1
|
Tsoi A, Gomez A, Boström C, Pezzella D, Chow JW, Girard-Guyonvarc'h C, Stamm T, Arnaud L, Parodis I. Efficacy of lifestyle interventions in the management of systemic lupus erythematosus: a systematic review of the literature. Rheumatol Int 2024; 44:765-778. [PMID: 38451302 PMCID: PMC10980639 DOI: 10.1007/s00296-024-05548-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/24/2024] [Indexed: 03/08/2024]
Abstract
We performed a systematic review to explore existing evidence regarding the efficacy of lifestyle interventions for the management of systemic lupus erythematosus (SLE). The search was conducted on the 22nd of June 2021 for publications between 1st of January 2000 and the date of search. Additional articles within the aforementioned timeframe and until December 2023 were added by hand searching. Databases utilized were Medline, Embase, Web of Science, and Cinahl. Lifestyle interventions were defined as any intervention encompassing one or more of the following: physical exercise, diet and nutrition, mental health, harmful exposures, sleep, and social relations. The Joanna Briggs Institute critical appraisal tools were used for risk of bias assessment. The search yielded 11,274 unique records, we assessed the full text of 199 records, and finally included 102 studies. Overall, the quality of the evidence is limited, and there were multiple sources of heterogeneity. The two domains most extensively researched were mental health (40 records) and physical exercise (39 records). Psychological interventions had a positive effect on depressive symptoms, anxiety, and health-related quality of life (HRQoL), whereas physical exercise improved fatigue, depressive symptoms, aerobic capacity, and physical functioning. Studies on diet and nutrition (15 records) support that low fat intake and Mediterranean diet may be beneficial for reducing cardiovascular risk, but large interventional studies are lacking. Studies on harmful exposures (7 records) support photoprotection and use of sunscreen. While studies imply benefits regarding disease burden and drug efficacy in non-smokers and regarding HRQoL in normal-weight patients, more survey is needed on tobacco smoking and alcohol consumption, as well as weight control strategies. Studies on social relations (1 record) and sleep (no records) were sparse or non-existent. In conclusion, psychosocial interventions are viable for managing depressive symptoms, and exercise appears essential for reducing fatigue and improving aerobic capacity and physical function. Photoprotection should be recommended to all patients. Lifestyle interventions should be considered a complement, not a substitute, to pharmacotherapy.
Collapse
Affiliation(s)
- Alexander Tsoi
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Denise Pezzella
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jun Weng Chow
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Girard-Guyonvarc'h
- Division of Rheumatology, Department of Medicine, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Laurent Arnaud
- Department of Rheumatology, Hôpitaux Universitaires de Strasbourg, Centre National de Référence (RESO), INSERM UMR-S 1109, Strasbourg, France
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| |
Collapse
|
2
|
Parodis I, Gomez A, Tsoi A, Chow JW, Pezzella D, Girard C, Stamm TA, Boström C. Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. RMD Open 2023; 9:e003297. [PMID: 37532469 PMCID: PMC10401222 DOI: 10.1136/rmdopen-2023-003297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Through this systematic literature review, we assembled evidence to inform the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). We screened articles published between January 2000 and June 2021. Studies selected for data extraction (118 for SLE and 92 for SSc) were thematically categorised by the character of their intervention. Of 208 articles included, 51 were classified as robust in critical appraisal. Physical activity was the most studied management strategy and was found to be efficacious in both diseases. Patient education and self-management also constituted widely studied topics. Many studies on SLE found psychological interventions to improve quality of life. Studies on SSc found phototherapy and laser treatment to improve cutaneous disease manifestations. In summary, non-pharmacological management of SLE and SSc encompasses a wide range of interventions, which can be combined and provided either with or without adjunct pharmacological treatment but should not aim to substitute the latter when this is deemed required. While some management strategies i.e., physical exercise and patient education, are already established in current clinical practice in several centres, others e.g., phototherapy and laser treatment, show both feasibility and efficacy, yet require testing in more rigorous trials than those hitherto conducted.
Collapse
Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Tsoi
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jun Weng Chow
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Denise Pezzella
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Girard
- Division of Rheumatology, Department of Medicine, University of Geneva, Geneva, Switzerland
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Vienna, Austria
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
3
|
Galoppini G, Marangoni A, Cirilli F, Ruffilli F, Garaffoni C, Govoni M, Scirè CA, Silvagni E, Bortoluzzi A. Optimizing Patient Care: A Systematic Review of Multidisciplinary Approaches for SLE Management. J Clin Med 2023; 12:4059. [PMID: 37373752 DOI: 10.3390/jcm12124059] [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: 05/08/2023] [Revised: 06/10/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is characterized by multisystemic clinical manifestations ranging from a relatively mild involvement to potentially life-threatening complications. Due to this complexity, a multidisciplinary (MD) approach is the best strategy for optimizing patients' care. The main aim of this systematic literature review (SLR) was to scrutinize the published data regarding the MD approach for the management of SLE patients. The secondary objective was to evaluate the outcomes of the MD approach in SLE patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used. We performed an SLR to retrieve articles available in English or Italian listed in PubMed, Embase, Cinahl, and Cochrane Library concerning the MD approach used in observational studies and clinical trials. Four independent reviewers performed the study selection and data collection. Of 5451 abstracts evaluated, 19 studies were included in the SLR. The MD approach was most frequently described in the context of SLE pregnancy, reported in 10 papers. MD teams were composed of a rheumatologist, except for one cohort study; a gynecologist; a psychologist; a nurse; and other health professionals. MD approaches had a positive impact on pregnancy-related complications and disease flares and improved SLE psychological impact. Although international recommendations advise an MD approach for managing SLE, our review highlighted the paucity of data supporting this strategy, with most of the available evidence on the management of SLE during pregnancy.
Collapse
Affiliation(s)
- Giorgio Galoppini
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Cona, Italy
| | - Antonio Marangoni
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Cona, Italy
| | - Francesca Cirilli
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Cona, Italy
| | - Francesca Ruffilli
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Cona, Italy
| | - Carlo Garaffoni
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Cona, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Cona, Italy
| | | | - Ettore Silvagni
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Cona, Italy
| | - Alessandra Bortoluzzi
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Cona, Italy
| |
Collapse
|
4
|
Jolly M, Katz P. Predictors of stress in patients with Lupus. Front Med (Lausanne) 2022; 9:986968. [PMID: 36250087 PMCID: PMC9556948 DOI: 10.3389/fmed.2022.986968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background Stress is common in patients with Systemic Lupus Erythematosus (SLE), and is associated with depression, fatigue, and disease flares. Stress may be modifiable and identifying those at high risk allows clinicians and allied health care professionals to develop a multidisciplinary management plan to direct appropriate resources. This study is aimed at identifying predictors of high stress over time among patients with SLE. Methods Longitudinal data from two interviews of the Lupus Outcomes Study 2 years apart from 726 patients with SLE were analyzed for stress, measured using the Perceived Stress Scale (PSS; high-stress PSS ≥6). T-test and Chi-square analyses compared patient characteristics by high-stress status. Logistic regressions were conducted with high stress as the dependent variable. Covariates included demographics, disease features, quality of life (QOL), health care utilization (HCU), and comorbidities. QoL was measured using the SF-36 form (Physical Component Score, PCS; Mental Component Score, MCS) and MOS Cognitive Functioning Scale (CFS). HCU indicated having established care with a rheumatologist, use of an emergency room or hospitalization, and quality of care. P ≤ 0.05 were considered significant. Results The mean age of the cohort was 50.6 (12.5) years, 92% were women and 68% were Caucasian. The mean (SD) PSS was 5.3 (3.6), and high stress (PSS >6) was noted in 253 participants. Those with high stress were more frequently below the poverty line and less commonly employed. They had a greater prevalence of comorbidities and HCU; and worse disease severity (activity, flare, damage) and QOL. In regression analyses, high stress (baseline) was associated with younger age, married status, worse QOL, and presence of diabetes. Better QOL (PCS, MCS) independently predicted decreased odds of high stress, while high stress (baseline) predicted high stress (OR 3.16, 95% CI 1.85, 5.37, p < 0.0001) at follow-up, after adjusting for demographics, disease features, HCU, and comorbidities. Conclusion Patients with SLE should be routinely screened for QOL and stress during their clinical care, to identify those at risk for poor health outcomes. This information can facilitate multidisciplinary management for those at risk for worse health outcomes.
