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1.
Medicine (Baltimore) ; 100(7): e24849, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607857

RESUMO

ABSTRACT: This study aimed to translate the Body Image Disturbance Questionnaire (BIDQ) into Chinese and evaluate its reliability and validity in a sample of patients with systemic lupus erythematosus (SLE).Following the translation and revision of the Chinese version of the BIDQ, 169 patients with SLE were chosen as respondents to test the questionnaire's reliability and validity. We tested the content's validity through expert group evaluation. It is structural validity was examined through exploratory factor analysis and confirmatory factor analysis, and reliability was evaluated using Cronbach's α and test-retest reliability.The Chinese version of the BIDQ showed a content validity of .92. A two-factor structure was revealed by exploratory factor analysis, which explained 67.83% of the variance and proved by confirmatory factor analysis. Its overall Cronbach's α was .82 (P  < .001), and the Cronbach's α for each item ranged from .76 to .83. The test-retest reliability was .82, with the Cronbach's α for each item ranging from .76 to .84.Thus, adequate reliability and validity of the Chinese version of the BIDQ were demonstrated for use in patients with SLE.


Assuntos
Transtornos Dismórficos Corporais/psicologia , Lúpus Eritematoso Sistêmico/psicologia , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Transtornos Dismórficos Corporais/diagnóstico , China/epidemiologia , Análise Fatorial , Feminino , Humanos , Lúpus Eritematoso Sistêmico/epidemiologia , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Traduções
2.
Medicine (Baltimore) ; 99(34): e21909, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846857

RESUMO

BACKGROUND: Systemic Lupus Erythematosus (SLE) is a diffuse connetive tissue disease, which is difficult to be conquered. However, the traditional Chinese medicine is significant in the treatment. And the Chinese medicine tripterygium and its plant extraction can help us to overcome this disease, to some extent. METHODS: The deadline should be from inception to February 2020 by computer from the databases: the Cochrane Library, Pubmed, Embase, Web of Science in English and the Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database and Chinese Science, Chinese Traditional Medicine Database, Chinese Science and Technology Periodical Database in Chinese. Included criteria are randomized controlled trials. The primary outcomes are the clinical symptoms, systemic lupus erythematosus disease activity index and quality of life questionnaire (the top 10 frequency). We will use RevMan 5.0 statistical software for data synthesis, sensitivity analysis, meta regression, subgroup analysis, and risk of bias assessment. The publish bias will be assessed by a funnel plot and the funnel plot symmetries will be evaluated by Begg and Egger tests. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. RESULTS: This article will give a protocol for meta analysis which can make sure the efficacy and side effect of the tripterygium and its plant extraction for SLE. CONCLUSION: The efficacy and side effect of the tripterygium and its plant extraction for SLE will be evaluated. ETHICS AND DISSEMINATION: Without personal information involved, ethical approval and informed consent form is no need. The review will be submitted to a peer-reviewed journal prospectively to spread our findings. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020176444.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Tripterygium/química , Humanos , Lúpus Eritematoso Sistêmico/psicologia , Medicina Tradicional Chinesa/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Tripterygium/efeitos adversos
3.
Qual Life Res ; 29(9): 2573-2584, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32410143

RESUMO

PURPOSE: A key limitation to widespread adoption of patient-reported outcome (PRO) measures is the lack of interpretability of scores. We aim to identify clinical severity thresholds to distinguish categories of no problems, mild, moderate, and severe along the PROMIS® Pediatric T-score metric for measures of anxiety, mobility, fatigue, and depressive symptoms for use in populations with juvenile idiopathic arthritis (JIA) and childhood-onset systemic lupus erythematosus (cSLE). METHODS: We used a modified standard setting methodology from educational testing to identify clinical severity thresholds (clinical cut scores). Using item response theory-based parameters from PROMIS item banks, we developed a series of clinical vignettes that represented different severity or ability levels along the PROMIS Pediatric T-score metric. In stakeholder workshops, participants worked individually and together to reach consensus on clinical cut scores. Median cut-score placements were taken when consensus was not reached. Focus groups were recorded and qualitative analysis was conducted to identify decision-making processes. RESULTS: Nine adolescents (age 13-17 years) with JIA (33% female) and their caregivers, five adolescents (age 14-16 years) with cSLE (100% female) and their caregivers, and 12 pediatric rheumatologists (75% female) participated in bookmarking workshops. Placement of thresholds for bookmarks was highly similar across stakeholder groups (differences from 0 to 5 points on the PROMIS t-score metric) for all but one bookmark placement. CONCLUSION: This study resulted in clinical thresholds for severity categories for PROMIS Pediatric measures of anxiety, mobility, fatigue, and depressive symptoms, providing greater interpretability of scores in JIA and cSLE populations.


