patients (95% women). A total of 17 codes emerged, summarizing the life experience of SLE patients; the most and least frequent codes in the meta-summary were "feeling not as I usually do" (69.2%) and "having wishes" (7.7%). The codes were then categorized into 5 main themes, summarizing the experience of living with SLE: 1) "experiencing waves of emotions due to the unpredictable nature of the disease," 2) "trying to live an ordinary life," 3) "listening to and obeying the body's limitations," 4) "reviewing my life projects," and 5) "dealing with future uncertainties." CONCLUSION Several qualitative studies have been published to date using good methodologic approaches. According to the findings, SLE negatively impacts patient experiences by affecting multiple dimensions of their daily lives, with fatigue and pain as the most frequent symptoms.
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Tabudlo J, Saligan L. A Transcultural Perspective of Systemic Lupus Erythematosus-Related Fatigue: Systematic Review and Narrative Synthesis. Asian Pac Isl Nurs J 2022; 6:e39132. [PMID: 36648284 PMCID: PMC9969875 DOI: 10.2196/39132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Fatigue is one of the most common symptoms of systemic lupus erythematosus (SLE) worldwide, yet it remains poorly assessed and managed. The lack of universal definition and standard measurement of fatigue may add to the continued limitations in its understanding across cultures. OBJECTIVE The psycho-sociocultural underpinnings of fatigue are understudied; therefore, in this paper, we conducted a systematic review to understand a transcultural perspective of SLE-related fatigue. METHODS Following PRISMA (Preferred Reporting items for Systematic Reviews and Meta-Analysis) systematic review guidelines, we searched CINAHL Complete, Scopus, and PubMed databases for all published articles covered until the search date. Search was expanded using citation and web search. A 3-step process was used to identify articles meeting the inclusion criteria. The results were analyzed using narrative synthesis. RESULTS From a total of 370 (n=364, 98.4% scientific databases; n=6, 1.6% web and citation search) articles searched, 18 (4.9%) studies met the inclusion and exclusion criteria and were included in this review. All (18/18, 100%) studies enrolled primarily female participants, and half (9/18, 50%) had cross-sectional designs. Although race was not reported in all studies, most studies had White racial background as the largest proportion of their samples. A majority (7/18, 39%) of the studies were conducted in the United States. Using a narrative synthesis, the prominent themes drawn based on the domains of the culture care theory (CCT) and the sunrise enabler were as follows: SLE-related fatigue (1) as an integral component of the disease process, (2) as a personal challenge, and (3) as a psychosocial dimension. CONCLUSIONS CCT and sunrise enabler by Leininger guided this review. There are still gaps on how other domains of the CCT and sunrise enabler might influence SLE-related fatigue experience, assessment, and evaluation. The findings from this review showed that SLE-related fatigue has disease, personal, and psychosocial components. Thus, a purely subjective assessment of fatigue in SLE and even other conditions may limit a more accurate assessment and management. The inclusion of disease, personal, and psychosocial indicators is warranted and essential. A culturally sensitive and congruent assessment as well as evaluation models and measurement tools should be developed to capture fatigue experiences accurately. In addition, since global migration is inevitable, advancement in symptom management strategies should coincide with the understanding that fatigue has subjective and objective indicators present across cultures.
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Affiliation(s)
- Jerick Tabudlo
- College of Nursing, University of the Philippines Manila, Manila, Philippines
| | - Leorey Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
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6
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Chen YT, Lescoat A, Khanna D, Murphy SL. Perceived Cognitive Function in People With Systemic Sclerosis: Associations With Symptoms and Daily Life Functioning. Arthritis Care Res (Hoboken) 2022. [PMID: 35997486 PMCID: PMC9947182 DOI: 10.1002/acr.25000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/30/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Perceived cognitive dysfunction is prevalent in patients with systemic sclerosis (SSc) but not well understood. This study aimed to examine potential factors associated with perceived cognitive function and to investigate the contributions of perceived cognitive function and symptoms to functional measures. METHODS A cross-sectional survey was conducted among patients with SSc (n = 106). Participants were mainly female (84%) and White (82%). Perceived cognitive function, symptoms, and functional measures were assessed with Patient-Reported Outcomes Measurement Information System (PROMIS) measures. A multivariable regression was conducted to identify factors associated with perceived cognition. Hierarchical linear regressions examined the unique contributions of perceived cognitive function and symptoms to social participation and physical function. RESULTS Fifty-nine (56%) patients with SSc perceived mild-to-severe cognitive dysfunction. Being on work disability and having more fatigue were both significantly associated with perceived cognitive dysfunction. When examining the contributions of cognition and other symptoms to functional measures, self-reported cognition became nonsignificant after fatigue and pain were entered into the regression model. CONCLUSION Being on work disability and having more fatigue were most highly associated with perceived cognitive dysfunction in patients with SSc. Unlike fatigue and pain, perceived cognitive function was not independently associated with functional measures. Nonetheless, future research should disentangle cognitive function and other symptoms, as well as their effects on daily activities, in SSc.
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Affiliation(s)
| | - Alain Lescoat
- University of Michigan, Ann Arbor, and Rennes University Hospital and University Rennes, CHU Rennes, INSERM, EHESP, Institut de Recherche en Santé, Environnement et Travail, Rennes, France
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7
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Eudy AM, Rogers JL, Corneli A, McKenna K, Maheswaranathan M, Pisetsky DS, Criscione-Schreiber LG, Doss J, Sadun RE, Sun K, Clowse MEB. Intermittent and Persistent Type 2 lupus: patient perspectives on two distinct patterns of Type 2 SLE symptoms. Lupus Sci Med 2022; 9:9/1/e000705. [PMID: 36927502 PMCID: PMC9362789 DOI: 10.1136/lupus-2022-000705] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We have developed a new conceptual model to characterise the signs and symptoms of SLE: the Type 1 and 2 SLE Model. Within the original model, Type 1 SLE consists of inflammatory manifestations like arthritis, nephritis and rashes; Type 2 SLE includes symptoms of fatigue, myalgia, mood disturbance and cognitive dysfunction. Through in-depth interviews, we explored how the Type 1 and 2 SLE Model fits within the lived experience of patients with SLE, with a focus on the connection between Type 1 and Type 2 SLE symptoms. METHODS Semistructured in-depth interviews were conducted among adult participants meeting 1997 American College of Rheumatology or Systemic Lupus International Collaborating Clinics criteria for SLE. Participants were purposefully selected for age, race, sex and nephritis history. All interviews were audio-recorded and transcribed. Data were analysed through episode profile and thematic analysis. RESULTS Through interviews with 42 patients with SLE, two patterns of Type 2 SLE emerged: Intermittent (n=18) and Persistent (n=24). Participants with Intermittent Type 2 SLE described feeling generally well when Type 1 is inactive; these participants were younger and had more internal SLE manifestations. Participants with Persistent Type 2 described always experiencing Type 2 symptoms despite inactive Type 1, although the severity may fluctuate. Participants with Persistent Type 2 SLE experienced traditional lupus symptoms of joint pain, hair loss and rash, but less often had severe organ system involvement. CONCLUSIONS By listening to the stories of our patients, we found two underlying patterns of Type 2 SLE: Intermittent Type 2 symptoms that resolve in synchrony with Type 1 inflammatory symptoms, and Persistent Type 2 symptoms that continue despite remission of Type 1 symptoms.