Collapse
Affiliation(s)
- Meenakshi Jolly
- Department of Medicine, Rush University Medical Center, Chicago, IL, United States
- *Correspondence: Meenakshi Jolly
| | - Patricia Katz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
5
|
Kasitanon N, Hamijoyo L, Li MT, Oku K, Navarra S, Tanaka Y, Mok CC. Management of non-renal manifestations of systemic lupus erythematosus: A systematic literature review for the APLAR consensus statements. Int J Rheum Dis 2022; 25:1220-1229. [PMID: 35916201 DOI: 10.1111/1756-185x.14413] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/31/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022]
Abstract
The prevalence of systemic lupus erythematosus (SLE) is higher in Asians than Caucasians, with higher frequency of renal and other major organ manifestations that carry a poorer prognosis. The outcome of SLE is still unsatisfactory in many parts of the Asia Pacific region due to limited access to healthcare systems, poor treatment adherence and adverse reactions to therapies. The Asia Pacific League of Associations for Rheumatology (APLAR) SLE special interest group has recently published a set of consensus recommendation statements for the management of SLE in the Asia Pacific region. The current article is a supplement of systematic literature search (SLR) to the prevalence and treatment of non-renal manifestations of SLE in Asian patients.
Collapse
Affiliation(s)
- Nuntana Kasitanon
- Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Laniyati Hamijoyo
- Rheumatology Division, Department of Internal Medicine, Padjadjaran University, Bandung, Indonesia
| | - Meng Tao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Kenji Oku
- Department of Rheumatology, Endocrinology and Nephrology Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sandra Navarra
- Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Chi Chiu Mok
- Division of Rheumatology, Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
| |
Collapse
|
6
|
Narupan N, Seeherunwong A, Pumpuang W. Prevalence and biopsychosocial factors associated with depressive symptoms among patients living with systemic lupus erythematosus in clinical settings in urban Thailand. BMC Psychiatry 2022; 22:103. [PMID: 35139821 PMCID: PMC8830079 DOI: 10.1186/s12888-022-03739-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/27/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Depressive symptoms are globally recognized as a significant mental health problem in patients with chronic disease, particularly those with systemic lupus erythematosus (SLE). The purpose of this study was to estimate the prevalence and examine biopsychosocial factors of depressive symptoms among patients with SLE. METHODS This cross-sectional study was conducted among 185 participants diagnosed with SLE and received treatment for at least 3 months, aged 18-59 years attending the outpatient clinic of a university hospital, Bangkok, Thailand. Depressive symptoms were measured by the Thai version of the Patient Health Questionnaire-9. We assessed Demographic data, the Systemic Lupus Erythematosus Activity Index, the Systemic Lupus International Collaborating Clinics Damage Index, Numeric Rating Scale, Fatigue Severity Scale, Body Image Scale, and the ENRICHD Social Support Instrument. Data were collected from March to May 2021. Multivariable logistic regression was used to analyze the data. RESULTS The proportion of the participants with depressive symptoms was 43.2%, which 8.1% of those patients presented moderate to severe depressive symptoms. In a multivariable logistic regression model, SLE patients with depressive symptoms were more likely to be severe pain (aOR = 12.11, 95% CI: 1.35, 108.46), fatigue (aOR = 2.36, 95%CI: 1.08, 5.14), taking prednisolone ≥15 mg daily (aOR = 5.75, 95%CI: 1.76, 18.80), low satisfied of body image (aOR = 12.49, 95%CI: 2.23, 69.80), and low social support (aOR = 17.96, 95% CI: 1.86, 173.77). Disease flare, organ damage, and family income sufficiency did not significantly increase the risk of depressive symptoms in patients with SLE. CONCLUSIONS The findings highlight depressive symptoms in patients with SLE. Therefore, the health professional should be concerned about the perception of body image, level of social support, fatigue, and pain while treating patients with SLE. Public health screening programs to identify depressive symptoms in patients with SLE are needed. In addition, a high dose of prednisolone should be considered if required, along with monitoring.
Collapse
Affiliation(s)
- Nirunya Narupan
- grid.10223.320000 0004 1937 0490M.N.S. Candidate, Faculty of Nursing, Mahidol University, Bangkok, Thailand ,grid.10223.320000 0004 1937 0490Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Acharaporn Seeherunwong
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
| | - Walailak Pumpuang
- grid.10223.320000 0004 1937 0490Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| |
Collapse
|
7
|
Strand V, Simon LS, Meara AS, Touma Z. Measurement properties of selected patient-reported outcome measures for use in randomised controlled trials in patients with systemic lupus erythematosus: a systematic review. Lupus Sci Med 2021; 7:7/1/e000373. [PMID: 32591423 PMCID: PMC7319706 DOI: 10.1136/lupus-2019-000373] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/17/2020] [Accepted: 05/24/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The heterogeneous multisystem manifestations of SLE include fatigue, pain, depression, sleep disturbance and cognitive dysfunction, and underscore the importance of a multidimensional approach when assessing health-related quality of life. The US Food and Drug Administration has emphasised the importance of patient-reported outcomes (PROs) for approval of new medications and Outcome Measures in Rheumatology has mandated demonstration of appropriate measurement properties of selected PRO instruments. METHODS Published information regarding psychometric properties of the Medical Outcomes Survey Short Form 36 (SF-36), Lupus Quality of Life Questionnaire (LupusQoL) and Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F), and their suitability as end points in randomised controlled trials (RCTs) and longitudinal observational studies (LOS) were assessed. A search of English-language literature using MEDLINE and EMBASE identified studies related to development and validation of these instruments. Evidence addressed content validity, reliability (internal consistency and test-retest reliability), construct validity (convergent and divergent) and longitudinal responsiveness, including thresholds of meaning and discrimination. RESULTS All instruments demonstrated strong internal consistency, reliability and appropriate face/content validity, indicating items within each instrument that measure the intended concept. SF-36 and LupusQoL demonstrated test-retest reliability; although not published with FACIT-F in SLE supported by evidence from other rheumatic diseases. All instruments demonstrated convergent validity with other comparable PROs and responsivity to treatment. CONCLUSION The measurement properties of PRO instruments with published data from RCTs including: SF-36, LupusQoL and FACIT-F indicate their value as secondary end points to support labelling claims in RCTs and LOS evaluating the efficacy of SLE treatments.
Collapse
Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
| | | | | | - Zahi Touma
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Chang A, Winquist NW, Wescott AB, Lattie EG, Graham AK. Systematic review of digital and non-digital non-pharmacological interventions that target quality of life and psychological outcomes in adults with systemic lupus erythematosus. Lupus 2021; 30:1058-1077. [PMID: 33779388 DOI: 10.1177/09612033211005085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with systemic lupus erythematous (SLE) experience psychological comorbidities and impaired quality of life (QOL). We conducted a systematic review to examine the efficacy of non-pharmacological interventions for improving psychological outcomes and/or QOL in patients with SLE. To expand on a previous systematic review in this area and enhance our understanding of efficacious interventions for this population, our search included quasi-experimental and experimental studies of interventions delivered or supported by remote methods (including digitally) or in person. METHODS A comprehensive literature search was conducted with a research librarian using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered before data extraction on the international prospective register of systematic reviews PROSPERO Web site (CRD42020154962). The search included controlled-vocabulary and title/abstract terms related to non-pharmacological interventions for SLE published through October 2019 in MEDLINE (Ovid), Cochrane Library databases (Wiley), Embase (Elsevier), CINAHL (EBSCO), PsycINFO (EBSCO), Web of Science (Clarivate), ACM Digital (Association of Computer Machinery), and IEEE Xplore. Studies were synthesized using a systematic narrative synthesis framework. Risk of bias was assessed. RESULTS Twenty-three studies were included: 21 randomized controlled trials and two quasi-experimental studies. Non-pharmacological diet, physical activity, psychological, and course-based interventions improved QOL and psychological outcomes, and were delivered in traditional settings (e.g., hospital) or remotely. No studies assessing digital non-pharmacological interventions were identified in our search. Quality assessments showed serious risk of bias for the two quasi-experimental studies, and high risk of bias in a subset of experimental studies. CONCLUSIONS Non-pharmacological interventions benefit patients with SLE. Future research should include more representative samples in rigorous evaluations and consider ways to incorporate digital technologies to increase accessibility.
