“…[3][4][5] Involuntary weight loss, generally up to 10% of body weight, is reported in up to 51% of patients, often early in disease, and associates with other SLE manifestations. [6][7][8] Physiologically, this may be explained by the cachexia syndrome, characterized by loss of metabolic homeostasis linked to overlapping pro-inflammatory mediators in SLE and other chronic diseases. 9 Fatigue may be the most prevalent symptom in SLE patients with up to 90% affected, 10 and profoundly affects quality of life.…”
Objective Constitutional symptoms (fatigue, lymphadenopathy, and weight loss) are not included in the SLE disease activity index-2000 (SLEDAI-2K). In this pilot study, we assessed the concurrent and construct validity of a revised SLEDAI-2K (SLED-R) that included these symptoms with the original SLEDAI-2K (SLED-O), using the physician global assessment of disease activity (PGA) as the reference. Methods Our revised SLED-R substituted the SLED-O’s fever descriptor with a constitutional descriptor that included fever, fatigue, lymphadenopathy, and/or weight loss. SLED-O, SLED-R, PGA and patient global assessment (PtGA) scores were collected prospectively. Bland-Altman correlations for repeated measures were calculated and Meng’s z-test was used to compare correlations between dependent and overlapping correlation coefficients. Associations between constitutional symptoms and disease activity measures were analyzed using Mann-Whitney U, Kruskal-Wallis, Chi-square tests and repeated measures correlations. Results 1123 SLED-O, SLED-R, PGA, and 1066 PtGA were collected in 239 subjects. The new descriptor was scored in 45 subjects (18.8%) and 92 instances (8.1%), while the original descriptor, fever, was scored in only 4 subjects (1.7%) and 5 instances (0.4%). Mean SLED-O, PGA and PtGA scores were higher when the constitutional descriptor was scored versus not ( p < .001). The correlation between SLED-R and PGA was marginally higher than between SLED-O and PGA ( p < .001). Fatigue contributed most to this increase ( p = .001) and associated with both higher PGA and PtGA scores ( p < .001). Mean SLED-O and PGA scores were higher when ≥1 constitutional symptom(s) were scored versus not ( p < .002). Correlations between PGA and PtGA when the new descriptor was scored versus not were similar ( p = .860). The frequency of concordance between PGA and PtGA was lower when the new descriptor was scored (55%) versus not (72.5%), with PGA > PtGA when the new descriptor was scored ( p < .001). Conclusion The addition of constitutional symptoms to SLEDAI-2K, particularly fatigue, resulted in a marginal increase in its correlation with PGA, and new constitutional symptoms associated with higher SLED-O and PGA scores. As fatigue is subjective and difficult to attribute to SLE, its validity and inter-rater reliability in scoring remains uncertain. The clinical utility of SLED-R remains unclear, and further studies of its validity and reliability are needed.
“…[3][4][5] Involuntary weight loss, generally up to 10% of body weight, is reported in up to 51% of patients, often early in disease, and associates with other SLE manifestations. [6][7][8] Physiologically, this may be explained by the cachexia syndrome, characterized by loss of metabolic homeostasis linked to overlapping pro-inflammatory mediators in SLE and other chronic diseases. 9 Fatigue may be the most prevalent symptom in SLE patients with up to 90% affected, 10 and profoundly affects quality of life.…”
Objective Constitutional symptoms (fatigue, lymphadenopathy, and weight loss) are not included in the SLE disease activity index-2000 (SLEDAI-2K). In this pilot study, we assessed the concurrent and construct validity of a revised SLEDAI-2K (SLED-R) that included these symptoms with the original SLEDAI-2K (SLED-O), using the physician global assessment of disease activity (PGA) as the reference. Methods Our revised SLED-R substituted the SLED-O’s fever descriptor with a constitutional descriptor that included fever, fatigue, lymphadenopathy, and/or weight loss. SLED-O, SLED-R, PGA and patient global assessment (PtGA) scores were collected prospectively. Bland-Altman correlations for repeated measures were calculated and Meng’s z-test was used to compare correlations between dependent and overlapping correlation coefficients. Associations between constitutional symptoms and disease activity measures were analyzed using Mann-Whitney U, Kruskal-Wallis, Chi-square tests and repeated measures correlations. Results 1123 SLED-O, SLED-R, PGA, and 1066 PtGA were collected in 239 subjects. The new descriptor was scored in 45 subjects (18.8%) and 92 instances (8.1%), while the original descriptor, fever, was scored in only 4 subjects (1.7%) and 5 instances (0.4%). Mean SLED-O, PGA and PtGA scores were higher when the constitutional descriptor was scored versus not ( p < .001). The correlation between SLED-R and PGA was marginally higher than between SLED-O and PGA ( p < .001). Fatigue contributed most to this increase ( p = .001) and associated with both higher PGA and PtGA scores ( p < .001). Mean SLED-O and PGA scores were higher when ≥1 constitutional symptom(s) were scored versus not ( p < .002). Correlations between PGA and PtGA when the new descriptor was scored versus not were similar ( p = .860). The frequency of concordance between PGA and PtGA was lower when the new descriptor was scored (55%) versus not (72.5%), with PGA > PtGA when the new descriptor was scored ( p < .001). Conclusion The addition of constitutional symptoms to SLEDAI-2K, particularly fatigue, resulted in a marginal increase in its correlation with PGA, and new constitutional symptoms associated with higher SLED-O and PGA scores. As fatigue is subjective and difficult to attribute to SLE, its validity and inter-rater reliability in scoring remains uncertain. The clinical utility of SLED-R remains unclear, and further studies of its validity and reliability are needed.