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Affiliation(s)
- Amanda M Eudy
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer L Rogers
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin McKenna
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mithu Maheswaranathan
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David S Pisetsky
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | | | - Jayanth Doss
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca E Sadun
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kai Sun
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Megan E B Clowse
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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8
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Raghunath S, Guymer EK, Glikmann-Johnston Y, Golder V, Kandane Rathnayake R, Morand EF, Stout JC, Hoi A. Fibromyalgia, mood disorders, cognitive test results, cognitive symptoms and quality of life in systemic lupus erythematosus. Rheumatology (Oxford) 2022; 62:190-199. [PMID: 35383358 PMCID: PMC9788827 DOI: 10.1093/rheumatology/keac207] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Cognitive dysfunction, and comorbidities such as mood disorder and fibromyalgia, are common in SLE. This study aims to explore the associations between fibromyalgia, mood disorders, cognitive symptoms and cognitive dysfunction in SLE patients, and their impact on quality of life. METHODS We tested cognition in SLE patients and healthy controls, and evaluated cognitive symptoms, mood disorder, fibromyalgia, fatigue and quality of life using patient-reported outcome measures. We examined associations of these comorbidities with both patient-reported cognitive symptoms and cognitive test performance. RESULTS High fibromyalgia symptom score and history of depression or anxiety were associated with cognitive dysfunction. There were no significant associations between current depression, anxiety symptoms or fatigue score and objective cognitive dysfunction. In contrast, mood disorder symptoms, history of mood disorder, fibromyalgia symptoms and fatigue all had significant associations with patient-reported cognitive symptoms. There were no significant associations between patient-reported cognitive symptoms and objective cognitive dysfunction. Objective cognitive dysfunction, patient-reported cognitive symptoms, history of mood disorder and fibromyalgia symptoms all had significant associations with poorer quality of life; fibromyalgia had the biggest impact. CONCLUSIONS Cognitive symptoms are common in SLE, but there were no associations between cognitive symptoms and objective cognitive dysfunction. Depression, anxiety and fibromyalgia were more consistently associated with patient-reported cognitive symptoms than with objective cognitive dysfunction. These factors all have a significant impact on quality of life. Understanding the discrepancy between patient-reported cognitive symptoms and cognitive test performance is essential to advance care in this area of unmet need.
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Affiliation(s)
- Sudha Raghunath
- Correspondence to: Sudha Raghunath, School of Clinical Sciences, Monash Medical Centre, Level 5, Block E, 246 Clayton Road, Clayton, VIC 3168, Australia. E-mail:
| | - Emma K Guymer
- Centre for Inflammatory Disease, School of Clinical Sciences, Monash University,Rheumatology Department, Monash Health
| | - Yifat Glikmann-Johnston
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Vera Golder
- Centre for Inflammatory Disease, School of Clinical Sciences, Monash University,Rheumatology Department, Monash Health
| | | | - Eric F Morand
- Centre for Inflammatory Disease, School of Clinical Sciences, Monash University,Rheumatology Department, Monash Health
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Alberta Hoi
- Centre for Inflammatory Disease, School of Clinical Sciences, Monash University,Rheumatology Department, Monash Health
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Morel T, Cano S, Bartlett SJ, Gordon C, Haier B, Regnault A, Schneider M, Stach C, Cleanthous S. The FATIGUE-PRO: A New Patient-Reported Outcome Instrument to Quantify Fatigue in Patients Affected by Systemic Lupus Erythematosus. Rheumatology (Oxford) 2021; 61:3329-3340. [PMID: 34897375 PMCID: PMC9348773 DOI: 10.1093/rheumatology/keab920] [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: 09/09/2021] [Revised: 12/06/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives This study aimed to implement a patient-centred and evidence-based approach to develop a novel patient-reported outcome (PRO) instrument to measure fatigue in patients with SLE. Methods A three-step mixed methods psychometric (MMP) approach was followed. Steps comprised first draft item generation and review using interview data; evaluation and refinement of second draft items using mixed methods data, including interview and quantitative data from a phase 2 clinical study in SLE analysed using Rasch Measurement Theory (RMT) analysis; and evaluation of the final FATIGUE-PRO items using RMT and complementary Classical Test Theory (CTT) analyses. Guided by MMP criteria, a team of clinicians and outcome-measurement experts assessed evidence to inform instrument development. Results Step 1 culminated in 55 items (n = 39 patients interviewed). Their refinement in step 2 using mixed methods evidence led to the final FATIGUE-PRO instrument comprising 31 items across three scales of fatigue: physical fatigue (9 items), mental and cognitive fatigue (11 items) and susceptibility to fatigue (11 items). Qualitative (n = 43 patients) and quantitative (n = 106 patients) evidence strongly supported the scales’ content comprehensiveness and targeting, item quality and fit, conceptual uniqueness and appropriateness of the response scale. The FATIGUE-PRO further benefited from excellent reliability (RMT: 0.92–0.94 and CTT: 0.95–0.96) and supportive evidence of construct validity from assessments against other PROs. Conclusion The conceptual advances, comprehensive coverage and strong psychometric properties of the FATIGUE-PRO will significantly advance the measurement and management of fatigue in SLE, both in clinical trials and routine practice. Trial registration ClinicalTrials.gov (https://clinicaltrials.gov), NCT02804763
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Affiliation(s)
| | | | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | | | - Matthias Schneider
- Poliklinik und Funktionsbereich für Rheumatologie,Heinrich-Heine-Universität, Düsseldorf, Germany
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The Patient Experience of Fatigue in Systemic Lupus Erythematosus: A Conceptual Model. Rheumatol Ther 2021; 9:95-108. [PMID: 34622426 PMCID: PMC8814226 DOI: 10.1007/s40744-021-00374-0] [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: 07/07/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Fatigue is frequently experienced in systemic lupus erythematosus (SLE) and is a key outcome in clinical research trials. However, SLE fatigue is complex and poorly understood, and challenging to measure. We aimed to characterise fatigue from the patients’ perspective and develop a conceptual model of fatigue based on qualitative interviews. Methods We conducted semi-structured qualitative interviews exploring fatigue in patients with SLE recruited from a social network (n = 29) and a phase 2 clinical study (n = 43). Transcripts were coded thematically, and codes were inductively categorised into a conceptual model. Results Fatigue was the most commonly reported symptom in the interviews and generated a wide range of codes. From these, our concept-driven approach revealed three overarching domains of the fatigue experienced in SLE: (i) physical manifestation of physical and bodily symptoms (including physical energy, stamina and impact on movement); (ii) mental and cognitive manifestation (including mental energy, motivation, and cognitive functioning symptoms); and (iii) susceptibility to fatigue or how easily ‘fatigable’ patients are, meaning how easily they become fatigued and how easily their fatigue is alleviated (including the rapid, disproportionate, and/or unpredictable onset of fatigue, non-restorative sleep, and need for more sleep/rest breaks). Within each of these, participants described the severity, variation and impact of fatigue on everyday life. Participants also described how the SLE fatigue experience differed from ‘everyday tiredness’. Conclusions The findings of this research indicate that comprehensive measurement of fatigue in SLE will require consideration and quantification of the three domains described in our conceptual model. Future research will explore whether this conceptual model can form the basis of a valid and reliable measurement of fatigue in SLE. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00374-0.