Collapse
Affiliation(s)
- Angela Chang
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan W Winquist
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annie B Wescott
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
9
|
Kernder A, Elefante E, Chehab G, Tani C, Mosca M, Schneider M. The patient's perspective: are quality of life and disease burden a possible treatment target in systemic lupus erythematosus? Rheumatology (Oxford) 2020; 59:v63-v68. [PMID: 33280017 PMCID: PMC7719037 DOI: 10.1093/rheumatology/keaa427] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
A few decades ago, the therapy goal of patients with systemic lupus erythematosus (SLE) was survival and the prevention of organ failure. Today, clinical remission and low disease activity are believed to be the optimal therapeutic targets. These aims are difficult to reach for many patients, but they still do not address the health-related quality of life (QoL) that is significantly impaired in SLE patients. Even in the state of remission, QoL and fatigue are insufficient controlled. Thus, patient-oriented research is essential to design new strategies for the management of lupus patients. The INTEGRATE project analyses the patients' and physicians' perspectives to pave the way to design an innovative therapeutic strategy for lupus and focuses on the multifaceted dimensions of the disease burden. Shared decision making (SDM) could include the patient's perspective of SLE to treatment strategy and consider QoL and the burden of lupus into the process of therapy decision.
Collapse
Affiliation(s)
- Anna Kernder
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gamal Chehab
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matthias Schneider
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| |
Collapse
|
10
|
Holtmaat K, van der Spek N, Lissenberg-Witte B, Breitbart W, Cuijpers P, Verdonck-de Leeuw I. Long-term efficacy of meaning-centered group psychotherapy for cancer survivors: 2-Year follow-up results of a randomized controlled trial. Psychooncology 2020; 29:711-718. [PMID: 31876012 PMCID: PMC7199891 DOI: 10.1002/pon.5323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/28/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Meaning-centered group psychotherapy for cancer survivors (MCGP-CS) is an effective intervention to improve personal meaning, psychological well-being, and depressive symptoms until 6 months after the intervention. In this study, the long-term effects of MCGP-CS (i.e., at 1- and 2-year follow-up) on meaning, psychological well-being and posttraumatic growth were assessed, in comparison to supportive group psychotherapy (SGP) and care as usual (CAU). METHODS Cancer survivors (n = 170) were randomized into MCGP-CS, SGP, or CAU. Assessments were scheduled at baseline, 1 week, 3 months, 6 months, 1 year, and 2 years postintervention. Outcome measures were the Personal Meaning Profile, Ryff's Scales of Psychological Well-Being (SPWB), the Posttraumatic Growth Inventory, and their subscales. Linear mixed models (LMM) were used and results were both reported on an intention-to-treat (ITT) basis, as well as for intervention completers only. RESULTS LMM and post hoc analyses with Bonferroni correction revealed that MCGP-CS participants reported more improvement on positive relations (subscale of SPWB) than CAU participants of 2-year postintervention (ITT analysis, Cohen's d = .82). Completers also reported more personal growth (subscale of SPWB) after MCGP-CS than after SGP 1-year postintervention (Cohen's d = .94). No long-term effects were found on the other outcome measures. CONCLUSIONS In the 2 years after MCGP-CS, the short-term significant effects on personal meaning and most positive effects related to psychological well-being faded. However, MCGP-CS had a long-term positive effect on positive relations with others and on survivors' sense of personal growth. TRIAL REGISTRATION Netherlands Trial Register: NTR3571.
Collapse
Affiliation(s)
- Karen Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute (APH), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam (CCA), Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands
| | - Nadia van der Spek
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute (APH), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam (CCA), Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands.,IDC Center for Psycho-Oncology Care, OLVG Hospital, Amsterdam, The Netherlands
| | - Birgit Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute (APH), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Irma Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute (APH), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam (CCA), Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands.,Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC, Amsterdam, The Netherland
| |
Collapse
|
11
|
Psychological distress and quality of life are improved in autoimmune patients through Tandem-Psychotherapy, combining individual hypnosis and eye movement desensitization and reprocessing (EMDR) treatment for trauma, followed by supportive-expressive group therapy. Clin Rheumatol 2019; 39:1331-1339. [PMID: 31858339 DOI: 10.1007/s10067-019-04862-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/09/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Autoimmune diseases are associated with psychological distress, resulting in greatly impaired quality of life. Tandem-Psychotherapy comprises trauma-focused psychotherapy with hypnosis and eye movement desensitization and reprocessing (EMDR), followed by supportive-expressive group therapy. The objective was to evaluate whether Tandem-Psychotherapy could reduce psychological distress and improve quality of life. METHODS In a case-control study, 45 patients were divided into two groups: 24 patients in the therapy group (TG) and 21 in the control group (CG). The autoimmune diagnoses were undifferentiated connective tissue disease (9 patients in TG and 12 in CG), Behçet's syndrome (4/TG, 5/CG), mixed connective tissue disease (3/TG, 1/CG), and other diagnoses (8/TG and 3/CG). At start of treatment point, the patients were evaluated with SCL-90-R for distress and psychological symptoms, Life Stressor Checklist-Revised for relevant trauma, and SF-36 for quality of life. SF36 and SCL-90 were repeated at the end of treatment and at 6-month follow-up. RESULTS Relevant trauma was found in 24/24 TG patients and in 17/21 CG. Eighteen out of twenty-four TG patients exhibited psychiatric comorbidity with 18/21 in the CG. At start of treatment, all patients exhibited high level of distress (GSI > 0.5) and high Depression and Anxiety scores in SCL-90-R. At end of therapy, the TG exhibited greatly improved GSI (p < 0.001), Depression (p < 0.001), and Anxiety (p < 0.001) compared with the GC; SF-36 scores were also much better in the TG, with significant differences ranging from p = 0.002 to p = 0.0004 at end of therapy. These results persisted at the 6-month follow-up. CONCLUSIONS Tandem-Psychotherapy is effective for improving psychological symptoms and quality of life in autoimmune patients with high levels of distress and relevant psychiatric comorbidity.Key Points• Psychological distress is very high in autoimmune patients, often for previous traumatic experiences.• Psychological support must be both trauma-focused and aimed to improve social functioning.• Quality of life is very much improved by reducing psychological distress.• Tandem-Psychotherapy is feasible because it is contained within a relatively limited time, also for patients with history of trauma.
Collapse
|
12
|
Fangtham M, Kasturi S, Bannuru RR, Nash JL, Wang C. Non-pharmacologic therapies for systemic lupus erythematosus. Lupus 2019; 28:703-712. [PMID: 30961418 DOI: 10.1177/0961203319841435] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Non-pharmacologic therapies have been deemed as potentially beneficial for patients with systemic lupus erythematosus. We conducted an updated review to determine the effects of these therapies to inform practice. METHODS A literature search was performed using PubMed (MEDLINE), EMBASE, Cochrane, PsychINFO, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Google Scholar from inception until August 2018. We included randomized controlled trials of non-pharmacologic therapies in systemic lupus erythematosus patients with sample size ≥10. Systemic lupus erythematosus was defined by 1982 or 1997 American College of Rheumatology criteria. Studies were synthesized separately by patient-reported outcomes and disease activity. Due to the heterogeneity of interventions and comparisons, a meta-analysis was not performed. RESULTS A total of 15 randomized controlled trials involving 846 participants met the inclusion criteria. Of the 15 trials, eight used exercise interventions, six used psychological interventions (one group psychotherapy, three cognitive behavioral therapies, one psychoeducation, one mindfulness-based cognitive therapy) and one used electro-acupuncture. Five of 15 studies utilized control groups consisting of usual medical care. Other studies included control interventions of relaxation, attention placebo, symptom monitoring support, education, minimal needling, isotonic and resistance exercise. Compared with the control conditions, non-pharmacological interventions were associated with a significant improvement in fatigue in three out of six studies. Three out of eight studies reported improved anxiety and depression, and one study reported improved pain after interventions. Seven out of 11 studies reported improvement in overall quality of life in at least one domain of the Short-Form Health Survey. Of note, no studies demonstrated an improvement in disease activity after 5-52 weeks of non-pharmacological therapies. CONCLUSION This review showed promising results for physical exercise and psychological interventions as adjuncts to traditional medical therapy for improvement in fatigue, depression, pain and quality of life for systemic lupus erythematosus. Further high-quality randomized controlled trials with longer follow-up periods are warranted.
