The contributions of socioeconomic status, perceived stress, and depression to disability in adults with systemic lupus erythematosus

Sumner, Lekeisha A.; Olmstead, Richard G.; Azizoddin, Desiree R.; Ormseth, Sarah R.; Draper, Taylor; Ayeroff, Julia R.; Zamora-Racaza, Geraldine; Weisman, Michael H.; Nicassio, Perry M.

doi:10.1080/09638288.2018.1522550

Cited by 23 publications

(19 citation statements)

References 22 publications

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“…30 Importantly, in the present evaluation, patients with and without flare were well balanced for gender, race, socioeconomic status, and smoking habits, minimizing the possible influence of these factors in the incidence of flares. 43–46…”

Section: Discussionmentioning

confidence: 99%

Understanding the dynamics of hydroxychloroquine blood levels in lupus nephritis

Pedrosa

Pasoto

Aikawa

et al. 2020

Lupus

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Objectives It is unknown if hydroxychloroquine blood level dynamics impact flare rates in lupus nephritis patients. We prospectively evaluated hydroxychloroquine levels to determine which blood-based patterns are more associated with disease activity. Methods In total, 82 lupus nephritis patients under a prescribed hydroxychloroquine dose of 4–5.5 mg/kg actual body weight (maximum 400 mg/day) for ≥3 months were evaluated at baseline and 7 months. Hydroxychloroquine blood levels were determined by liquid chromatography-tandem mass spectrometry. Flare was defined as increase ≥3 in the Systemic Lupus Erythematosus Disease Activity Index 2000 score and/or a change or increase in therapy. Results Overall, 9/82(11%) patients had flares during follow-up and had lower baseline hydroxychloroquine blood levels than those without flares (220.4 (53.5–1471.1) vs. 1006.3 (53.5–2137.8) ng/ml, p = 0.013). The hydroxychloroquine blood level cut-off that best predicted flares was 613.5 ng/ml (odds ratio = 8.67, 95% confidence interval: 1.66–45.18, p = 0.006). For 77 (94%) patients, the 7-month hydroxychloroquine level dynamics was evaluated and revealed: 59/77 (77%) had a persistent pattern of adequate (41/77(53%)) or fluctuating (18/77 (23%)) levels, with a low and comparable risk of flares (2/41 (5%) vs. 1/18 (5%), p = 1.000). The remaining group had persistent low levels (18/77 (23%)) and their flare frequency was significantly higher than the adequate group (5/18 (28%) vs. 2/41 (5%), p = 0.023). The frequencies of adequate/inadequate hydroxychloroquine blood levels in patients were comparable at baseline and 7 months (McNemar’s test, p = 0.480). Conclusion We provide novel evidence that hydroxychloroquine blood-level patterns (persistently low, adequate, or intermittent) have distinct impacts on flare rates in lupus nephritis patients. These findings reinforce the need of routine hydroxychloroquine measurements to maintain the appropriate blood levels.

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Section: Discussionmentioning

confidence: 99%

Understanding the dynamics of hydroxychloroquine blood levels in lupus nephritis

Pedrosa

Pasoto

Aikawa

et al. 2020

Lupus

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“…In SLE, the study carried out by Plantinga et al 29 identified that the increase in stress was associated with greater forgetfulness and difficulty in concentrating, especially in patients with active disease. In contrast, Sumner et al 30 described that perceived stress in depressed patients led to disability. Our results did not find a relationship between stress and CI.…”

Section: Discussionmentioning

confidence: 94%

Disability and cognitive impairment are interdependent in primary antiphospholipid syndrome

Garcia

Cimé-Aké

Bonilla-Vázquez

et al. 2022

Lupus

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Background Cognitive impairment (CI) occurs at a high frequency in primary antiphospholipid syndrome (PAPS). Its psychosocial-related factors are of interest. Objective We aimed to determine disability and perceived stress and their correlation with CI in PAPS. Methods First study phase: a longitudinal study including patients with PAPS and paired controls for cardiovascular risk factors, age, and sex, determining CI with Montreal Cognitive Assessment (MoCA) and then repeating the measurement 1 year later. Second study phase: a cross-sectional analytical study by quantification of disability with the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and perceived stress with the Perceived Stress Scale (PSS-14). Descriptive statistics and Spearman correlation coefficient were used. Results Sixty-three patients with PAPS and 60 controls were studied. In PAPS, age (range, 48.0 ± 13.5 years), thrombotic artery events (TAE) (44.4%), and stroke/TIA (42.8%) were found. Disability was documented in the majority of WHODAS 2.0 domains and the total score for this was higher in participation and mobility, the stress level was normal, and 65.1% had CI. PAPS exhibited greater deterioration in the WHODAS 2.0 total score ( p .017) and the MoCA test ( p < .0001). Personal domains and the total WHODAS 2.0 score correlated inversely with MoCA. Life activities ( rho = –0.419) and self-care ( rho = –0.407) were those that correlated to the greatest degree. Stroke conferred risk for CI. Conclusions Disability in PAPS and CI are interdependent. New treatment options and neurocognitive stimulation strategies are necessary to maintain functionality and prevent further cognitive dysfunction in PAPS patients.

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“…SLE is a systemic autoimmune disease, characterized by the presence of a wide variety of autoantibodies and multiple organ system involvement [40]. SLE is characterized by a plethora of clinical manifestations, leading to fatal complications and chronic disability requiring tailored rehabilitation strategies [41][42][43][44][45]. Thrombosis substantially contributes to morbidity and mortality in this clinical setting, being related to a complex interaction between traditional thrombotic risk factors, systemic inflammation, and autoimmunity [40].…”

Section: Apl Ppositivity and Systemic Lupus Erythematosusmentioning

confidence: 99%

Risk Assessment and Antithrombotic Strategies in Antiphospholipid Antibody Carriers

et al. 2021

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Antiphospholipid antibodies (aPL) are a cluster of autoantibodies directed against plasma proteins with affinity for membrane phospholipids. The most frequently tested aPL are lupus anticoagulant (LA), anti-cardiolipin antibodies (aCL), and anti-β2-glycoprotein I antibodies (anti-β2GPI). aPL play a key pathogenic role in the development of the antiphospholipid syndrome (APS), a systemic autoimmune disease characterized by recurrent thrombotic and/or pregnancy complications in patients with persistent aPL. However, aPL positivity is occasionally documented in patients with no previous history of thrombotic or pregnancy morbidity. LA activity, multiple aPL positivity, high-titer aPL, and a concomitant systemic autoimmune disease are recognized risk factors for future thrombotic events in asymptomatic carriers. Moreover, an accelerated atherosclerosis with increased cardiovascular (CV) risk has also been associated with aPL positivity, thus exposing aPL carriers to fatal complications and chronic disability requiring cardiac rehabilitation. Overall, an accurate risk stratification is recommended for aPL-positive subjects in order to prevent both venous and arterial thrombotic complications. In this review, we provide an overview of the main antithrombotic and risk assessment strategies in aPL carriers.

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The contributions of socioeconomic status, perceived stress, and depression to disability in adults with systemic lupus erythematosus

Cited by 23 publications

References 22 publications

Understanding the dynamics of hydroxychloroquine blood levels in lupus nephritis

Understanding the dynamics of hydroxychloroquine blood levels in lupus nephritis

Disability and cognitive impairment are interdependent in primary antiphospholipid syndrome

Risk Assessment and Antithrombotic Strategies in Antiphospholipid Antibody Carriers

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