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Fatigue in Systemic Lupus Erythematosus: An Update on Its Impact, Determinants and Therapeutic Management. J Clin Med 2021; 10:jcm10173996. [PMID: 34501444 PMCID: PMC8432566 DOI: 10.3390/jcm10173996] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022] Open
Abstract
Fatigue is a complex and multifactorial phenomenon which is often neglected by clinicians. The aim of this review was to analyze the impact, determinants and management of fatigue in patients with Systemic Lupus Erythematosus (SLE). Fatigue is one of the most prevalent symptoms in SLE, reported by 67% to 90% of patients. It is also described as the most bothersome symptom, considering that it may impair key aspects of health-related quality of life, while also leading to employment disability. It is a multifactorial phenomenon involving psychological factors, pain, lifestyle factors such as reduced physical activity, whereas the contribution of disease activity remains controversial. The management of fatigue in patients with SLE should rely upon a person-centered approach, with targeted interventions. Some pharmacological treatments used to control disease activity have demonstrated beneficial effects upon fatigue and non-pharmacological therapies such as psychological interventions, pain reduction and lifestyle changes, and each of these should be incorporated into fatigue management in SLE.
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Psychometric properties of FACIT-Fatigue in systemic lupus erythematosus: a pooled analysis of three phase 3 randomised, double-blind, parallel-group controlled studies (BLISS-SC, BLISS-52, BLISS-76). J Patient Rep Outcomes 2021; 5:33. [PMID: 33830377 PMCID: PMC8032841 DOI: 10.1186/s41687-021-00298-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/19/2021] [Indexed: 02/08/2023] Open
Abstract
Background Fatigue is a key symptom in patients with systemic lupus erythematosus (SLE), and regulatory bodies recommend its assessment in clinical trials of SLE therapies. Methods This post hoc pooled analysis of the three BeLimumab In Subjects with Systemic lupus erythematosus (BLISS) Phase 3 randomised, double-blind, parallel-group controlled trials evaluated the measurement properties of the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue. Patients (N = 2520) completed the FACIT-Fatigue every 4 weeks from baseline until the end of each study period. Internal consistency, test–retest reliability, convergent validity, and ability to detect changes in SLE were evaluated for the FACIT-Fatigue. Results The FACIT-Fatigue showed good internal consistency reliability (Cronbach’s alpha > 0.90), very good test–retest reliability (0.76 ≤ intraclass correlation coefficient ≤ 0.92), and moderate-strong convergent validity (0.49 ≤ |r| ≤ 0.86) against scale and summary measure scores from the Short Form 36 Health Survey Version 2. Correlations between FACIT-Fatigue and British Isles Lupus Assessment Group (BILAG) General/Musculoskeletal scores (0.24 ≤ |r| ≤ 0.43) supported convergent validity. Correlations between FACIT-Fatigue and the Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) scores and SLE annualised flare rate were weak but in the expected direction (ranging from − 0.02 to − 0.25). Known-groups validity testing showed that the FACIT-Fatigue can significantly discriminate between patient groups with differing scores for SELENA-SLEDAI, BILAG (General and Musculoskeletal) ratings, and Physician’s Global Assessment (PGA). Patients showing improvement in PGA and meeting the BILAG responder criteria had significantly higher mean improvement in FACIT-Fatigue scores than those without improvements in either measure (Week 52 mean score difference [95% confidence interval]: − 4.0 [− 5.0, − 3.0] and −2.2 [−3.1, −1.2], respectively; both p < 0.0001). The range of important (i.e. meaningful) change in FACIT-Fatigue, based on multiple anchors, was 3–6 points. Conclusions The FACIT-Fatigue demonstrated adequate psychometric properties in patients with SLE. The body of evidence from the three BLISS trials (both pooled and individually) supports the FACIT-Fatigue as a reliable and valid measure of SLE-related fatigue in clinical trials. Clinical trial identifiers BLISS-SC (NCT01484496), BLISS-52 (NCT00424476), and BLISS-76 (NCT00410384). Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00298-x.
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Raymond K, Park J, Joshi AV, White MK. Patient Experience With Fatigue and Qualitative Interview-Based Evidence of Content Validation of The FACIT-Fatigue in Systemic Lupus Erythematosus. Rheumatol Ther 2021; 8:541-554. [PMID: 33687688 PMCID: PMC7991018 DOI: 10.1007/s40744-021-00292-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Fatigue is highly prevalent and burdensome in systemic lupus erythematosus (SLE). The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) is a patient-reported questionnaire that measures physical and mental fatigue and consequent impact on daily living. Qualitative evidence of content validity in SLE is limited. This study (GSK Study 209226) assessed the content validity of the FACIT-Fatigue for SLE and explored patients' experiences of SLE-related fatigue using qualitative methods. METHODS Fatigue-related themes were identified through semi-structured, hybrid cognitive debriefing and concept elicitation interviews and evaluated for concordance with the FACIT-Fatigue. RESULTS Fatigue was experienced regularly by all participants (N = 15, 86.7% female) and was rated as the most bothersome symptom of SLE by 11/15 participants. All participants reported emotional impacts of fatigue, while 14/15 and 9/15 participants also reported impacts on social life and physical functioning, respectively. Most (12/15) reported that fatigue interfered with their ability to fulfill work- or school-related roles, and activities of daily living were limited in all participants. All (14/14) reported that a meaningful change in their level of fatigue would be the ability to have a more active and normal lifestyle. Concept mapping showed that all 13 FACIT-Fatigue items mapped directly onto concepts spontaneously mentioned by participants. Cognitive debriefing revealed that 13/15 participants found the instructions easy to understand and 11/15 participants endorsed the recall period (7 days) as appropriate. Participants found the FACIT-Fatigue items were clear and relevant. Most participants (11/15) reported that all response options adequately captured their experience of fatigue. CONCLUSIONS Qualitative evaluation of the content validity of the FACIT-Fatigue supports it as an appropriate measure for assessing the impact of fatigue on daily living of patients with SLE. The tool is easily understood by patients and a valuable resource for measuring a common and debilitating symptom of this condition.