Collapse
Affiliation(s)
- M Fangtham
- 1 Division of Rheumatology, University of New Mexico, Albuquerque, NM, USA
| | - S Kasturi
- 2 Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - R R Bannuru
- 3 Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - J L Nash
- 4 Health Sciences Library and Informatics Center, University of New Mexico, Albuquerque, NM, USA
| | - C Wang
- 3 Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
13
|
Flournoy-Floyd M, Ortiz K, Egede L, Oates JC, Faith TD, Williams EM. "We Would Still Find Things to Talk About": Assessment of Mentor Perspectives in a Systemic Lupus Erythematosus Intervention to Improve Disease Self-Management, Empowering SLE Patients. J Natl Med Assoc 2018; 110:182-189. [PMID: 29580453 PMCID: PMC6931279 DOI: 10.1016/j.jnma.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder with significant disparate impact on African American women. The current study sought to highlight how the Peer Approaches to Lupus Self-management (PALS) intervention worked bi-directionally wherein both women with SLE leading the disease self-management program (mentors), and those participants who served as mentees, were empowered toward greater disease self-efficacy. METHODS Data was captured for this study in two formats from the seven mentors participating in the pilot study: 1) mentor logs and 2) mentor interviews with the principle investigator. This information was then analyzed for themes relating to their experience within the study. RESULTS We found that empowerment was facilitated by mentors taking their mentorship responsibilities seriously and seeking several avenues for collaboratively developing success with their mentees. Mentors reported that although challenges arose, their desire for success resulted in multiple approaches to be flexible and responsive to the needs of their mentees. Additionally, reciprocity was found to be a vital element of the program. CONCLUSIONS Key thematic areas supported our ability to demonstrate the usefulness of a peer mentoring program for SLE disease self-management on evoking empowerment through reciprocal relationships among mentors and mentees within our study population. Furthermore the feedback from PALS participants yielded very rich and contextual information that can be used as a thematic guide for developing and refining evidence-based interventions that seek to incorporate empowerment into disease self-management efforts for women suffering from SLE.
Collapse
Affiliation(s)
- Minnjuan Flournoy-Floyd
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857, USA
| | - Kasim Ortiz
- University of New Mexico, Department of Sociology, MSC05 3080 1915 Roma NE Ste. 1103, Albuquerque NM 87131-0001, USA
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Clinical Cancer Center Building, 5th Floor, Suite C5400, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA
| | - Jim C Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, USA; Rheumatology Section, Ralph H. Johnson VA Medical Center 109 Bee Street, Charleston, SC 29401, USA
| | - Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA
| | - Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| |
Collapse
|
14
|
Williams EM, Egede L, Faith T, Oates J. Effective Self-Management Interventions for Patients With Lupus: Potential Impact of Peer Mentoring. Am J Med Sci 2017; 353:580-592. [PMID: 28641721 PMCID: PMC6249683 DOI: 10.1016/j.amjms.2017.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/28/2016] [Accepted: 01/20/2017] [Indexed: 01/22/2023]
Abstract
Systemic lupus erythematosus (SLE) is associated with significant mortality, morbidity and cost for the individual patient and society. In the United States, African Americans (AAs) have 3-4 times greater prevalence of lupus, risk of developing lupus at an earlier age and lupus-related disease activity, organ damage and mortality compared with whites. Evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function and delayed disability among patients with lupus. However, AAs and women are still disproportionately affected by lupus. This article presents the argument that peer mentoring may be an especially effective intervention approach for AA women with SLE. SLE peers with a track record of success in lupus management and have a personal perspective that clinicians often lack. This commonality and credibility can establish trust, increase communication and, in turn, decrease disparities in healthcare outcomes.
Collapse
Affiliation(s)
- Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Trevor Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - James Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina; Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| |
Collapse
|
15
|
Williams EM, Lorig K, Glover S, Kamen D, Back S, Merchant A, Zhang J, Oates JC. Intervention to Improve Quality of life for African-AmericaN lupus patients (IQAN): study protocol for a randomized controlled trial of a unique a la carte intervention approach to self-management of lupus in African Americans. BMC Health Serv Res 2016; 16:339. [PMID: 27485509 PMCID: PMC4971708 DOI: 10.1186/s12913-016-1580-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic Lupus Erythematosus (lupus) is a chronic autoimmune disease that can impact any organ system and result in life-threatening complications. African-Americans are at increased risk for morbidity and mortality from lupus. Self-management programs have demonstrated significant improvements in health distress, self-reported global health, and activity limitation among people with lupus. Despite benefits, arthritis self-management education has reached only a limited number of people. Self-selection of program could improve such trends. The aim of the current study is to test a novel intervention to improve quality of life, decrease indicators of depression, and reduce perceived and biological indicators of stress in African-American lupus patients in South Carolina. METHODS/DESIGN In a three armed randomized, wait list controlled trial, we will evaluate the effectiveness of a patient-centered 'a-la-carte' approach that offers subjects a variety of modes of interaction from which they can choose as many or few as they wish, compared to a 'set menu' approach and usual care. This unique 'a-la-carte' self-management program will be offered to 50 African-American lupus patients participating in a longitudinal observational web-based SLE Database at the Medical University of South Carolina. Each individualized intervention plan will include 1-4 options, including a mail-delivered arthritis kit, addition and access to an online message board, participation in a support group, and enrollment in a local self-management program. A 'set menu' control group of 50 lupus patients will be offered a standardized chronic disease self-management program only, and a control group of 50 lupus patients will receive usual care. Outcomes will include changes in (a) health behaviors, (b) health status, (c) health care utilization, and (d) biological markers (urinary catecholamines). DISCUSSION Such a culturally sensitive educational intervention which includes self-selection of program components has the potential to improve disparate trends in quality of life, disease activity, depression, and stress among African-American lupus patients, as better outcomes have been documented when participants are able to choose/dictate the content and/or pace of the respective treatment/intervention program. Since there is currently no "gold standard" self-management program specifically for lupus, this project may have a considerable impact on future research and policy decisions. TRIAL REGISTRATION NCT01837875 ; April 18, 2013.
Collapse
Affiliation(s)
- Edith M. Williams
- Department of Public Health Sciences, Department of Medicine, Division of Rheumatology, Core Investigator, MUSC Center for Health Disparities Research, Medical University of South Carolina, 135 Cannon Street, Suite 303, MSC835, Charleston, SC 29425 USA
| | - Kate Lorig
- Department of Medicine, Stanford University, 291 Campus Drive, Room LK3C02, Stanford, CA 94305 USA
| | - Saundra Glover
- Institute of Health Disparities, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210 USA
| | - Diane Kamen
- Department of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 912, Charleston, SC 29425 USA
| | - Sudie Back
- Department of Psychiatry/Behavioral Science, Division of Clinical Neuroscience, Medical University of South Carolina, 67 President Street, Charleston, SC 29425 USA
| | - Anwar Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, 800 Sumter Street, Room 211, Columbia, SC 29208 USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208 USA
| | - James C. Oates
- Department of Medicine, Division of Rheumatology, Medical University of South Carolina, 114 Doughty Street, Room 425-C, Charleston, SC 29414 USA
| |
Collapse
|
16
|
The diagnosis and clinical management of the neuropsychiatric manifestations of lupus. J Autoimmun 2016; 74:41-72. [PMID: 27427403 DOI: 10.1016/j.jaut.2016.06.013] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 06/21/2016] [Indexed: 01/03/2023]
Abstract
Neuropsychiatric (NP) involvement in Systemic Lupus Erythematosus (SLE), can be a severe and troubling manifestation of the disease that heavily impacts patient's health, quality of life and disease outcome. It is one of the most complex expressions of SLE which can affect central, peripheral and autonomous nervous system. Complex interrelated pathogenetic mechanisms, including genetic factors, vasculopathy, vascular occlusion, neuroendocrine-immune imbalance, tissue and neuronal damage mediated by autoantibodies, inflammatory mediators, blood brain barrier dysfunction and direct neuronal cell death can be all involved. About NPSLE a number of issues are still matter of debate: from classification and burden of NPSLE to attribution and diagnosis. The role of neuroimaging and new methods of investigation still remain pivotal and rapidly evolving as well as is the increasing knowledge in the pathogenesis. Overall, two main pathogenetic pathways have been recognized yielding different clinical phenotypes: a predominant ischemic-vascular one involving large and small blood vessels, mediated by aPL, immune complexes and leuko-agglutination which it is manifested with more frequent focal NP clinical pictures and a predominantly inflammatory-neurotoxic one mediated by complement activation, increased permeability of the BBB, intrathecal migration of autoantibodies, local production of immune complexes and pro-inflammatory cytokines and other inflammatory mediators usually appearing as diffuse NP manifestations. In the attempt to depict a journey throughout NPSLE from diagnosis to a reasoned therapeutic approach, classification, epidemiology, attribution, risk factors, diagnostic challenges, neuroimaging techniques and pathogenesis will be considered in this narrative review based on the most relevant and recent published data.