Assuntos
Ansiedade/psicologia , Artrite Juvenil/psicologia , Artrite Juvenil/reabilitação , Depressão/psicologia , Lúpus Eritematoso Sistêmico/psicologia , Lúpus Eritematoso Sistêmico/reabilitação , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida/psicologia , Adolescente , Criança , Feminino , Humanos , Masculino
4.
Clinics (Sao Paulo) ; 75: e1515, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32321114

RESUMO

This study aimed to systematically review neuropsychiatric lupus erythematosus (NPSLE) and establish a simplified diagnostic criterion for NPSLE. Publications from 1994 to 2018 in the database (Wanfang data (http://www.wanfangdata.com.cn/index.html) and China National Knowledge Internet (http://www.cnki.net)) were included. In total, 284 original case reports and 24 unpublished cases were collected, and clinical parameters were analyzed. An attempt was made to develop a set of simplified diagnostic criteria for NPSLE based on cases described in the survey and literature; moreover, and pathophysiology and management guidelines were studied. The incidence rate of NPSLE was estimated to be 12.4% of SLE patients in China. A total of 408 NPSLE patients had 652 NP events, of which 91.2% affected the central nervous system and 8.8% affected the peripheral nervous system. Five signs (manifestations, disease activity, antibodies, thrombosis, and skin lesions) showed that negative and positive predictive values were more than 70%, included in the diagnostic criteria. The specificity, accuracy, and positive predictive value (PPV) of the revised diagnostic criteria were significantly higher than those of the American College of Rheumatology (ACR) criteria (χ2=13.642, 15.591, 65.010, p<0.001). The area under the curve (AUC) for revised diagnostic criteria was 0.962 (standard error=0.015, 95% confidence intervals [CI] =0.933-0.990), while the AUC for the ACR criteria was 0.900 (standard error=0.024, 95% CI=0.853-0.946). The AUC for the revised diagnostic criteria was different from that for the ACR criteria (Z=2.19, p<0.05). Understanding the pathophysiologic mechanisms leading to NPSLE is essential for the evaluation and design of effective interventions. The set of diagnostic criteria proposed here represents a simplified, reliable, and cost-effective approach used to diagnose NPSLE. The revised diagnostic criteria may improve the accuracy rate for diagnosing NPSLE compared to the ACR criteria.


Assuntos
Lúpus Eritematoso Sistêmico , Vasculite Associada ao Lúpus do Sistema Nervoso Central , China , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Lúpus Eritematoso Sistêmico/psicologia , Vasculite Associada ao Lúpus do Sistema Nervoso Central/fisiopatologia , Vasculite Associada ao Lúpus do Sistema Nervoso Central/psicologia , Reumatologia , Inquéritos e Questionários
5.
Qual Life Res ; 29(9): 2415-2423, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32270369

RESUMO

PURPOSE: This study aimed to assess mental health status (depression, anxiety, and stress) and explore factors associated with the disease-specific quality of life among Systemic Lupus Erythematosus (SLE) patients in Thailand. METHODS: This cross-sectional study used an online convenience sampling of 650 SLE patients who were registered members of the Thailand SLE Club. The study survey comprised of demographic information, health history, Depression, Anxiety, Stress Scale (DASS), and Lupus Quality of Life Scale (LupusQoL). RESULTS: The survey response rate was 61.2%. Out of 344 respondents, most were female (96.9%). The scores were suggestive of the presence of mild depression and stress, but moderate anxiety. The higher depression, anxiety, and stress levels were associated with lower education and income (r = - .14 to - .29, p < .01) and higher number of SLE symptoms (r = .17 to .33, p < .05). Better quality of life was significantly related to lower number of symptoms, lower levels of stress/anxiety/depression, higher education, and better income. Also, the longer the patients were kept out of the hospital (last hospitalization), the better their quality of life. By using hierarchical multiple regression, four predictors of the quality of life were identified; the number of symptoms, stress, anxiety, and depression. These predictors combined explained 51% of the variance, F(5,108) = 24.34, p < .001, adjusted R2 = .51. CONCLUSIONS: To improve the quality of life, SLE patients should focus on self-management of their symptoms. Health care providers should include SLE self-care health education in the plan of care. They also should use multidisciplinary approach in order to provide holistic treatment, including psychological care.