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Affiliation(s)
| | - Josephine Park
- GlaxoSmithKline, Value Evidence and Outcomes, Collegeville, PA, USA
| | - Ashish V Joshi
- GlaxoSmithKline, Value Evidence and Outcomes, Collegeville, PA, USA
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Moazzami M, Strand V, Su J, Touma Z. Dual trajectories of fatigue and disease activity in an inception cohort of adults with systemic lupus erythematosus over 10 years. Lupus 2021; 30:578-586. [PMID: 33413006 DOI: 10.1177/0961203320983892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Fatigue is one of the most common symptoms reported in patients living with SLE. We aim to: 1) determine if different trajectories of fatigue associate with specific latent classes of disease activity and 2) define the patient characteristics and associated factors in different latent classes. METHODS Data from an inception cohort of adult patients from the Toronto Lupus Clinic from 1997-2018 were analyzed. Fatigue levels were measured using Fatigue Severity Scale (FSS) and disease activity by the Adjusted Mean Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) (AMS). Dual latent class trajectory analysis, for fatigue and AMS, was performed. Univariable and multivariable logistic regression analyses assessed the association of baseline variables with class membership. RESULTS Among 280 patients, 4 dual classes (C) of fatigue and disease activity were identified: C1- lowest disease activity and second highest fatigue trajectory (27%); C2- second highest disease activity and highest fatigue trajectory (30%); C3-moderate disease activity and lowest fatigue trajectory (33%); and C4- highest disease activity and moderate fatigue trajectory (10%). CONCLUSION 4 distinct latent classes of dual fatigue and disease activity trajectories were identified. Fatigue and disease activity follow distinct trajectories and disease activity alone cannot fully explain fatigue trajectories. Trajectories with higher FSS scores were associated with more fibromyalgia and trajectories with higher disease activity were associated with higher cumulative glucocorticoid use. Higher baseline glucocorticoid use was more likely associated with more fatigue while older age at SLE diagnosis was associated with less fatigue.
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Affiliation(s)
- Mitra Moazzami
- George Washington University School of Medicine, Washington, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, USA
| | - Jiandong Su
- Division of Rheumatology, Department of Medicine; Toronto Western Hospital-Lupus Clinic; University of Toronto, Toronto, Canada
| | - Zahi Touma
- Division of Rheumatology, Department of Medicine; Toronto Western Hospital-Lupus Clinic; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Hoge C, Bowling CB, Lim SS, Drenkard C, Plantinga LC. Association of Poverty Income Ratio with Physical Functioning in a Cohort of Patients with Systemic Lupus Erythematosus. J Rheumatol 2020; 47:983-990. [PMID: 32115428 DOI: 10.3899/jrheum.190991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the association of income relative to the poverty threshold [poverty income ratio (PIR)] with self-reported physical functioning (PF) in a cohort of patients with systemic lupus erythematosus. METHODS We used cross-sectional data on 744 participants from Georgians Organized Against Lupus (GOAL), and secondary analyses used data on 56 participants from a nested pilot study. Primary analyses used multivariable linear regression to estimate the association between PIR (categorized as < 1.00, 1.00-1.99, 2.00-3.99, and ≥ 4.00; lower PIR indicate higher poverty) and PF (scaled subscore from the Medical Outcomes Study Short Form-12 survey; range 0-100, higher scores indicate better functioning). Secondary analyses summarized complementary measures of PF as means or percentages by PIR (categorized as < 1.00, 1.00-1.99, and ≥ 2.00). RESULTS The mean age of participants was 48.0 years; 6.7% were male; 80.9% were black; and 37.5%, 21.0%, 29.6%, and 12.0% had PIR of < 1.00, 1.00-1.99, 2.00-3.99, and ≥ 4.00, respectively. The overall mean PF score was 45.8 (36.2, 40.7, 55.5, and 61.2 for PIR of < 1.00, 1.00-1.99, 2.00-3.99, and ≥ 4.00). With adjustment, higher PIR remained associated with higher PF scores [2.00-3.99 vs 1.00-1.99: β = 10.9 (95% CI 3.3-18.6); ≥ 4.00 vs 1.00-1.99: β = 16.2 (95% CI 6.4-26.0)]. In secondary analyses, higher PIR was also associated with higher scores for objective physical performance. CONCLUSION Our results show that higher income relative to the poverty threshold is associated with better PF across multiple domains, warranting further research into multicomponent functional assessments to develop individual treatment plans and potentially improve socioeconomic disparities in outcomes.
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Affiliation(s)
- Courtney Hoge
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - C Barrett Bowling
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - S Sam Lim
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - Cristina Drenkard
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA.,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University
| | - Laura C Plantinga
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), and Department of Medicine, Duke University, Durham, North Carolina; and Department of Medicine, Emory University, Atlanta, Georgia, USA. .,C. Hoge, MSPH, Department of Epidemiology, Rollins School of Public Health, Emory University; C.B. Bowling, MD, MSPH, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham VAMC; S.S. Lim, MD, MPH, Department of Medicine, Emory University; C. Drenkard, MD, PhD, Department of Medicine, Emory University; L.C. Plantinga, PhD, Department of Epidemiology, Rollins School of Public Health, Department of Medicine, Emory University.
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Using the Concept of Frailty to Understand Variability in Health Outcomes Among Individuals with Systemic Lupus Erythematosus. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Fatigue is highly prevalent in inflammatory arthritis, and people living with the symptom have described it as overwhelming and a challenge to manage. In this article, we explore the experience, impact and non-pharmacological management of fatigue from a multi-disciplinary perspective. We start by presenting qualitative evidence from people living with fatigue, including the physical, cognitive and emotional nature of the symptom and its impact on daily life. This is followed by discussion of current conceptual models of mechanisms and factors that may cause and maintain fatigue, within and between individuals. We then address the issue of fatigue measurement and modes of assessment, which is an integral aspect of management and evaluating support provision. This leads to a review of the research evidence for non-pharmacological interventions to reduce fatigue severity and impact. Finally, we consider implementation of this evidence in clinical practice and we introduce some key practical tools and techniques.
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Kwan A, Katz P, Touma Z. The Assessment of Anxiety and Depression and its Associated Factors in SLE. Curr Rheumatol Rev 2019; 15:90-98. [PMID: 30255761 DOI: 10.2174/1573397114666180926101513] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/13/2018] [Accepted: 09/23/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depression and anxiety are common neuropsychiatric complaints in patients with Systemic Lupus Erythematosus (SLE). While numerous studies have been performed to investigate the prevalence, impact, and associated factors of depression and anxiety, current literature presents mixed results. In particular, the prevalence of anxiety and depression varies substantially between studies due to methodological limitations, and heterogeneity in defining anxiety and depression, patient selection, and metrics used. Moreover, there is a lack of studies evaluating the validity, reliability, and interpretability of commonly used screening tools for depression and anxiety in SLE patients. RESULT AND CONCLUSION Further investigations should aim to reach a consensus surrounding the role of controversial associated factors in depression and anxiety of SLE patients, while also focusing on the identification of novel factors that have not yet been highlighted in the literature.