Collapse
|
17
|
Messmer Uccelli M, Mancuso Mohr L, Battaglia MA, Zagami P, Mohr DC. Peer support groups in multiple sclerosis: current effectiveness and future directions. Mult Scler 2016; 10:80-4. [PMID: 14760957 DOI: 10.1191/1352458504ms973oa] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Peer support programs have become a common method of providing support for patients with chronic illness. Utilizing peers as resources has been proposed as an effective means for coping with a stressful life experience and for gaining support from others who share a common factor, although data are somewhat mixed on the efficacy of peer support. The aim of the present study was to evaluate the effectiveness of eight weeks of a standard form of peer support in improving quality of life and reducing depressive symptoms in 44 patients with multiple sclerosis (MS). O ne person from each of six groups participated in a training course in order to learn basic principles of peer support. Eight weekly sessions were held and patients completed self-administered questionnaires pre- and post- treatment assessing quality of life and depression. Results showed that support groups do not provide consistent improvement in quality of life or depression in patients with MS and suggest that patients who have better mental health functioning could be at risk for deterioration in support groups.
Collapse
Affiliation(s)
- M Messmer Uccelli
- Italian Multiple Sclerosis Society, Department of Health Services and Research, Genoa, Italy.
| | | | | | | | | |
Collapse
|
18
|
Abstract
Health-related quality of life (HRQoL) is an important outcome measure in patients with systemic lupus erythematosus (SLE). A review was undertaken of the literature relating to HRQoL in SLE. MEDLINE, EMBASE, CINAHL, Allied and Complimentary Medicine were searched to locate full papers in the English language reporting on HRQoL in adult SLE patients published between 1990 and 2005. In total 53 papers were included and the review was subdivided into: 1) description of HRQoL in SLE patients; 2) HRQoL and disease activity and/or damage; 3) the impact of other variables on HRQoL; and 4) HRQoL measures used in clinical trials in SLE patients. The findings were as follows: HRQoL is reduced in SLE patients; HRQoL is not correlated to disease activity or damage; age appears to have a negative impact on HRQoL especially physical health but the effect of disease duration is unclear; other potentially modifiable variables such as fatigue and psychosocial factors impact on HRQoL in a complex manner; and HRQoL measures which are sensitive to change should be an essential outcome measure in all clinical trials on SLE patients.
Collapse
Affiliation(s)
- K McElhone
- Department of Rheumatology, Royal Blackburn Hospital, Blackburn, UK
| | | | | |
Collapse
|
19
|
Abstract
This article is the first to review published research on psychosocial factors and behavioral interventions related to systemic lupus erythematosus (SLE). The first section presents descriptive studies, followed by studies that investigate psychosocial factors as predictor and outcome variables. These studies demonstrate that the consideration of psychosocial factors is critical to understanding the disease experience of persons with SLE. Next, studies of behavioral interventions are presented, leading to the conclusion that randomized controlled trials are essential yet rare. The final section highlights limitations of the extant literature and suggests directions for future research and recommendations for clinicians.
Collapse
Affiliation(s)
- A H Seawell
- Department of Psychology, University at Albany, State University of New York, New York 12222, USA.
| | | |
Collapse
|
20
|
Sahebalzamani M, Farahani H, Jamarani MT, Faezi ST, Moradi K, Paragomi P. Effects of a Continuous Care Model on Patients' Knowledge and Health-Related Quality of Life in Systemic Lupus Erythematosus. Rehabil Nurs 2016; 42:E9-E18. [PMID: 27302184 DOI: 10.1002/rnj.283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of applying the continuous care model (CCM) on the knowledge level and health-related quality of life (HRQoL) of systemic lupus erythematosus (SLE) patients and their perceptions of family awareness about the disease. DESIGN The Continuous Care Model (CCM) was implemented for 3 months on 34 SLE patients, in a pretest-posttest quasiexperimental design. METHODS Two sets of questionnaires were designed for knowledge assessment. HRQoL was assessed by SF-36 questionnaires. Analysis was by paired t test and one-way ANOVA. FINDINGS The continuous care model significantly improved patients' knowledge level and their perceptions of their family members' awareness of their disease. HRQoL status in SLE patients was poorer than the general population in six of eight SF-36 scales (p < .05), except for Bodily Pain and Mental Health. Postintervention scores showed improvement in six SF-36 scales (p < .001), except for Bodily Pain and Social Functioning. CONCLUSIONS Our results underlined the advantages of applying the CCM as a comprehensive method of self-care in SLE. CLINICAL RELEVANCE Despite many improvements in SLE care, the patients' quality of life is still much affected by SLE. Implementation of the CCM could lead to improvement in the knowledge and HRQoL of SLE patients.
Collapse
Affiliation(s)
- Mohammad Sahebalzamani
- 1 Department of Nursing and Midwifery, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran2 Department of Psychology, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran3 Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | |
Collapse
|
21
|
Yuen HK, Cunningham MA. Optimal management of fatigue in patients with systemic lupus erythematosus: a systematic review. Ther Clin Risk Manag 2014; 10:775-86. [PMID: 25328393 PMCID: PMC4199565 DOI: 10.2147/tcrm.s56063] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Among the host of distressing pathophysiological and psychosocial symptoms, fatigue is the most prevalent complaint in patients with systemic lupus erythematosus (SLE). This review is to update the current findings on non-pharmacological, pharmacological, and modality strategies to manage fatigue in patients with SLE and to provide some recommendations on optimal management of fatigue based on the best available evidence. We performed a systematic literature search of the PubMed and Scopus databases to identify publications on fatigue management in patients with SLE. Based on the studies reported in the literature, we identified nine intervention strategies that have the potential to alleviate fatigue in patients with SLE. Of the nine strategies, aerobic exercise and belimumab seem to have the strongest evidence of treatment efficacy. N-acetylcysteine and ultraviolet-A1 phototherapy demonstrated low-to-moderate levels of evidence. Psychosocial interventions, dietary manipulation (low calorie or glycemic index diet) aiming for weight loss, vitamin D supplementation, and acupuncture all had weak evidence. Dehydroepiandrosterone is not recommended due to a lack of evidence for its efficacy. In addition to taking treatment efficacy and side effects into consideration, clinicians should consider factors such as cost of treatment, commitments, and burden to the patient when selecting fatigue management strategies for patients with SLE. Any comorbidities, such as psychological distress, chronic pain, sleep disturbance, obesity, or hypovitaminosis D, associated with fatigue should be addressed.
Collapse
Affiliation(s)
- Hon K Yuen
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melissa A Cunningham
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, SC, USA
| |
Collapse
|
22
|
Effect of psychological intervention on health-related quality of life in people with systemic lupus erythematosus: A systematic review. Int J Nurs Sci 2014. [DOI: 10.1016/j.ijnss.2014.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
23
|
Williams EM, Ortiz K, Browne T. Social Determinants of Health, the Chronic Care Model, and Systemic Lupus Erythematosus. Int J Chronic Dis 2014; 2014:361792. [PMID: 26464854 PMCID: PMC4590929 DOI: 10.1155/2014/361792] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/09/2013] [Accepted: 12/09/2013] [Indexed: 11/17/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions.