Assuntos
Ansiedade/psicologia , Depressão/psicologia , Lúpus Eritematoso Sistêmico/psicologia , Qualidade de Vida/psicologia , Estresse Psicológico/psicologia , Adulto , Transtornos de Ansiedade/psicologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Internet , Lúpus Eritematoso Sistêmico/terapia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inquéritos e Questionários , Tailândia
6.
Psiquiatr. biol. (Internet) ; 27(1): 23-27, ene.-abr. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193257

RESUMO

El lupus eritematoso sistémico (LES) es una enfermedad inflamatoria crónica autoinmune que afecta al tejido conectivo de múltiples órganos. Las alteraciones neuropsiquiátricas en el LES son habituales y definitorias, con prevalencias de hasta el 95% según algunos estudios. Sin embargo, la psicosis lúpica es poco común, con prevalencias que oscilan entre el 2 y el 11%. Se presenta el caso de una mujer de 30 años con 2 hospitalizaciones psiquiátricas previas por clínica psicótica y actualmente en tratamiento antipsicótico, que ingresa por cuadro compatible con síndrome hemolítico urémico. Dados los resultados de la batería de pruebas complementarias efectuada, se diagnostica de LES y se postula de forma retrospectiva la impresión diagnóstica de una psicosis lúpica. Esta revisión recalca el valor de la realización de pruebas complementarias como baterías de autoinmunidad con anticuerpos antinucleares y técnicas de neuroimagen en los primeros episodios psicóticos para descartar etiologías orgánicas, como la psicosis lúpica


Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that affects the connective tissue in multiple organs. The neuropsychiatric changes in SLE are common and well-defined, with prevalences up to 95% according to some studies. However, lupus psychosis is uncommon, with prevalences that vary between 2% and 11%. The case is presented of a 30 year-old woman with 2 previous psychiatric hospital admissions due to a clinical picture of psychosis. She was currently on anti-psychotic treatment, and was admitted due to a clinical picture compatible with Uraemic Haemolytic Syndrome. Given the results of the battery of complementary tests carried out, she was diagnosed with SLE, and retrospectively a lupus psychosis was diagnosed. This review re-assesses the value of carrying out batteries of complementary tests of autoimmunity with antinuclear antibodies and neuro-imaging techniques in the primary psychotic episodes in order to rule organic origins, such as lupus psychosis


Assuntos
Humanos , Feminino , Adulto , Lúpus Eritematoso Sistêmico/psicologia , Lúpus Eritematoso Sistêmico/diagnóstico , Transtornos Psicóticos/psicologia , Palmitato de Paliperidona/administração & dosagem , Antipsicóticos/administração & dosagem , Transtornos Psicóticos
7.
Nat Commun ; 11(1): 1403, 2020 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-32179753

RESUMO

Patients with Systemic lupus erythematosus (SLE) experience various peripheral and central nervous system manifestations including spatial memory impairment. A subset of autoantibodies (DNRAbs) cross-react with the GluN2A and GluN2B subunits of the NMDA receptor (NMDAR). We find that these DNRAbs act as positive allosteric modulators on NMDARs with GluN2A-containing NMDARs, even those containing a single GluN2A subunit, exhibiting a much greater sensitivity to DNRAbs than those with exclusively GluN2B. Accordingly, GluN2A-specific antagonists provide greater protection from DNRAb-mediated neuronal cell death than GluN2B antagonists. Using transgenic mice to perturb expression of either GluN2A or GluN2B in vivo, we find that DNRAb-mediated disruption of spatial memory characterized by early neuronal cell death and subsequent microglia-dependent pathologies requires GluN2A-containing NMDARs. Our results indicate that GluN2A-specific antagonists or negative allosteric modulators are strong candidates to treat SLE patients with nervous system dysfunction.


Assuntos
Autoanticorpos/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/psicologia , Receptores de N-Metil-D-Aspartato/imunologia , Memória Espacial , Animais , Morte Celular , Feminino , Humanos , Lúpus Eritematoso Sistêmico/genética , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Neurônios/citologia , Neurônios/imunologia , Receptores de N-Metil-D-Aspartato/genética
8.
Ann Rheum Dis ; 79(3): 356-362, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31915121

