Sociodemographic profiles and organ damage accural in the Black Women's Experience Living with Lupus study.

OBJECTIVE: Black/African American women with systemic lupus erythematosus (SLE) experience greater organ damage and at younger ages than white women. The objective of this study was to advance research on SLE inequities by identifying sociodemographic risk profiles associated with organ damage accrual specifically among Black/African American women. METHODS: Latent profile analysis was conducted among 438 Black/African American women with SLE living in Atlanta, GA and enrolled in the Black Women's Experiences Living with Lupus (BeWELL) Study (May 2015 to April 2017). Proportional hazard and Poisson regression models examined prospective associations between sociodemographic profiles and the timing and degree of organ damage accrual over 2 years. RESULTS: Four profiles emerged: (1) "Younger/Lower SES with Uncontrolled SLE" (44.8%), (2) "Older/Lower SES with Uncontrolled SLE" (23.3%), (3) "Mid-SES with Controlled SLE" (19.6%), and (4) "Higher SES with Controlled SLE" (11.2%). Approximately 42% of participants experienced new organ damage during the follow-up period. Proportional hazard models indicated that "Older/Lower SES with Uncontrolled SLE" participants were at greatest risk of new organ damage (HR = 2.41; 95% CI = 1.39, 4.19), followed by "Younger/Lower SES with Uncontrolled SLE" participants (HR = 1.56; 95% CI = 0.92, 2.67), compared to those in the "Higher SES with Controlled SLE" profile. Poisson regression models revealed that these two groups also exhibited greater organ damage accrual (b = 0.98, SE = 0.24, 95% CI = 0.52, 1.44 and b = 0.72, SE = 0.23, 95% CI = 0.27, 1.17, respectively). CONCLUSIONS: Black/African American women with fewer socioeconomic resources and uncontrolled SLE are at greatest risk for increasing disease severity over time. Social inequities likely contribute to racial inequities in SLE progression.

Incident racial discrimination predicts elevated C-Reactive protein in the Black Women's experiences Living with Lupus (BeWELL) study.

INTRODUCTION: Racial discrimination is a distinct health threat that increases disease risk among Black Americans. Psychosocial stress may compromise health through inflammatory mechanisms. This study examines incident experiences of racial discrimination and changes in the inflammatory biomarker C-reactive protein (CRP) over a two-year period among Black women with systemic lupus erythematosus (SLE)-an inflammatory autoimmune disease sensitive to psychosocial stress and characterized by stark racial inequities in outcomes. METHODS: Data are from the Black Women's Experiences Living with Lupus (BeWELL) Study. Participants (n = 380) from metropolitan Atlanta, Georgia were enrolled from April 2015 to May 2017. Incident racial discrimination was assessed bi-annually via self-report using the Experiences of Discrimination measure. CRP was assessed annually over a two-year period. Latent change score analyses modeled longitudinal within-person associations between incident racial discrimination and change in log-transformed CRP from baseline to Year 2. RESULTS: Incident experiences of racial discrimination were associated with elevated log-CRP across the two-year study period (b = 0.039, SE = 0.017, 95% CI: 0.006, 0.071). For each domain of incident racial discrimination experienced, CRP increased 3.98%. CONCLUSION: This study contributes to growing evidence on the biological consequences of racism and is the first to document an association between incident racial discrimination and changes in inflammation among Black women with SLE. Racial inequities in SLE outcomes and other diseases driven by inflammatory pathways may be explained in part through experiences of racial discrimination.

Differential Diagnosis of a Case of Dercum's Disease with Possible Familial Involvement and Review of Literature.

Dercum's disease (DD), also described as adiposis dolorosa, is a poorly understood and rare adipose tissue disorder involving obesity and painful adipose tissue masses. Patients may have associated bruising and constitutional symptoms such as fatigue, difficulty concentrating, and sleep disturbance. DD was initially described in 1888 by Francis Xavier Dercum, and was classified into four subtypes, including generalized diffuse, generalized nodular, localized nodular, and juxta-articular subtypes. While this disease has been described for more than 130 years, its etiology and treatment remain elusive. We describe a case of a patient with DD who presented to Ochsner Medical Center, New Orleans, LA, for evaluation of treatment options. We review current knowledge on this rare disease and data on modern treatment methods.

Fibromyalgia: can online cognitive behavioral therapy help?

BACKGROUND: Cognitive behavioral therapy (CBT) has proven useful in treating fibromyalgia, depression, and anxiety. Computerized delivery of CBT allows increased access to such therapy. This study assessed the effect of internet-based CBT on Fibromyalgia Impact Questionnaire (FIQ) composite scores and tender point assessments. METHODS: This 12-week randomized controlled trial included patients ≥18 years of age with 1990 American College of Rheumatology criteria for fibromyalgia and mild to moderate depression and anxiety. A total of 56 subjects were randomized into either a 6-week internet-based CBT group (MoodGYM) or a control group (standard care). We evaluated patients in both groups at 1-, 6-, and 12-week follow-up. The primary outcome measure was change in FIQ composite score. A secondary outcome measure was change in tender point assessment. RESULTS: The mean age of study participants was 55 years, and 88% were female. Mean FIQ scores were significantly lower in the MoodGYM group compared to the control group (P<0.05 for group differences at 6 and 12 weeks). Mean tender point scores were also significantly lower in the MoodGYM group (P<0.001 at 6 and 12 weeks). We found no significant difference in the FIQ scores across the 3 timepoints in the MoodGYM group, but tender points showed a significant negative trend from baseline to 12-week follow-up. CONCLUSION: Patients in the internet-based MoodGYM CBT program had lower FIQ and tender point scores at 6- and 12-week follow-up. Internet-based CBT could be beneficial in the treatment of mild to moderate depression and anxiety in patients with fibromyalgia by allowing increased access to CBT.

Infiltration of histiocytes and multinucleated giant cells in the myocardium of a patient with multicentric reticulohistiocytosis.

Multicentric reticulohistiocytosis (MRH) is a rare multisystem disease characterized by skin nodules and a destructive polyarthritis. We describe cardiac disease in a 42-year-old African American female with a history of MRH for 29 years and dilated cardiomyopathy for 5 years. During a congestive heart failure flare, the patient was slow to respond to standard treatment. A left/right heart catheterization and endomyocardial biopsy were performed, and the patient was found to have evidence of myocardial MRH infiltration.