Collapse
Affiliation(s)
- Edith M. Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210, USA
| | - Kasim Ortiz
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210, USA
| | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, SC 29208, USA
| |
Collapse
|
24
|
Williams EM, Penfield M, Kamen D, Oates JC. An Intervention to Reduce Psychosocial and Biological Indicators of Stress in African American Lupus Patients: The Balancing Lupus Experiences with Stress Strategies Study. ACTA ACUST UNITED AC 2014; 4:22-31. [PMID: 24999444 DOI: 10.4236/ojpm.2014.41005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Very little is known about the impact of psychosocial stress on African American lupus patients. Due to the exposure of African Americans to a unique trajectory of stressors throughout life, it may be critical to understand the relationship between psychosocial stress and underlying biological mechanisms that influence disease activity and pathology in this high risk group. METHODS The Balancing Lupus Experiences with Stress Strategies (BLESS) study piloted the validated "Better Choices, Better Health" Chronic Disease Self-Management Program (CDSMP) in 30 African-American lupus patients participating in the SLE Clinic Database Project at the Medical University of South Carolina (MUSC). Measures of psychosocial and biological indicators of stress were collected in all of the patients in each of the study conditions before and after intervention activities, as well as four months post-intervention, to assess the effectiveness of the program in reducing perceived and biological indicators of stress. RESULTS Participation in the workshops had large effects upon depression (d=1.63 and d = 1.68), social/role activities limitations (d =1.15), health distress (d =1.13 and d = 0.78), fatigue (d =1.03), pain (d =0.96), and lupus self-efficacy (d =0.85). Neither the differences in cortisol or DHEA levels pre- and post-intervention were found to be significantly different between intervention participants and controls. CONCLUSION The intervention workshops acted to reduce perceived stress and improve quality of life. Our findings imply that comparable, if not more significant gains in relevant health indicators are possible in African American patients when provided the opportunity to participate in CDSMP's.
Collapse
Affiliation(s)
- Edith M Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 208, Columbia, SC 29210
| | - Megan Penfield
- Institutional Assessment and Compliance, University of South Carolina, 1710 College Street, Suite 205, Columbia, SC 29208
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425
| | - James C Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425; Medical Service, Ralph H. Johnson VA Medical Center, Charleston, SC
| |
Collapse
|
25
|
Williams EM, Kamen D, Penfield M, Oates JC. Stress Intervention and Disease in African American Lupus Patients: The Balancing Lupus Experiences with Stress Strategies (BLESS) Study. Health (London) 2014; 6:71-79. [PMID: 24932382 PMCID: PMC4052946 DOI: 10.4236/health.2014.61011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Edith M Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425
| | - Megan Penfield
- Institutional Assessment and Compliance, University of South Carolina, 1710 College Street, Suite 205, Columbia, SC 29208
| | - James C Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425 and Medical Service, Ralph H. Johnson VA Medical Center, Charleston, SC
| |
Collapse
|
26
|
Supportive-expressive and coping group teletherapies for HIV-infected older adults: a randomized clinical trial. AIDS Behav 2013; 17:3034-44. [PMID: 23474642 DOI: 10.1007/s10461-013-0441-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This clinical trial tested whether telephone-administered supportive-expressive group therapy or coping effectiveness training reduce depressive symptoms in HIV-infected older adults. Participants from 24 states (N = 361) completed the Geriatric Depression Scale at pre-intervention, post-intervention, and 4- and 8-month follow-up and were randomized to one of three study arms: (1) 12 weekly sessions of telephone-administered, supportive-expressive group therapy (tele-SEGT; n = 122); (2) 12 weekly sessions of telephone-administered, coping effectiveness training (tele-CET; n = 118); or (3) a standard of care (SOC) control group (n = 121). Tele-SEGT participants reported fewer depressive symptoms than SOC controls at post-intervention (MSEGT = 11.9, MSOC = 14.3) and 4- (MSEGT = 12.5, MSOC = 14.4) and 8-month follow-up (MSEGT = 12.7, MSOC = 14.5) and fewer depressive symptoms than tele-CET participants at post-intervention (MSEGT = 12.4, MCET = 13.6) and 8-month follow-up (MSEGT = 12.7, MCET = 14.1). Tele-CET participants reported no statistically significant differences from SOC controls in GDS values at any assessment period. Tele-SEGT constitutes an efficacious treatment to reduce depressive symptoms in HIV-infected older adults.
Collapse
|
27
|
Wakefield JRH, Bickley S, Sani F. The effects of identification with a support group on the mental health of people with multiple sclerosis. J Psychosom Res 2013; 74:420-6. [PMID: 23597330 DOI: 10.1016/j.jpsychores.2013.02.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 02/04/2013] [Accepted: 02/06/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is associated with various psychological problems, including depression and anxiety. Whilst MS support groups are intended to improve mental health, this goal is not always achieved. Taking a social identity approach, we hypothesise that it is the level of subjective identification with a support group (rather than simply support group membership per se) that positively affects the mental health of people with MS. METHODS 152 individuals with MS were recruited via UK MS support groups and completed a questionnaire. This included measures of support group identification, depression, anxiety and satisfaction with life, as well as control variables (education level and age). RESULTS Analyses revealed that, as hypothesised, support group identification was significantly linked to depression, anxiety and satisfaction with life. Moreover, group identification explained a significant amount of variance in addition to that explained by education and age on each health outcome. Repeating the analysis to compare each of the three main sub-types of MS revealed these effects to be present for individuals with relapsing-remitting (RR) and Primary Progressive (PP) MS, but not for those with secondary progressive (SP) MS. CONCLUSIONS We suggest that identifying highly with an MS support group has important positive outcomes for MS patients' mental health. This has implications for practicing clinicians: people with MS (particularly RRMS and PPMS) should be encouraged to engage with support groups, but more must be done to ensure they subjectively identify with these groups, rather than merely attend them.
Collapse
|
28
|
Zhang J, Wei W, Wang CM. Effects of psychological interventions for patients with systemic lupus erythematosus: a systematic review and meta-analysis. Lupus 2012; 21:1077-87. [PMID: 22570339 DOI: 10.1177/0961203312447667] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this systematic review was to quantify the effects of psychological interventions on psychological health, physical health and disease activity in patients with systemic lupus erythematosus (SLE). Studies were identified through a systematic search of six electronic databases and were included if they used a randomized controlled trial designed to explore the effects of psychological interventions in patients with SLE. Two authors independently assessed the methodological quality of included studies using a quality-scoring instrument developed by Jadad et al. and extracted relevant information according to a pre-designed extraction form. Data was analysed using the Cochrane Collaboration’s Revman5.1. Finally, six studies involving 537 patients were included. Meta-analysis showed that psychological interventions could reduce the levels of anxiety (standard mean difference (SMD) −0.95, 95% confidence interval (CI) −1.57,−0.34, p-value 0.00), depression (SMD −1.14, 95% CI −1.84,−0.44, p-value 0.00), stress (SMD −0.63, 95% CI −1.02,−0.23, p-value 0.00), and disease activity (SMD −0.34, 95% CI −0.57,−0.11, p-value 0.00). Although the effects on mental health, fatigue and physical function were in the expected direction, they were not statistically significant ( p > 0.05). The present data indicate that psychological interventions are promising treatments for patients with SLE. The findings were based on only six randomized controlled trials (RCTs), some of which were relatively small, so more methodologically rigorous large-scale randomized controlled trials are required to confirm these preliminary estimates of effectiveness.
Collapse
Affiliation(s)
- J Zhang
- School of Nursing, Tianjin Medical University, China
| | - W Wei
- Department of Infection and Immunology, General Hospital, Tianjin Medical University, China
| | - CM Wang
- School of Nursing, Tianjin Medical University, China
| |
Collapse
|
29
|
Cal SFLDM. Revisão da literatura sobre a eficácia da intervenção psicológica no tratamento do lúpus eritematoso sistêmico. PSICOLOGIA: TEORIA E PESQUISA 2011. [DOI: 10.1590/s0102-37722011000400012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Manifestações neuropsiquiátricas são comuns no lúpus eritematoso sistêmico (LES), especialmente depressão, ansiedade e psicose. O estresse psicológico e o uso de corticóide têm sido responsabilizados pelas manifestações psicopatológicas. Objetivou-se realizar revisão de literatura sobre a eficácia da intervenção psicológica no tratamento do LES, utilizando-se pesquisas em bases de dados, através dos descritores "psychotherapy" and "lupus", incluindo-se os ensaios clínicos randomizados e os estudos prospectivos. Foram encontrados seis artigos, sendo quatro ensaios clínicos randomizados e dois estudos prospectivos. Cinco artigos encontraram evidências de acentuada melhora nos pacientes que tinham acompanhamento psicológico e apenas um não encontrou tal evidência. Concluiu-se que a intervenção psicológica pode ser uma ferramenta importante no tratamento do LES.