“…Clinical features can be quite variable, ranging from mild joint and skin involvement to severe internal organ disease 1 and affect mainly women at childbearing age. 2 SLE can affect the central nervous system (CNS), causing a variety of neurological and psychiatric manifestations. 3 Physical and psychological stress are involved in autoimmune diseases 4 as onset and trigger of disease flares.…”
Objective: To evaluate the effectiveness in the long-term follow-up of brief group psychoanalytic psychotherapy in improving quality of life, symptoms, coping strategies, anxiety, and depression levels in systemic lupus erythematosus (SLE) patients. Methods: Prospective, randomized clinical trial including 80 SLE patients divided into two groups: therapy (n=37) and control (n=43), with standard clinical care. Therapy group received weekly therapy for 20 weeks. The assessments were at baseline, after 20 weeks and after 24 months from the end of intervention. Damage and disease activity were assessed by rheumatologists. Self-administered questionnaires were supervised by blind evaluators: quality of life, symptoms, coping strategies, anxiety, and depression. Intent to treat statistical analysis. Comparisons of variance between groups over time (ANOVA repeated measures). P <0.05 significant. Results: At baseline, both groups were homogeneous. After intervention, therapy group showed significant improvement in most domains of quality of life, symptoms, all domains of anxiety, and depression and several domains of coping strategies. Benefits in quality of life and coping remained at 24 months follow-up. However, the improvement in anxiety, and depression was not maintained. Medications and clinical variables did not change. Conclusion: This study showed the effectiveness of brief group psychoanalytic psychotherapy in improving quality of life, symptoms and coping strategies in SLE patients even in the long-term follow-up. Depression and anxiety levels reduced at the end of therapy, although, the improvement did not last 24 months.
“…Weight loss is a common manifestation in systemic lupus erythematosus (SLE), with an incidence ranging between 17% and 51% in a large series (1). The extent of weight loss is generally described as being <10%, and it usually precedes the diagnosis of SLE (2). Since it is so common, several disease activity indices record weight loss.…”
Section: Introductionmentioning
confidence: 99%
“…In the Systemic Lupus Activity Measure, Revised (4), weight loss can be recorded as mild if <10% of preexisting body weight, and severe if >10% of body weight. On the other hand, the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and European Consensus Lupus Activity Measure do not record weight loss (2). Cachexia is an underrecognized syndrome in patients with systemic lupus erythematosus (SLE) affecting >50% of patients.Most SLE patients recover their previous weight over time, but 18% of patients have continuous cachexia.The risk factors for cachexia development were a body mass index of <20 kg/m 2 , current steroid use, vasculitis, lupus nephritis, serositis, hematologic lupus, positive anti–double‐stranded DNA, anti‐Sm, and anti‐RNP.SLE patients with intermittent cachexia have significantly higher risk for future organ damage compared to patients without cachexia and those with continuous cachexia.…”
Objective
Cachexia is a disorder characterized by involuntary weight loss in addition to loss of homeostatic control of both energy and protein balance. Despite an abundance of data from other inflammatory diseases, cachexia in systemic lupus erythematosus (SLE) remains a largely undescribed syndrome. The present study was undertaken to define the prevalence of cachexia in SLE and to identify the main factors that place patients at risk of developing cachexia.
Methods
A total of 2,452 patients in a prospective SLE cohort had their weight assessed at each visit. Patients were categorized into 5 predetermined groups based on weight. Cachexia was defined based on modified Fearon criteria (5% stable weight loss in 6 months without starvation relative to the average weight in all prior visits and/or a weight loss of >2% without starvation relative to the average weight in all prior cohort visits and a body mass index [BMI] of <20 kg/m2). Risk of cachexia within 5 years of cohort entry was based on Kaplan‐Meier estimates. The association of prior disease manifestations with risk of cachexia adjusted by current steroid use was determined using Cox regression. An analysis of variance test was used to determine whether Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) scores varied based on cachexia status.
Results
Within 5 years of cohort entry, 56% of patients developed cachexia, 18% of which never recovered their weight during follow‐up. The risk factors for cachexia development were a BMI of <20 kg/m2, current steroid use, vasculitis, lupus nephritis, serositis, hematologic lupus manifestations, positive anti–double‐stranded DNA, anti‐Sm, and anti‐RNP. Patients with intermittent cachexia had significantly higher SDI scores compared to those with continuous cachexia or without cachexia.
Conclusion
Cachexia is an underrecognized syndrome in patients with SLE. SLE patients with intermittent cachexia have the highest risk of future organ damage.
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