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Affiliation(s)
- Andrew Kwan
- Queen's University, Kingston, Ontario, Canada.,University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
| | - Patricia Katz
- Department of Medicine, UCSF, Philip R. Lee Institute for Health Policy Studies, St, San Francisco, CA 94117, United States
| | - Zahi Touma
- University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
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Živković V, Mitić B, Stamenković B, Stojanović S, Dinić BR, Stojanović M, Jurišić V. Analysis on the risk factors for organ damage in patients with systemic lupus erythematosus: a cross-sectional single-center experience. SAO PAULO MED J 2019; 137:155-161. [PMID: 31314876 PMCID: PMC9721237 DOI: 10.1590/1516-3180.2018.0258060219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 02/06/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Organ damage in patients with systemic lupus erythematosus (SLE) occurs as a consequence of the disease itself, the therapy applied and the accompanying conditions and complications. Organ damage predicts further organ damage and is associated with an increased risk of death. OBJECTIVE This study aimed to assess the degree of irreversible organ changes in SLE patients, using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI); to establish correlations between organ damage and disease activity, quality of life, intensity of fatigue and serological factors; and to ascertain the risk factors for organ damage. DESIGN AND SETTING Cross-sectional single-center study conducted at the Institute for Treatment and Rehabilitation "Niška Banja", Niš, Serbia. METHODS 83 patients with SLE were enrolled: 58 patients formed the group with organ damage (SDI ≥ 1), and 25 patients without organ damage served as controls (SDI = 0). RESULTS Organ damage correlated with age (P = 0.002), disease duration (P = 0.015), disease activity (grade 1, P = 0.014; and grade 2, P = 0.007), poor quality of life, severe fatigue (P = 0.047) and treatment with azathioprine (P = 0.037). The following factors were protective: use of hydroxychloroquine (P = 0.048) and higher scores obtained for the physical (P = 0.011), mental (P = 0.022) and general health (P = 0.008) domains. CONCLUSION It is very important to evaluate risk factors for organ damage in the body, including physicians' overall assessment, to try to positively influence better treatment outcomes.
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Affiliation(s)
- Valentina Živković
- MD, PhD. Assistant Professor, Faculty of Medicine, University of Niš, and Institute for Treatment and Rehabilitation "Niška Banja", Niš, Serbia
| | - Branka Mitić
- MD, PhD. Assistant Professor, Faculty of Medicine, University of Niš, and Clinic of Nephrology, Clinical Centre, Niš, Serbia
| | - Bojana Stamenković
- MD, PhD. Assistant Professor, Faculty of Medicine, University of Niš, andInstitute for Treatment and Rehabilitation "Niška Banja", Niš, Serbia
| | - Sonja Stojanović
- MD, PhD. Assistant Professor, Faculty of Medicine, University of Niš, and Institute for Treatment and Rehabilitation "Niška Banja", Niš, Serbia
| | - Biljana Radovanović Dinić
- MD, PhD. Associate Professor,Faculty of Medicine, University of Niš, and Clinic for Gastroenterology and Hepatology, Clinical Centre, Niš, Serbia
| | - Miodrag Stojanović
- MD, PhD. Associate Professor, Faculty of Medicine, University of Niš, and Public Health Institute, Niš, Serbia
| | - Vladimir Jurišić
- MD, PhD. Professor,Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Feng C, He Q, Wu Y, Hu X, Wu J, He X, Zhao S. Psychometric properties of fatigue severity scale in Chinese systemic lupus erythematosus patients. Health Qual Life Outcomes 2019; 17:71. [PMID: 31014340 PMCID: PMC6480827 DOI: 10.1186/s12955-019-1141-x] [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: 04/17/2018] [Accepted: 04/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Fatigue is the most common symptom in Systemic Lupus Erythematosus (SLE) patients. Many fatigue instruments have been used in SLE, with Fatigue Severity Scale (FSS) mostly adopted. However, fatigue instruments haven't been tested in the Chinese SLE population. The aim of our study was to test the psychometric properties of FSS in Chinese SLE patients. METHODS A cross-sectional study was conducted. 201 patients diagnosed with SLE were enrolled in the study with convenience sampling. Fatigue score, depression score and vitality subscale score of SF-36 were collected. Floor and ceiling effects were tested. Factor analysis was conducted. Reliability and validity of FSS were also tested. RESULTS Floor (4.50%) and ceiling (4.00%) effects were minimal. One factor was extracted, explaining 61.80% of total variance. When item1 and item 2 were deleted, one factor explained 69.54% of variance, and Cronbach's Alpha increased from 0.92 to 0.93. Intraclass correlation coefficient (ICC) was 0.94. Fatigue correlated with both depression (r = 0.52, P < 0.01) and vitality (r = - 0.55, P < 0.01), indicating acceptable construct validity for original FSS. When item 1 and 2 were removed, the correlation coefficient between 7-item FSS and vitality increased (r = - 0.58, P < 0.01), while correlation coefficient between 7-item FSS and depression remained the same (r = 0.52, P < 0.01). Known-groups validity was verified by that patients with depression showed higher fatigue score both for 9-item (Z = -5.56, P < 0.001) and 7-item FSS (Z = -5.70, P < 0.001). CONCLUSIONS 9-item FSS is a reliable instrument and can be used to assess fatigue problem in Chinese SLE patients, and 7-item FSS also demonstrated good psychometric properties in the same participants.
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Affiliation(s)
- Chenchen Feng
- Outpatient Department, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Qian He
- Outpatient Department, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Yan Wu
- Outpatient Department, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Xiaokun Hu
- Outpatient Department, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Juan Wu
- Outpatient Department, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Xiaoli He
- Outpatient Department, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Shuzhen Zhao
- Outpatient Department, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China.
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Horisberger A, Courvoisier D, Ribi C. The Fatigue Assessment Scale as a simple and reliable tool in systemic lupus erythematosus: a cross-sectional study. Arthritis Res Ther 2019; 21:80. [PMID: 30909957 PMCID: PMC6434822 DOI: 10.1186/s13075-019-1864-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/11/2019] [Indexed: 12/25/2022] Open
Abstract
Background The vast majority of patients with systemic lupus erythematosus (SLE) complain about fatigue. They also report fatigue as one of their most debilitating symptoms. Yet, in clinical practice, fatigue is only rarely assessed and remains poorly understood. The purpose of this study is to validate the Fatigue Assessment Scale (FAS) and assess the impact of disease activity on fatigue in SLE. Methods A cross-sectional single-center study of patients was included in the Swiss SLE Cohort Study. The FAS and the Short Form 36 (SF-36) were administered to SLE patients and controls with primary Sjogren’s syndrome (pSS) and healthy volunteers (HV) attending our clinic. Disease activity in SLE was captured at the same time as patient-reported outcomes using the SLE Disease Activity Index score with the Safety of Estrogens in SLE National Assessment modification (SELENA-SLEDAI) and the physician’s global assessment. We explored the internal consistency, reproducibility, construct validity, and convergence of the FAS, in comparison to the vitality subscale (VT) of the SF-36. We examined the association of FAS with demographics, disease type, SLE disease activity, and clinical features. Results Of the 73 SLE subjects, 89% were women and 77% were Caucasians. The median age was 43 years, and 23 (32%) patients had active SLE. Demographics in pSS and HV were similar. Within the SLE group, FAS displayed good internal consistency (Cronbach’s alpha = 0.93), unidimensionality, and test-retest reliability (ICC = 0.90). FAS and VT correlated well. The total FAS was highest in active SLE and pSS and higher in non-active SLE compared to HV. Conclusion The FAS is a promising tool to measure fatigue in SLE. Patients with SLE display a significantly higher level of fatigue than HV, which is even more pronounced in active disease and comparable to fatigue levels measured in pSS.