Collapse
|
30
|
Haija AJ, Schulz SW. The role and effect of complementary and alternative medicine in systemic lupus erythematosus. Rheum Dis Clin North Am 2010; 37:47-62. [PMID: 21220085 DOI: 10.1016/j.rdc.2010.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The use of complementary and alternative medicine (CAM) is common among patients with systemic lupus erythematosus (SLE), especially those with active disease who often have poorer quality of life and significant unmet needs. It is important for the rheumatologist to be aware of these therapies and to ask the patient with SLE about their active use or future interest in CAM. Future studies on the effectiveness of the aforementioned therapies will be crucial to find better ways for the rheumatologist to integrate their use into the care of the patient with SLE.
Collapse
Affiliation(s)
- Anan J Haija
- Division of Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | | |
Collapse
|
31
|
Abstract
Epidemiologic, socioeconomic, and psychosocial factors play an important role in health care and handling of patients with the various clinical forms of lupus erythematosus (LE). Patients with LE are mostly young women; adolescents and some ethnic groups are especially prone to a severe course of disease. The unpredictable and fluctuating flares of disease, the need for longterm treatment, and the side effects and damage caused by the disease itself severely reduce quality of life. Problems arise, involving family members, adherence to medical advice and therapy, communication and self management. Socioeconomically, patients are often unable to take regular employment and to pay for health insurance. Stress factors that arise have a negative impact on the course of disease, increasing both fatigue and the basic burden of illness. Healthcare professionals must pay careful attention to all these items, as they attempt to treat flares, minimize drug side effects, provide pain relief, arrange communication and exercise programs along with behavioral and psychosocial interventions in multidisciplinary cooperation, and also involve and support family members.
Collapse
Affiliation(s)
- E Aberer
- Department of Dermatology and Venerology, Medical University of Graz, Auenbrugger Platz 8, A-8036 Graz, Austria.
| |
Collapse
|
32
|
Abstract
The authors' goal was to assess unmet needs of patients with systemic lupus erythematosus (SLE). Participants (N = 112), who were recruited through the mailing list and support group meetings of a Lupus Alliance of America Affiliate, completed a survey based on prior research. All participants perceived at least 1 unmet need. The most frequently reported unmet needs were in the physical symptoms domain. Older patients were more likely than younger patients to have higher levels of unmet needs related to physical and psychological functioning. African American patients were more likely than white patients to have higher levels of unmet needs related to health services and information. Our findings document the high prevalence and variety of unmet needs among these patients, as well as variations among demographic groups. To address unmet needs of SLE patients, targeted referrals to patient educators, mental health professionals, and support organizations are important adjuncts to medical treatment.
Collapse
|
33
|
Yuen SY, Pope JE. Learning from past mistakes: assessing trial quality, power and eligibility in non-renal systemic lupus erythematosus randomized controlled trials. Rheumatology (Oxford) 2008; 47:1367-72. [PMID: 18577549 DOI: 10.1093/rheumatology/ken230] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To evaluate the post hoc study power of randomized controlled trials (RCTs) in the treatment of non-renal SLE and to determine the generalizability of these RCTs using an SLE database. METHODS RCTs in non-renal SLE were identified using PubMed (1975-2007). Inclusion/exclusion criteria, trial quality (5-point scale) and results of each study were recorded. The inclusion/exclusion criteria were compared with an SLE database to determine the proportion of patients from the database who would theoretically be eligible for these trials. For each negative study, we calculated the post hoc study power. We also looked for temporal improvements of trials in the literature and examined if pharmaceutical involvement influenced trial quality. RESULTS Sixty-four articles were included; the mean power of 30 negative studies was 24.6 +/- s.e.m. 3.9% (range 2.5-81.1%). Only one study had a power > 80%. Overall, potential eligibility of SLE patients in the database was 45.1 +/- s.e.m. 3.6%. Only 14 studies (21.9%) were of good quality. Fortunately, RCT quality is improving over time (trials <1995, compared with 1996-2002 and >2003; P < 0.001). Trials with pharmaceutical involvement had a significantly higher number of enrollees and better study quality. CONCLUSIONS Negative RCTs in SLE were mostly underpowered but the generalizability of these trials was high. Determination of study power and the impact of eligibility criteria on generalizability of study results are crucial in the design of clinical trials to ensure applicability to clinical practice.
Collapse
Affiliation(s)
- S Y Yuen
- St Joseph's Health Care London, 268 Grosvenor Street, Box 5777, London, ON N6A 4V2, Canada.
| | | |
Collapse
|
34
|
Koehn CL, Esdaile JM. Patient education and self-management of musculoskeletal diseases. Best Pract Res Clin Rheumatol 2008; 22:395-405. [DOI: 10.1016/j.berh.2008.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
35
|
Thumboo J, Strand V. Health-related Quality of Life in Patients with Systemic Lupus Erythematosus: An Update. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n2p115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
With improvements in mortality in systemic lupus erythematosus (SLE), the functional status of these patients, assessed using health-related quality of life (HRQoL) instruments, is increasingly being recognised as an important outcome measure in clinical research. Domains of HRQoL of particular importance to SLE patients include fatigue, ability to work, good health, independence, social and family life, learned helplessness (reflecting the unpredictability of lupus), pain and the home environment. The SF-36 currently appears to be the best available generic instrument for the assessment of HRQoL in SLE, and is likely to be complemented by several newly-developed disease-specific HRQoL instruments. It has been shown that SLE patients have poorer functional status than the general population, and that specific manifestations of SLE (disease activity, previous renal involvement and fibromyalgia) may influence HRQoL. HRQoL in SLE patients has been improved by (1) psycho-educational interventions including telephone counselling, a self-help course, group psychotherapy; (2) therapies including Riquent, belimumab, mycophenolate mofetil, dehydroepiandrosterone, oestrogen therapy and a cholesterol- lowering diet. Additional research is needed to identify strategies which can improve HRQoL in SLE patients.
Key words: Clinical Trials, Intervention studies, Outcome assessment (health care), Review
Collapse
|
36
|
Alarcón GS, Calvo-Alén J, McGwin G, Uribe AG, Toloza SMA, Roseman JM, Fernández M, Fessler BJ, Vilá LM, Ahn C, Tan FK, Reveille JD. Systemic lupus erythematosus in a multiethnic cohort: LUMINA XXXV. Predictive factors of high disease activity over time. Ann Rheum Dis 2006; 65:1168-74. [PMID: 16905579 PMCID: PMC1798273 DOI: 10.1136/ard.200x.046896] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To ascertain the predictive factors of high levels of disease activity in systemic lupus erythematosus (SLE). PATIENTS AND METHODS Patients with SLE (American College of Radiology criteria), aged >or=16 years, with disease duration <or=5 years and of Hispanic (Texas and Puerto Rico), African American and Caucasian ethnicities, were included. The outcome was high disease activity at any time (Systemic Lupus Activity Measure-Revised >10). A basic multivariable model (including age, sex, ethnicity, health insurance, social support, abnormal illness-related behaviours, helplessness and prior disease activity) was first examined. Additional models were built by including other variables. RESULTS 554 patients (100 Hispanics from Texas, 94 Hispanics from Puerto Rico, 199 African Americans, 161 Caucasians) and 2366 visits were analysed; 47% of the patients and 29% of the visits met the definition of high disease activity (more common among African Americans (72.0%) and Hispanics from Texas (71.3%) than among Caucasians (43.9%) and Hispanics from Puerto Rico (31.9%)). Variables found to predict high levels of disease activity were Hispanic (from Texas) and African American ethnicities, lack of health insurance, helplessness, abnormal illness-related behaviours and poor social support; age was negatively associated with high levels of disease activity. African admixture and anti-double-stranded DNA antibodies also predicted high levels of disease activity, as did prior disease activity. None of the human leucocyte antigen variables were retained in the models. CONCLUSIONS Socioeconomic-demographic (age, ethnicity, health insurance), behavioural and psychological variables are important mediators of high levels of disease activity in SLE during its course. Interventions aimed at modifiable factors may improve the outcomes of SLE.