RESUMO

OBJECTIVES: Using a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus erythematosus (SLE) patients. METHODS: Annual assessments for 19 NP events attributed to SLE and non-SLE causes, physician determination of outcome and patient HRQoL (short-form (SF)-36 scores) were measured. Time-to-event analysis and multistate modelling examined the onset, recurrence and transition between NP states. RESULTS: NP events occurred in 955/1827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. In the first 2 years of follow-up the relative risk (95% CI) for SLE NP events was 6.16 (4.96, 7.66) and non-SLE events was 4.66 (4.01, 5.43) compared with thereafter. Patients without SLE NP events at initial assessment had a 74% probability of being event free at 10 years. For non-SLE NP events the estimate was 48%. The majority of NP events resolved over 10 years but mortality was higher in patients with NP events attributed to SLE (16%) versus patients with no NPSLE events (6%) while the rate was comparable in patients with non-SLE NP events (7%) compared with patients with no non-SLE events (6%). Patients with NP events had lower SF-36 summary scores compared with those without NP events and resolved NP states (p<0.001). CONCLUSIONS: NP events occur most frequently around the diagnosis of SLE. Although the majority of events resolve they are associated with reduced HRQoL and excess mortality. Multistate modelling is well suited for the assessment of NP events in SLE.


Assuntos
Lúpus Eritematoso Sistêmico/psicologia , Vasculite Associada ao Lúpus do Sistema Nervoso Central/psicologia , Adulto , Feminino , Humanos , Estudos Longitudinais , Lúpus Eritematoso Sistêmico/mortalidade , Vasculite Associada ao Lúpus do Sistema Nervoso Central/mortalidade , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Análise Multinível , Estudos Prospectivos , Qualidade de Vida
10.
Rheumatology (Oxford) ; 59(6): 1398-1406, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31620787

RESUMO

OBJECTIVE: To explore, at an item-level, the effect of disease activity (DA) on specific health-related quality of life (HRQoL) in SLE patients using an item response theory longitudinal model. METHODS: This prospective longitudinal multicentre French cohort EQUAL followed SLE patients over 2 years. Specific HRQoL according to LupusQoL and SLEQOL was collected every 3 months. DA according to SELENA-SLEDAI flare index (SFI) and revised SELENA-SLEDAI flare index (SFI-R) was evaluated every 6 months. Regarding DA according to SFI and each SFI-R type of flare, specific HRQoL of remitting patients was compared with non-flaring patients fitting a linear logistic model with relaxed assumptions for each domain of the questionnaires. RESULTS: Between December 2011 and July 2015, 336 patients were included (89.9% female). LupusQoL and SLEQOL items related to physical HRQoL (physical health, physical functioning, pain) were most affected by musculoskeletal and cutaneous flares. Cutaneous flares had significant influence on self-image. Neurological or psychiatric flares had a more severe impact on specific HRQoL. Patient HRQoL was impacted up to 18 months after a flare. CONCLUSION: Item response theory analysis is able to pinpoint items that are influenced by a given patient group in terms of a latent trait change. Item-level analysis provides a new way of interpreting HRQoL variation in SLE patients, permitting a better understanding of DA impact on HRQoL. This kind of analysis could be easily implemented for the comparison of groups in a clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov, http://clinicaltrials.gov, NCT01904812.


Assuntos
Lúpus Eritematoso Sistêmico/psicologia , Qualidade de Vida , Exacerbação dos Sintomas , Adulto , Feminino , França , Humanos , Análise de Classes Latentes , Modelos Logísticos , Estudos Longitudinais , Lúpus Eritematoso Sistêmico/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
11.
Arthritis Care Res (Hoboken) ; 72(10): 1440-1448, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-31421030

RESUMO

OBJECTIVE: Fatigue is common among individuals with systemic lupus erythematosus (SLE), but the causes are not well understood. Our objective was to examine perceived stress and depressive symptoms as predictors of fatigue in SLE. METHODS: Data from 2 years of the Lupus Outcomes Study (n = 650 patients), obtained through annual structured interviews, were used. Fatigue was measured with the Short Form 36 (SF-36) vitality scale along with a variety of self-report measures of disease, depression, and stress. Multivariate linear regression models examined predictors of changes in fatigue. Model 1 tested the association of time 1 (T1) depression with time 2 (T2) fatigue; model 2 added T1 perceived stress to model 1, and final models added T1-to-T2 decrease in stress. All analyses controlled for T1 fatigue, age, sex, self-report of fibromyalgia, pain, and SLE duration, activity, and damage. RESULTS: Mean ± SD age was 51 ± 12 years, 92% of participants were women, and 68% were white. The mean ± SD SF-36 fatigue score was 55 ± 24. T1 depression significantly predicted T2 fatigue. When T1 stress was added, stress (ß = 1.7 [95% confidence interval (95% CI) 1.1, 2.2]; P < 0.0001) significantly predicted T2 fatigue, but depression was no longer significant. The addition of T1-to-T2 decrease in stress was associated with a clinically meaningful decline in fatigue (ß = -11.8 [95% CI -15.6, -8.9]; P < 0.0001). CONCLUSION: While depressive symptoms initially predicted subsequent fatigue, the effects were mediated by stress. A decrease in stress, in addition, was associated with a clinically meaningful decrease in fatigue. These results suggest that perceived stress plays an important role in SLE fatigue and may be an important focus of interventions for fatigue.