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Affiliation(s)
- Alice Horisberger
- Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier Universitaire Vaudois, CHUV BH09-627, CH-1011, Lausanne, Switzerland.
| | - Delphine Courvoisier
- Division of Rheumatology, Department of Internal Medicine Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Camillo Ribi
- Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier Universitaire Vaudois, CHUV BH09-627, CH-1011, Lausanne, Switzerland
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Yilmaz-Oner S, Ilhan B, Can M, Alibaz-Oner F, Polat-Korkmaz O, Ozen G, Mumcu G, Kremers HM, Tuglular S, Direskeneli H. Fatigue in systemic lupus erythematosus : Association with disease activity, quality of life and psychosocial factors. Z Rheumatol 2019; 76:913-919. [PMID: 27600110 DOI: 10.1007/s00393-016-0185-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of the study was to determine which disease-related factors and non-disease features can explain the presence of systemic lupus erythematosus (SLE)-related fatigue in Turkish patients. METHODS This cross-sectional study was carried out with 99 SLE patients and 71 healthy controls. To assess fatigue and health-related quality of life (HRQoL) the participants were asked to complete two questionnaires: the short form-36 health survey (SF-36) and the multidimensional assessment of fatigue (MAF) scale. Anxiety and depression of participants were assessed by the hospital anxiety and depression scale (HADS). RESULTS A total of 99 patients (female/male 95/4) and 71 controls (female/male 40/31) were studied. The mean age and standard deviation (±SD) of patients and controls were 43.3 ± 12.2 years and 43.2 ± 12.1 years, respectively. The mean (SD) disease duration was 7.8 ± 5.3 years and median SLE disease activity index (SLEDAI) score was 0 (range = 0-16). The level of fatigue was higher in patients compared to controls with mean MAF scores of 24.7 ± 12.2 and 12.8 ± 9.9 (p < 0.001), respectively. The HADS-D and HADS-A scores were also significantly higher in SLE patients (6.6 ± 4.3 vs. 3.6 ± 2.9, p < 0.001 and 7.2 ± 4 vs. 4.9 ± 4, p = 0.007, respectively). There were no significant associations between the MAF and SLEDAI scores (r = 0.05, p = 0.63) but MAF scores positively correlated with age, HADS-A and HADS-D scores and negatively correlated with physical component summary (PCS), mental component summary (MCS) and each domain of SF-36 except role emotional in SLE patients. CONCLUSION Fatigue is an important factor influencing patient daily life independent from disease activity in our study. The SLE patients with severe fatigue should also be assessed for other possible underlying causes such as anxiety, depression and poor quality of life.
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Affiliation(s)
- S Yilmaz-Oner
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey.
| | - B Ilhan
- School of Medicine, Marmara University, Istanbul, Turkey
| | - M Can
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
| | - F Alibaz-Oner
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
| | | | - G Ozen
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
| | - G Mumcu
- Faculty of Health Sciences, Department of Health Management, Marmara University, Istanbul, Turkey
| | - H M Kremers
- College of Medicine, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - S Tuglular
- School of Medicine, Department of Nephrology, Marmara University, Istanbul, Turkey
| | - H Direskeneli
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
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Hammam N, Gamal RM, Rashed AM, Elfetoh NA, Mosad E, Khedr EM. Fatigue in Rheumatoid Arthritis Patients: Association With Sleep Quality, Mood Status, and Disease Activity. ACTA ACUST UNITED AC 2018; 16:339-344. [PMID: 30139690 DOI: 10.1016/j.reuma.2018.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/11/2018] [Accepted: 07/19/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by polyarthritis and systemic manifestations. RA-fatigue is a significant problem and adds on disease burden. Sleep disturbance, depression, and disease activity are suggested contributing factors to RA-fatigue; however, their combined role did not examine before among Egyptian RA patients. The objective of the study was to investigate the presence of fatigue, sleep and mood disturbances in RA patients. Also, to evaluate the possible association of poor sleep, depression, and disease activity with RA-fatigue. METHODS This cross-sectional study included 115 RA patients diagnosed according to the 2010 ACR-EULAR criteria and 46 age and sex matched controls. Fatigue using the Multidimensional Assessment of Fatigue-Global Fatigue Index, sleep using the Pittsburgh Sleep Quality Index and mood status using Beck Depression Inventory were assessed for all participants. RA disease activity was evaluated using disease activity score-28 joints. RESULTS RA patients had higher mean fatigue, sleep disturbance, and depression scores (27.2±8.9, 6.4±3.6, and 12.8±7.3; respectively) than controls (22.7±7, 4.8±3, 7.8±5.9; respectively) (P<.05). Poor sleep, depression and higher disease activity were significantly correlated with fatigue (r=0.4, r=0.65, r=0.55; respectively) (P<.001). The three variables may explain up to 49.1% of the variation in fatigue on multiple regression analysis. CONCLUSION Fatigue, poor sleep, and depression are more common in Egyptian patients with RA. A remarkably higher fatigue was associated with poor sleep, depression, and high disease activity, thus monitoring these silent comorbidities in clinical practice is required.
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Affiliation(s)
- Nevin Hammam
- Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.
| | - Rania M Gamal
- Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt
| | - Ahmed Mohammed Rashed
- Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt
| | - Noha Abo Elfetoh
- Department of Neuropsychiatry, Assiut University Hospitals, Assiut, Egypt
| | - Eman Mosad
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Eman M Khedr
- Department of Neuropsychiatry, Assiut University Hospitals, Assiut, Egypt
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24
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Living with systemic lupus erythematosus in the developing world. Rheumatol Int 2018; 38:1601-1613. [DOI: 10.1007/s00296-018-4017-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/19/2018] [Indexed: 12/15/2022]
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25
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Du X, Zhao Q, Zhuang Y, Chen H, Shen B. Fatigue of systemic lupus erythematosus in China: contributors and effects on the quality of life. Patient Prefer Adherence 2018; 12:1729-1735. [PMID: 30233152 PMCID: PMC6134956 DOI: 10.2147/ppa.s170984] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Fatigue is a very common symptom of systemic lupus erythematosus (SLE), which significantly impairs patients' quality of life. The purpose of this study is to evaluate contributors of fatigue and effects of fatigue on the quality of life in Chinese SLE patients. METHODS A survey of 119 SLE patients using the Fatigue Severity Scale (FSS) to assess the severity of fatigue was carried out. SLE patients completed the Systemic Lupus Erythematosus Disease Activity Index, the Hospital Anxiety and Depression Scale, the Short Form 36 health survey and the Pittsburgh Sleep Quality Index. Meanwhile, 105 healthy individuals completed FSS, the Hospital Anxiety and Depression Scale and Short Form 36 health survey. We used chi-squared analysis, independent samples t-tests and logistic regression models to analyze data. RESULTS Our results found that the FSS score of patients with SLE was higher than that of healthy controls. The disease duration, anxiety, depression, subjective sleep quality and sleep disorders significantly correlated with fatigue in SLE patients. Moreover, logistic regression models showed depression and sleep disorders as predictors of fatigue. In SLE patients, fatigued patients had lower quality of life than those who were non-fatigued. CONCLUSION This is the first time to explore contributors of fatigue and the influence of fatigue on SLE patients' quality of life in China. Our study showed that depression and sleep disorders were predictors of fatigue, and fatigue seriously damaged SLE patients' quality of life. The results indicate that it is necessary to conduct holistic assessment and effective intervention, such as systemic psychiatric screening, psychological care and practical sleep guidance, to relieve symptoms of fatigue and finally improve their quality of life in SLE patients.