Collapse
Affiliation(s)
- G S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Bricou O, Taïeb O, Baubet T, Gal B, Guillevin L, Moro MR. Stress and coping strategies in systemic lupus erythematosus: a review. Neuroimmunomodulation 2006; 13:283-93. [PMID: 17709950 DOI: 10.1159/000104856] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Systemic lupus erythematosus (SLE), a chronic and unpredictable disease accompanied by functional disability and a possible involvement of the central nervous system, leads to considerable psychological distress. A review of studies on stress and/or coping strategies in SLE since 1990 is presented. Many studies have investigated the place of major and minor stress and coping strategies in SLE morbidity (disease activity, organ damage, and physical and mental components of quality of life). Stress as a causal factor is not proved, but it seems to act as an exacerbating factor in disease activity and to have an impact on the quality of life. Coping strategies are more consistently associated with quality of life than with disease activity. Organ damage appears to be less associated with psychosocial factors than disease activity or quality of life. Despite the limitations of these studies, therapeutic interventions should be proposed to reduce psychological distress, to improve the quality of life and possibly to moderate the evolution of the disease.
Collapse
Affiliation(s)
- Olivier Bricou
- Department of Psychiatry, Hôpital Avicenne (AP-HP), Paris 13 University, Bobigny, France
| | | | | | | | | | | |
Collapse
|
38
|
Haupt M, Millen S, Jänner M, Falagan D, Fischer-Betz R, Schneider M. Improvement of coping abilities in patients with systemic lupus erythematosus: a prospective study. Ann Rheum Dis 2005; 64:1618-23. [PMID: 15829575 PMCID: PMC1755287 DOI: 10.1136/ard.2004.029926] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate a novel specific psychological intervention aimed at improving coping in patients with systemic lupus erythematosus (SLE). METHODS 34 community living SLE patients were recruited for the study. Intervention was undertaken in groups of up to eight patients and in two blocks over six months each. Eight patients were enrolled as a waiting list group. The 18 group sessions focused on information about the disease and specific problems of SLE patients, combining psychoeducative and psychotherapeutic elements. Psychological and medical evaluations were conducted at baseline and after three, six, and 12 months, using validated instruments. RESULTS The 34 SLE patients (91% female, mean age 42 years) improved significantly over a six month period on most of the psychological measuring instruments applied, such as depression, anxiety, and overall mental burden. The waiting list group showed no significant changes. CONCLUSIONS Conceptualised psychoeducational support may produce a significant and sustained improvement in coping skills of SLE patients and hence in their quality of life.
Collapse
Affiliation(s)
- M Haupt
- Centre of Rheumatology, Heinrich-Heine-University Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | | | | | | | | | | |
Collapse
|
39
|
Bricou O, Taïeb O, Baubet T, Gal B, Guillevin L, Moro MR. Stress et stratégies d’ajustement dans le lupus érythémateux systémique. Presse Med 2004; 33:1284-92. [PMID: 15611711 DOI: 10.1016/s0755-4982(04)98908-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNDENIABLE PSYCHOLOGICAL IMPACT: Systemic lupus erythematosus (SLE), a chronic and unpredictable disease with functional disability and with a possible involvement of the central nervous system, leads to severe psychological distress. THE ROLE OF STRESS AND COPING: Many studies have investigated the place of major and minor stress and coping strategies in SLE morbidity (activity, organ damage, and physical and mental component of quality of life). Stress as a provoking factor is not proved, but stress seems to act as an exacerbating factor in the activity and to have an impact on quality of life. Coping strategies are more consistently associated with quality of life than activity. Organ damage appears to be less associated with psychosocial factors than activity or quality of life. THE NEED FOR ACTION: Despite the limitations of these studies, therapeutic interventions have to be proposed to reduce psychological distress, to improve quality of life, and maybe to moderate the progression of the disease.
Collapse
Affiliation(s)
- Olivier Bricou
- Service de psychopathologie de l'enfant et de l'adolescent et psychiatrie générale, CHU Avicenne, Bobigny (93)
| | | | | | | | | | | |
Collapse
|
40
|
Greco CM, Rudy TE, Manzi S. Effects of a stress-reduction program on psychological function, pain, and physical function of systemic lupus erythematosus patients: a randomized controlled trial. ACTA ACUST UNITED AC 2004; 51:625-34. [PMID: 15334437 DOI: 10.1002/art.20533] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the effects of a stress-reduction program on pain, psychological function, and physical function in persons with systemic lupus erythematosus (SLE) who experience pain. METHODS Ninety-two SLE patients were assigned randomly to receive either biofeedback-assisted cognitive-behavioral treatment (BF/CBT), a symptom-monitoring support (SMS) intervention, or usual medical care (UC) alone. RESULTS BF/CBT participants had significantly greater reductions in pain and psychological dysfunction compared with the SMS group (pain, P = 0.044; psychological functioning, P < 0.001) and the UC group (pain, P = 0.028; psychological functioning, P < 0.001). BF/CBT had significantly greater improvement in perceived physical function compared with UC (P = 0.035), and improvement relative to SMS was marginally significant (P = 0.097). At a 9-month followup evaluation, BF/CBT continued to exhibit relative benefit compared with UC in psychological functioning (P = 0.023). CONCLUSION This study supports the utility of a brief stress management program for short-term improvement in pain, psychological function, and perceived physical function among persons with SLE who experience pain.
Collapse
Affiliation(s)
- Carol M Greco
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15232, USA.
| | | | | |
Collapse
|
41
|
Karlson EW, Liang MH, Eaton H, Huang J, Fitzgerald L, Rogers MP, Daltroy LH. A randomized clinical trial of a psychoeducational intervention to improve outcomes in systemic lupus erythematosus. ACTA ACUST UNITED AC 2004; 50:1832-41. [PMID: 15188360 DOI: 10.1002/art.20279] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In a cross-sectional study, we previously identified 2 potentially modifiable risk factors for adverse outcomes in systemic lupus erythematosus (SLE): self-efficacy and social support. The goal of this study was to evaluate in a randomized controlled trial a theory-based intervention to improve patient self-efficacy and partner support to manage SLE. METHODS Patients with SLE ages 18 years and older who met the American College of Rheumatology criteria and were able to identify a partner (spouse or family member) were recruited from 2 academic medical centers and randomized into an experimental group or a control group. Patients in the experimental group and their partners received an intervention designed to enhance self-efficacy, couples communication about lupus, social support, and problem solving, in the form of a 1-hour session with a nurse educator followed by monthly telephone counseling for 6 months. Patients in the control group and their partners received an attention placebo, including a 45-minute video presentation about lupus, and monthly telephone calls. Measures of physical and mental health status, disease activity, and psychosocial factors were collected at baseline, 6 months, and 12 months. The effect of the intervention on physical and mental health and disease activity at 6 and at 12 months was modeled with linear regression and adjusted for baseline health status, disease activity, sociodemographic factors, treatment change, and psychosocial factors. RESULTS One hundred twenty-two patients (plus their partners) were enrolled and randomized as follows: 64 to the experimental intervention and 58 to the attention control group. The participants were predominantly white, approximately half were college educated, and the groups were balanced for sociodemographic factors. At 6 months, significantly higher scores for couples communication (P = 0.01) and problem-focused coping (P = 0.03) were seen in the experimental group compared with the control group. At 12 months (6 months after the intervention ended), social support was higher (4.4 versus 4.1; P = 0.03), self-efficacy was higher (7.2 versus 6.2; P = 0.02), couples communication was higher (3.5 versus 3.1; P = 0.03), and fatigue was lower (5.1 versus 6.3; P = 0.02) in the experimental group compared with the control group. Global mental health status at 12 months, as measured by the Short Form 36 survey, was 69 points in the experimental group compared with 58 points in the control group (P = 0.04). In multivariate models, adjusting for baseline covariates, scores for couple communication (P = 0.01) were significantly higher at 6 months, and scores for self-efficacy (P = 0.004) and global mental health status (P = 0.03) were significantly higher at 12 months in the experimental group compared with the control group, and the mean score for global physical function was higher by 7 points, which was a clinically meaningful change (P = 0.2). The mean score for fatigue was also significantly lower in the experimental group than in the control group (P = 0.05). SLE disease activity was unchanged by this intervention. CONCLUSION This randomized, controlled trial of a theory-based educational intervention in SLE demonstrated significantly higher scores for couple communication, self-efficacy, and mental health status, and lower fatigue scores in the experimental group compared with the control group. Because couple communication and self-efficacy appear to be modifiable risk factors, they may also be potential targets in more disadvantaged populations.
Collapse
Affiliation(s)
- Elizabeth W Karlson
- Brigham and Women's Hospital, and Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | |
Collapse
|