Assuntos
Depressão/complicações , Fadiga/etiologia , Lúpus Eritematoso Sistêmico/psicologia , Estresse Psicológico/complicações , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Lúpus Eritematoso Sistêmico/complicações , Pessoa de Meia-Idade , Análise de Regressão
12.
J Dermatolog Treat ; 31(3): 264-269, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30935255

RESUMO

Objective: To obtain the opinion of patients with rheumatoid arthritis or lupus erythematosus about the use of antimalarials through questionnaires and to evaluate their adherence to medication.Methods: A cross-sectional study of patients treated with antimalarial medication for a period equal to or longer than 1 year attended between November 2012 and October 2014. A structured questionnaire with 12 questions was filled out.Results: Among 300 patients examined, 92% (275) used medication regularly. Hydroxychloroquine was used by 55% (166) of patients, chloroquine by 25% (75), and 20% (59) reported using both medications at different moments. Most of the patients (221 or 74%) were using medication seven days a week and had taken it for a period longer than 5 years; 61% (182) considered the treatment good and said, 21% (63) said, 'It is good, but I'm afraid of taking it'. Most of the patients (70% or 211) did not report any adverse symptoms. Their main claim was related to blurred vision, which was solved by a refraction examination.Conclusions: Fear has been a factor that makes adherence to treatment difficult. Making patients aware of the importance of the treatment is strongly relevant because antimalarials are well tolerated.


Assuntos
Antimaláricos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Adesão à Medicação , Adulto , Antimaláricos/efeitos adversos , Artrite Reumatoide/patologia , Artrite Reumatoide/psicologia , Cloroquina/efeitos adversos , Cloroquina/uso terapêutico , Estudos Transversais , Feminino , Cefaleia/etiologia , Humanos , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Sistêmico/patologia , Lúpus Eritematoso Sistêmico/psicologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
13.
Arthritis Care Res (Hoboken) ; 72(8): 1159-1162, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31199590

RESUMO

OBJECTIVE: To determine if low disease activity state (LDAS)/remission predicts a better health-related quality of life (HRQoL). METHODS: Patients with systemic lupus erythematosus from a single center and having completed at least 2 visits were included. Visits were performed every 6 months. HRQoL was measured with the LupusQoL questionnaire. The definition of remission included a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score of 0, prednisone daily dosage of ≤5 mg/day, and immunosuppressive drugs on maintenance dose. LDAS was defined as a SLEDAI-2K score of ≤4, prednisone daily dosage of ≤7.5 mg/day, and immunosuppressive drugs as maintenance therapy. For these analyses, remission and LDAS were combined as one variable. Generalized estimating equations were calculated, using as the outcome 1 of each of the 8 components of the LupusQoL questionnaire in the subsequent visit and the activity state in the previous visit. Multivariable models were adjusted for possible confounders. RESULTS: A total of 243 patients were included. During the follow-up, 590 visits (61.6%) were categorized as LDAS/remission. LDAS/remission predicted a better HRQoL in the components of physical health (B = 4.17 [95% confidence interval (95% CI) 1.20, 7.14]; P = 0.006), pain (B = 6.47 [95% CI 3.18, 9.76]; P < 0.001), planning (B = 4.97 [95% CI 1.43, 8.52]; P = 0.006), burden to others (B = 4.12 [95% CI 0.24, 8.01]; P = 0.037], emotional health (B = 4.50 [95% CI 1.56, 7.44]; P = 0.003), and fatigue (B = 3.25 [95% CI 0.04, 6.47]; P = 0.048). CONCLUSION: Being in LDAS/remission predicts a better HRQoL, especially in the components of physical health, pain, planning, burden to others, emotional health, and fatigue.