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Affiliation(s)
- Xian Du
- Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, China,
- School of Nursing, Nantong University, Nantong, China,
| | - Qian Zhao
- School of Nursing, Nantong University, Nantong, China,
| | - Yuan Zhuang
- School of Nursing, Nantong University, Nantong, China,
| | - Haoyang Chen
- Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, China,
| | - Biyu Shen
- Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, China,
- School of Nursing, Nantong University, Nantong, China,
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Katz PP, Andrews J, Yazdany J, Schmajuk G, Trupin L, Yelin E. Is frailty a relevant concept in SLE? Lupus Sci Med 2017; 4:e000186. [PMID: 28243456 PMCID: PMC5294024 DOI: 10.1136/lupus-2016-000186] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 12/29/2022]
Abstract
Objective In geriatric populations, frailty is associated with poor health outcomes, including mortality. Frailty has not been examined in lupus, although components of the phenotype seem relevant. Methods Women with lupus (n=152) participated in research visits in 2008–2009. Frailty was assessed by Fried's frailty phenotype criteria: low weight/unintentional weight loss, slow gait (4-m walk using sex and height criteria), weakness (grip strength using gender and body mass index criteria), exhaustion (2 specific questions) and inactivity (from physical activity questionnaire). Women accumulating 3+ components were classified as ‘frail’, one or two components as ‘prefrail’, and none as ‘robust’. Physical function (36-item Short Form (SF-36) Physical Functioning subscale and Valued Life Activities disability scale), cognitive function (from a 12-test battery) and mortality were examined as outcomes. Mortality was determined as of December 2015. Multiple regression analyses examined concurrent and 2-year function controlling for age, lupus duration, race/ethnicity, glucocorticoid use, obesity, self-reported disease activity and damage and, for longitudinal analyses, baseline function. Mortality analyses controlled for age, lupus duration and baseline disease damage scores. Results Mean age was 48 (±12) years, mean lupus duration was 16 (±9) years. 20% of the sample was classified as frail and 50% as prefrail. Frail women had significantly worse physical functioning than both robust and prefrail women and were more likely to have cognitive impairment. Frail women were also more likely to experience declines in functioning and onset of cognitive impairment. Mortality rates were significantly higher in the frail group (frail 19.4%; prefrail 3.9%; robust 2.3%). Odds (95% CI) of death for frail women were elevated, even after adjusting for age, lupus duration and baseline disease damage (5.9 (0.6 to 57.1)). Conclusions Prevalence of frailty in this sample of women with lupus was higher than in samples of older adults. Frailty was associated with poor physical and cognitive function, functional declines and mortality.
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Affiliation(s)
- Patricia P Katz
- University of California San Francisco , San Francisco, California , USA
| | - James Andrews
- University of Washington , Seattle, Washington , USA
| | - Jinoos Yazdany
- University of California San Francisco , San Francisco, California , USA
| | - Gabriela Schmajuk
- University of California San Francisco , San Francisco, California , USA
| | - Laura Trupin
- University of California San Francisco , San Francisco, California , USA
| | - Edward Yelin
- University of California San Francisco , San Francisco, California , USA
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27
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Kier AØ, Midtgaard J, Hougaard KS, Berggreen A, Bukh G, Hansen RB, Dreyer L. How do women with lupus manage fatigue? A focus group study. Clin Rheumatol 2016; 35:1957-1965. [PMID: 27225245 DOI: 10.1007/s10067-016-3307-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/14/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Half of patients with systemic lupus erythematosus (SLE) consider fatigue to be the most disabling disease symptom. To develop and promote strategies to prevent and control fatigue, this study aimed to describe how women with SLE manage the experience of fatigue. METHODS Four focus groups were conducted with 27 women with SLE, and data were analyzed by means of framework analysis. Two patient representatives with SLE were part of the investigator team. RESULTS The analysis revealed three main themes (i.e., learning how to be open about fatigue, learning to listen to the body, and learning to accept fatigue) and six sub-themes (i.e., the search for recognition, legitimization, planning and prioritizing, the body's limits and self-indulgence, adjusting life to comply with resources, and acceptance of dependence). CONCLUSION Fatigue is the controlling element in everyday life of women with SLE. Patients try to integrate fatigue into their everyday lives by attempting to control it and meet the challenges of structure and planning. This study indicates a need for clinicians to acknowledge patients' fatigue, including supporting patients' own resources, offering information, and conversation about fatigue, as well as involving patients' relatives.
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Affiliation(s)
- Anne Ørnholt Kier
- Department of Rheumatology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, 2900, Hellerup, Denmark.
| | - Julie Midtgaard
- The University Hospitals Centre for Health Care Research (UCSF), Copenhagen University Hospital Rigshospitalet, Department 9701, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Karin Sørig Hougaard
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | | | - Gunhild Bukh
- Department of Rheumatology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - Renata Baronaite Hansen
- Department of Rheumatology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - Lene Dreyer
- Department of Rheumatology, Herlev and Gentofte University Hospital, Kildegårdsvej 28, 2900, Hellerup, Denmark
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Katz P, Margaretten M, Trupin L, Schmajuk G, Yazdany J, Yelin E. Role of Sleep Disturbance, Depression, Obesity, and Physical Inactivity in Fatigue in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 68:81-90. [PMID: 25779719 DOI: 10.1002/acr.22577] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/17/2015] [Accepted: 03/03/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Fatigue is a major concern for individuals with rheumatoid arthritis (RA). However, in order to treat fatigue adequately, its sources need to be identified. METHODS Data were collected during a single home visit (number of participants = 158). All participants had physician-diagnosed RA. Assessments of self-reported sleep quality, depression, physical activity, RA disease activity, muscle strength, functional limitations, and body composition were made. Information on demographics, medications, and smoking was collected. The Fatigue Severity Inventory (FSI; measuring average fatigue over the past 7 days) was used as the primary outcome. Analyses were first conducted to evaluate bivariate relationships with fatigue. Correlations among risk factors were examined. Multivariate analyses identified independent predictors of fatigue. RESULTS The mean ± SD age was 59 ± 11 years, the mean ± SD disease duration was 21 ± 13 years, and 85% of subjects were female. The mean ± SD FSI rating was 3.8 ± 2.0 (range 0-10). In multivariate analyses, self-reported disease activity, poor sleep, depression, and obesity were independently associated with fatigue. Physical inactivity was correlated with poor sleep, depression, and obesity. Mediation analyses indicated that physical inactivity had an indirect association with fatigue, mediated by poor sleep, depression, and obesity. CONCLUSION This cross-sectional study suggests that fatigue may not be solely a result of RA disease activity, but may result from a constellation of factors that includes RA disease activity or pain, but also includes inactivity, depression, obesity, and poor sleep. The results suggest new avenues for interventions to improve fatigue in individuals with RA, such as increasing physical activity or addressing depression or obesity.