Assuntos
Grupos Étnicos/psicologia , Lúpus Eritematoso Sistêmico/psicologia , Qualidade de Vida , Índice de Gravidade de Doença , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/etnologia , Masculino , Pessoa de Meia-Idade , Peru/etnologia , Prednisona/uso terapêutico , Indução de Remissão , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
14.
Arthritis Care Res (Hoboken) ; 72(9): 1282-1288, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31309733

RESUMO

OBJECTIVE: To evaluate the longitudinal responsiveness (sensitivity to change) of the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form (PROMIS10) in outpatients with systemic lupus erythematosus (SLE). METHODS: Outpatients with SLE who were receiving care at an academic medical center completed the PROMIS10 at 2 visits that were a minimum of 1 month apart. Responsiveness of the PROMIS10 global physical and mental health domains to Patient-Reported improvement or deterioration of health status was evaluated, as measured by standard validated instruments. Effect sizes of changes in PROMIS10 scores between visits were evaluated using Kruskal-Wallis testing. RESULTS: A total of 223 SLE patients enrolled and completed baseline surveys, with 186 (83.4%) completing a second set of questionnaires. The PROMIS10 demonstrated mild-to-moderate responsiveness to Patient-Reported improvement (effect size 0.29) and worsening (effect sizes -0.27 and -0.54) of health status for both global physical health and global mental health. Changes in the PROMIS10 correlated poorly with changes in physician-reported measures of disease activity. CONCLUSION: The PROMIS10 showed responsiveness over time to Patient-Reported changes in SLE health status, but not physician-assessed changes. These data suggest that the PROMIS10 can be used to efficiently measure and monitor important aspects of the SLE patient experience that are not captured by standard physician-derived metrics. Further studies are needed to evaluate the role of the PROMIS10 in optimizing longitudinal disease management in SLE and to determine its responsiveness in other chronic health conditions.


Assuntos
Lúpus Eritematoso Sistêmico/psicologia , Saúde Mental , Qualidade de Vida , Adulto , Idoso , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Medidas de Resultados Relatados pelo Paciente , Autorrelato , Inquéritos e Questionários , Adulto Jovem
15.
Neural Plast ; 2019: 9408612, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31885539

RESUMO

Objective: This study is aimed at investigating the characteristics of the spontaneous brain activity in inactive patients with nonneuropsychiatric systemic lupus erythematosus (non-NPSLE). Methods: Thirty-one female inactive patients with non-NPSLE and twenty healthy controls were examined by resting-state functional magnetic resonance imaging (RS-fMRI). Three amplitude methods including amplitude of low-frequency fluctuations (ALFF), fractional amplitude of low-frequency fluctuations (fALFF), and percent amplitude of fluctuation (PerAF) (with and without standardization) were applied to evaluate the spontaneous brain activity. The correlation was performed between low-frequency oscillations and clinical and neuropsychological factors in inactive patients with non-NPSLE. Results: Compared to healthy controls, patients with non-NPSLE showed increased standardized ALFF (mALFF) in the left inferior temporal gyrus and left putamen, decreased PerAF in the right postcentral gyrus and bilateral precentral gyrus, and increased standardized PerAF (mPerAF) in the left putamen and decreased mPerAF in the right postcentral gyrus and bilateral precentral gyrus. By standardized fALFF (mfALFF), no significant brain regions were found between the two groups. Correlation analysis revealed significantly positive correlations between glucocorticoid dose and PerAF in the right precentral gyrus and mPerAF in the left putamen, and Complement 3 (C3) and mPerAF in the right postcentral gyrus. There was a significant negative correlation between C3 and mALFF in the left putamen. Conclusion: Abnormal low-frequency oscillations in multiple brain regions were found in inactive patients with non-NPSLE, indicating that the alteration of mALFF, PerAF, and mPerAF in specific brain regions might be an imaging biomarker of brain dysfunction in inactive patients with non-NPSLE.


Assuntos
Encéfalo/diagnóstico por imagem , Progressão da Doença , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/psicologia , Imagem por Ressonância Magnética/métodos , Adulto , Encéfalo/fisiopatologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino
16.
J Clin Rheumatol ; 25(8): 325-328, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31764492