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29
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Mahieu MA, Ahn GE, Chmiel JS, Dunlop DD, Helenowski IB, Semanik P, Song J, Yount S, Chang RW, Ramsey-Goldman R. Fatigue, patient reported outcomes, and objective measurement of physical activity in systemic lupus erythematosus. Lupus 2016; 25:1190-9. [PMID: 26869353 DOI: 10.1177/0961203316631632] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/14/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Fatigue is a common symptom in systemic lupus erythematosus (SLE), and engaging in physical activity may reduce fatigue. We aimed to characterize relationships between fatigue, other health status measures assessed with the Patient Reported Outcomes Measurement Information System (PROMIS) instruments, and accelerometer-based physical activity measurements in patients with SLE. The internal consistency of each PROMIS measure in our SLE sample was also evaluated. METHODS This cross-sectional study analyzed 123 adults with SLE. The primary fatigue outcome was Fatigue Severity Scale score. Secondary outcomes were PROMIS standardized T-scores in seven health status domains. Accelerometers were worn for seven days, and mean daily minutes of light, moderate/vigorous, and bouted (10 minutes) moderate/vigorous physical activity were estimated. Cronbach's alpha was determined for each PROMIS measure to assess internal consistency. Relationships between Fatigue Severity Scale, PROMIS, and physical activity were summarized with Spearman partial correlation coefficients (r), adjusted for average daily accelerometer wear time. RESULTS Mean Fatigue Severity Scale score (4.3, SD 1.6) was consistent with clinically relevant levels of fatigue. Greater daily and bouted moderate/vigorous physical activity minutes correlated with lower Mean Fatigue Severity Scale score (r = -0.20, p = 0.03 and r = -0.30, p = 0.0007, respectively). For PROMIS, bouted moderate/vigorous physical activity minutes correlated with less fatigue (r = -0.20, p = 0.03). PROMIS internal consistency was excellent, with Cronbach's alpha > 0.90 for each domain. Mean PROMIS T-scores for fatigue, pain interference, anxiety, sleep disturbance, sleep-related impairment, and physical function were worse than reported for the general US population. More moderate/vigorous physical activity minutes were associated with less pain interference (r = -0.22, p = 0.01). Both light physical activity and moderate/vigorous physical activity minutes correlated with better physical function (r = 0.19, p = 0.04 and r = 0.25, p = 0.006, respectively). CONCLUSION More time spent in moderate/vigorous physical activity was associated with less fatigue (Fatigue Severity Scale and PROMIS), less pain interference, and better physical function (PROMIS). PROMIS had excellent internal consistency in our SLE sample, and six of seven PROMIS measures indicated poorer average health status in SLE patients compared with the general US population.
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Affiliation(s)
- M A Mahieu
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - G E Ahn
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Arthritis and Rheumatism Associates, Wheaton, MD, USA
| | - J S Chmiel
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D D Dunlop
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - I B Helenowski
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - P Semanik
- Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, IL, USA
| | - J Song
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Yount
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R W Chang
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R Ramsey-Goldman
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Pollard C, Hartz S, Leage SL, Paget MA, Cook J, Enstone A. Elicitation of health state utilities associated with varying severities of flares in Systemic Lupus Erythematosus. Health Qual Life Outcomes 2015; 13:66. [PMID: 26018556 PMCID: PMC4445979 DOI: 10.1186/s12955-015-0262-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background Systemic Lupus Erythematosus (SLE) is characterised by fluctuating periods of minimal disease activity and ‘flare’. Flare is an important outcome variable impacting the disease burden associated with SLE. The objective of this study was to obtain population-based utility values for varying severities of flare to measure the impact on health-related quality of life (HRQoL) in Australia, Canada, France, Japan, Spain and the UK. Methods Six health states (HS) for varying severities of flare were developed based on literature, patient blogs, and interviews with patients (n = 12), rheumatologists (n = 7) and nurses (n = 2). HS were validated by independent clinical experts (n = 6) and pilot interviews (n = 10, UK). HS were evaluated using the time-trade-off (TTO) method during face-to-face interviews with a minimum representative sample (n = 100) of the general population, per-country. Visual Analog Scale (VAS) scores were obtained to validate TTO scores. TTO scores were converted into utility values. Results The highest mean TTO utility scores were observed for the anchor HS (minimal disease activity) across all countries; means ranged from 0.66 in Japan to 0.82 in UK. All flare HS were associated with a disutility compared with the anchor HS (p < 0.001), means ranged across countries: mild flare HS: 0.55–0.71, moderate flare HS: 0.38–0.53, severe renal flare HS: 0.33–0.45, severe central nervous system (CNS) flare HS: 0.30–0.45 and severe generalised flare HS: 0.19–0.33. Mean VAS scores followed the same trend. Conclusions These results show increasing severity of flare has a detrimental impact on HRQoL. The severe generalised flare HS received the lowest mean utility score suggesting that the perceived day-to-day impact of a severe generalised flare was greater than a severe CNS or severe renal flare. This is, to the best of our knowledge, the first utility study to assess varying severities of flare in SLE across six different countries.
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Affiliation(s)
- C Pollard
- Adelphi Values, Adelphi Mill, Bollington, Macclesfield, SK10 5JB, Cheshire, UK.
| | - S Hartz
- Eli Lilly, Erl Wood Manor, Windlesham, GU20 6PH, Surrey, UK.
| | - S Liu Leage
- Eli Lilly, Erl Wood Manor, Windlesham, GU20 6PH, Surrey, UK.
| | - M A Paget
- Eli Lilly, Erl Wood Manor, Windlesham, GU20 6PH, Surrey, UK.
| | - J Cook
- Adelphi Values, Adelphi Mill, Bollington, Macclesfield, SK10 5JB, Cheshire, UK.
| | - A Enstone
- Adelphi Values, Adelphi Mill, Bollington, Macclesfield, SK10 5JB, Cheshire, UK.
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The Lived Experience of Lupus Flares: Features, Triggers, and Management in an Australian Female Cohort. Int J Chronic Dis 2014; 2014:816729. [PMID: 26464865 PMCID: PMC4590935 DOI: 10.1155/2014/816729] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/23/2014] [Indexed: 01/09/2023] Open
Abstract
Individuals living with lupus commonly experience daily backgrounds of symptoms managed to acceptable tolerance levels to prevent organ damage. Despite management, exacerbation periods (flares) still occur. Varied clinical presentations and unpredictable symptom exacerbation patterns provide management and assessment challenges. Patient perceptions of symptoms vary with perceived impact, lifestyles, available support, and self-management capacity. Therefore, to increase our understanding of lupus' health impacts and management, it was important to explore lupus flare characteristics from the patient viewpoint. Lupus flares in 101 Australian female patients were retrospectively explored with the use of a novel flare definition. Qualitative methods were used to explore patient-perceived flare symptoms, triggers, and management strategies adopted to alleviate symptom exacerbations. A mean of 29.9 flare days, with 6.8 discrete flares, was experienced. The study confirmed that patients perceive stress, infection, and UV light as flare triggers and identified new potential triggers of temperature and weather changes, work, and chemical exposure from home cleaning. The majority of flares were self-managed with patients making considered management choices without medical input. Barriers to seeking medical support included appointment timings and past negative experiences reflecting incongruence between clinician and patient views of symptom impact, assessment, and ultimately flare occurrence.
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