RESUMO

BACKGROUND/OBJECTIVE: Systemic lupus erythematosus (SLE) is an inflammatory, chronic, and multisystemic disease, which may be associated with a wide range of neuropsychiatric manifestations, including cognitive impairment. Cognitive evaluations based on screening tests might identify early SLE-related cognitive alterations. The aim of this study was to evaluate and to compare the efficacy of three screening tests (Montreal Cognitive Assessment [MoCA], Mini Mental State Examination [MMSE], Cognitive Symptom Inventory [CSI]) against the gold standard (neuropsychological battery), in order to identify the most efficient screening test for cognitive impairment in patients with SLE. METHODS: This observational cross-sectional study recruited 44 patients, from August to December 2017, who were diagnosed with SLE according to the Systemic Lupus International Collaborating Clinics (SLICC) Criteria 2012, and had no medical or psychiatric comorbidities. The patients were evaluated using the MoCA, MMSE, CSI, and the gold standard. Spearman's correlation and area under the curve analysis were performed; p < 0.05 was considered significant. RESULTS: The MoCA test showed the highest correspondence with the gold standard (AUC = 99.4%, p < 0.001), sensitivity (84%), and specificity (100%). This was followed by the MMSE (AUC = 92.6%, p < 0.001; sensitivity, 54.8%; specificity, 100%) and the CSI (AUC = 30.6%, p < 0.05; sensitivity, 54.8%; specificity, 30.76%). CONCLUSION: The MoCA is a brief, easily applied screening test that is highly effective for detecting cognitive impairment in SLE patients. It could be useful in clinical follow-up as a tool for early detection of cognitive alterations.


Assuntos
Disfunção Cognitiva , Lúpus Eritematoso Sistêmico/psicologia , Programas de Rastreamento/métodos , Testes de Estado Mental e Demência/normas , Adulto , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/fisiopatologia , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Bateria Neuropsicológica de Luria-Nebraska , Masculino
17.
J Clin Rheumatol ; 25(8): 348-350, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31764496

RESUMO

BACKGROUND/OBJECTIVE: Women with systemic lupus erythematosus (SLE) are at increased risk for cervical neoplasia likely due to infection with high-risk human papillomavirus (HR-HPV) and should be considered for HPV vaccination. We sought to determine the frequency of HR-HPV infection and uptake of HPV vaccination in our regional female lupus population. METHODS: For this medical records review study, data were analyzed from our electronic health records EPIC for women with International Classification of Diseases-10 or International Classification of Diseases -9 billing codes for SLE seen June 6, 2007, to May 1, 2017. This study was approved by the Central Michigan University/Covenant Medical Center institutional review board. Statistical analyses consisted of Student t test, χ, and Z test for proportions using SPSS v. 24 software. RESULTS: A total of 1349 women with SLE were identified, mean age of 53 years, 70.8% white, 20.8% African American, with 49% exposed to cigarette smoke. High-risk HPV testing performed in 195 (14.5%; mean age, 50 years) showed 16.9% (33/195) were positive, with those testing positive for HR-HPV being slightly younger (p < 0.05).Comparing our proportion testing positive for HR-HPV (0.169) versus National Health and Nutrition Examination Survey (0.088), we calculated a Z = 3.99 (p < 0.001) indicating HPV infection is significantly higher (2×) in our female SLE cohort. Only 16.0% (38/238) of the 238 women eligible to receive an HPV vaccine were tested for HR-HPV with 9 being positive and only 4.6% (11/238) vaccinated. CONCLUSIONS: Human papillomavirus infection is a serious health issue in women with SLE, but HPV testing and vaccination rates remain low. Efforts should be directed to promote awareness of the importance of HPV vaccination in this high-risk population.


Assuntos
Lúpus Eritematoso Sistêmico , Adesão à Medicação/estatística & dados numéricos , Infecções por Papillomavirus , Vacinas contra Papillomavirus/uso terapêutico , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/psicologia , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Estados Unidos/epidemiologia , Neoplasias do Colo do Útero/virologia , Recusa de Vacinação/psicologia , Recusa de Vacinação/estatística & dados numéricos
19.
PLoS One ; 14(11): e0224437, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31682630

RESUMO

BACKGROUND: Cognitive impairment (CI) in systemic lupus erythematosus (SLE) is a frequent neuropsychiatric manifestation affecting several domains, even in apparently asymptomatic patients. Current research revealed that the typical CI pattern affects frontal-subcortical circuit and thus executive functions. The impairment of non-literal language or pragmatic language (PL), including metaphors, idioms, inferences or irony has been well described in several conditions such as autism disorders, Parkinson's disease, brain injury and even in earlier phases of neurodegenerative processes. Even if PL neuro-anatomy remains controversial, correlation between executive dysfunctions and non-literal language involvement has been reported both in traumatic injury and mild cognitive impairment patients. Nonetheless, no specific study has been performed to evaluate PL impairment in SLE patients so far. OBJECTIVES: We aimed at assessing the PL domain in a Italian monocentric SLE cohort in comparison to healthy controls, matched to age and education, through a specific battery, the batteria sul linguaggio dell'emisfero destro (BLED). Secondly, we focused attention on possible correlations between CI and clinical and laboratory SLE-related features. METHODS: Forty adult patients affected by SLE, according to the American College of Rheumatology (ACR) criteria, and thirty healthy subjects were enrolled consecutively in this cross-sectional study. The protocol included complete physical examination, extensive clinical and laboratory data collection (comprehensive of demographics, past medical history, co-morbidities, disease activity, chronic damage evaluation, previous and concomitant treatments) and cognitive assessment for five different domains: memory, attention, pragmatic language, executive and visuospatial functions. Self-reported scale for anxiety and depression were performed to exclude the influence of mood disorders on cognitive dysfunction. RESULTS: We studied 40 Caucasian SLE patients [male (M)/ female (F) 3/37; mean±standard deviation (SD) age 45.9±10.1 years, mean±SD disease duration 120.8±81.2 months] and 30 healthy subjects (M/F 9/21; mean±SD age 41.3±13 years). According to the low level of disease activity and damage (mean±SD Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) of 1.3±2.3, mean±SD Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) of 0.2±0.5), only 30% of patients was on glucocorticoid treatment at the study entry. PL was the most compromised domain in terms of Mean Domain Z scores. As for the Domain Cognitive Dysfunction score, a deficit of PL was observed in 45% of patients and was significantly more prevalent than memory, executive and visuospatial functions impairment (P = 0.0002, P = 0.0002 and P<0.000001, respectively). According to Global Cognitive Dysfunction score, 25% of patients experienced a mild impairment and 7.5% a moderate one. Anti-phospholipid antibodies positivity was significantly associated with memory impairment (P<0.0005), whereas the presence of other neuropsychiatric events was associated with executive dysfunctions (P<0.05); no further significant association nor correlation were identified. CONCLUSION: In this study we evaluated for the first time PL in SLE patients finding a dysfunction in almost half of patients. The dysfunction of PL was significantly more frequent than the other domains assessed.


Assuntos
Função Executiva/fisiologia , Idioma , Lúpus Eritematoso Sistêmico/complicações , Transtorno de Comunicação Social/epidemiologia , Adulto , Estudos Transversais , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Itália/epidemiologia , Lúpus Eritematoso Sistêmico/psicologia , Masculino , Pessoa de Meia-Idade , Transtorno de Comunicação Social/etiologia , Transtorno de Comunicação Social/psicologia
20.
Lupus ; 28(14): 1628-1639, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31674267

RESUMO

OBJECTIVES: To quantify changes in generic patient-reported outcomes against clinically meaningful, disease activity measures in systemic lupus erythematosus (SLE). METHODS: Using BLISS-52 trial data (867 SLE patients), we estimated the mean difference in change of patient-reported outcome scores (Medical Outcomes Study SF-36 and FACIT-fatigue) in relation to disease activity (SELENA-SLEDAI, SELENA-SLEDAI flare index, SLE responder index and British Isles Lupus Assessment Group (BILAG)), considering all study visits by the mean of multivariate mixed models. Predefined disease activity criteria were used to define for improvement and worsening. RESULTS: Mean changes in physical component summary/mental component summary and FACIT-fatigue in response to changes in SELENA-SLEDAI and SELENA-SLEDAI flare index were significantly lower than 2.5. New SELENA-SLEDAI flare index flare led to a significant change in all patient-reported outcome scores, except role emotional. Mean improvement in patient-reported outcomes with achievement of SLE responder index ranged between +6.2 (physical function) and +11.3 (bodily pain) for SF-36 domains, + 3.4 and +3.3 for mental component summary and physical component summary, and was +4.2 for FACIT-fatigue. When considering disease activity changes by organ system, changes in BILAG (constitutional) was independently associated with significant changes in FACIT-fatigue and all SF-36 domains (except physical function), changes in BILAG (musculoskeletal and hematological) were independently associated with significant changes in patient-reported outcome scores, except for role emotional (musculoskeletal) and general health/mental health (hematological). Mean changes in every SF-36 domain varied (and was >5) with SLE responder index attainment. CONCLUSIONS: Knowledge of changes in patient-reported outcomes, against clinically meaningful changes in SLE disease activity measures, is crucial for designing of clinical trials, interpretation of results and shared decision-making for patient care.


Assuntos
Lúpus Eritematoso Sistêmico/fisiopatologia , Lúpus Eritematoso Sistêmico/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto Jovem
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