Determinants of sleep quality in women with systemic lupus erythematosus

OBJECTIVE: To characterize sleep complaints in women with systemic lupus erythematosus (SLE) and to identify correlates of sleep quality. METHODS: Sleep quality in 100 women with SLE was assessed using the Pittsburgh Sleep Quality Index (PSQI). Participants completed standardized questionnaires assessing depressed mood, leisure time physical activity, functional disability, and pain severity. A clinical examination determined disease activity, cumulative damage, and whether patients fulfilled the American College of Rheumatology criteria for fibromyalgia. A series of hierarchical multiple regressions were computed. RESULTS: The mean +/- SD global PSQI score was 6.98 +/- 4.03, with moderate to severe sleep impairment reported by 56% of the sample. The first model testing the importance of demographic factors was not statistically significant. In the disease-related model, the use of prednisone and functional disability both contributed to poor sleep quality (P < 0.001). The addition of level of exercise participation to the demographic set significantly added to the model (P = 0.001). Depression significantly added to the demographic set, explaining 29% of the variance (P < 0.0001). When these variables, along with disease related variables, were simultaneously regressed on the PSQI Global Score, only depressed mood appeared as a significant independent determinant of global sleep quality (P < 0.001). However, the point estimates for the Beta coefficients were consistent with effects for lack of exercise and prednisone use. CONCLUSION: A significant proportion of women with SLE suffer from poor sleep quality. The findings suggest that depressed mood, prednisone use, and lack of exercise contribute to decreased overall sleep quality.     

The association between the lupus anticoagulant and cerebral infarction in systemic lupus erythematosus

The lupus anticoagulant (LAC) is associated with the occurrence of thromboembolic complications. Assuming that thrombosis may underlie manifestations of the central nervous system (CNS) in patients with systemic lupus erythematosus (SLE), we studied 20 patients with SLE and CNS manifestations for the presence of LAC. In 8 patients (40%) including 4 with overt cerebral infarction, LAC was demonstrated. The 4 patients with LAC and cerebral infarction all had thrombocytopenia, 2 had a history of peripheral thrombosis, and one recurrent abortion. In the 4 LAC-positive patients without overt cerebral infarction, thrombocytopenia was present in 3, a history of thrombosis in 2, and fetal wastage in one. We conclude that LAC identifies within the CNS-SLE group a subpopulation of patients in whom CNS manifestations are caused by cerebral infarction. This subpopulation is further characterized by increased prevalence of thrombocytopenia, peripheral thrombosis and fetal wastage. A possible pathogenetic role of LAC may be related to a hypercoagulable state occurring in this subgroup of SLE patients.     

Impact of obesity on functioning among women with systemic lupus erythematosus

Objective

Obesity is associated with high rates of disability in the general population. The nature of the relationship between obesity and disability in systemic lupus erythematosus (SLE), a condition with a high background rate of disability, is unknown.

Methods

Data were from 2 interviews, 4 years apart, of a longitudinal cohort of individuals with SLE (n = 716 women). Body mass index (BMI) was calculated from self‐reported height and weight; obesity was classified by usual (BMI ≥30) and revised (BMI ≥26.8) definitions. Three measures of functioning were examined: the Short Form 36 (SF‐36) Health Survey physical function (PF) subscale, Valued Life Activities (VLA) Disability Questionnaire, and employment. Multivariate analyses controlled for demographics, SLE duration and disease activity, glucocorticoid use, depression, and comorbidities. Prospective analyses also controlled for baseline function.

Results

At a BMI of ≥30, 27.8% of the subjects were obese; at a BMI of ≥26.8, 40.6% of the subjects were obese. Regardless of obesity definition, obese women exhibited poorer baseline function, with decrements ranging from 20–33% depending on the functional measure and obesity definition. With a BMI of ≥26.8, the adjusted SF‐36 PF scores were 4.3 points lower for obese women (P < 0.0001), VLA difficulty was 0.09 higher (P = 0.01), and odds of employment were 80% of nonobese women (odds ratio 0.8, 95% confidence interval 0.5–1.1). At the 4‐year followup, women who were obese at baseline had poorer function and experienced greater functional declines.

Conclusion

Obesity was associated with clinically significant negative effects on function, both concurrently and prospectively. This negative impact occurred at a lower BMI than is often considered problematic clinically. Because of the high rate of SLE‐related disability, addressing preventable risk factors such as obesity may improve long‐term SLE outcomes.     

Risk of unintended pregnancy among women with systemic lupus erythematosus

OBJECTIVE: It is recommended that women with systemic lupus erythematosus carefully time their pregnancies, but little is known about use of contraception and risk of unintended pregnancy in this population. The goal of this study was to estimate the proportion of women with lupus at risk for unintended pregnancy. METHODS: We surveyed 309 women with lupus, ages 18-50 years, seen at the University of Pittsburgh lupus center between January and May 2007. RESULTS: Of the women surveyed, 212 (69%) completed the survey. In the past 3 months, 97 (46% of 212) had faced some risk of unintended pregnancy. Of these, 53 (55% of 97) reported >or=1 occasion on which they had unprotected sex and 22 (23% of 97) reported that in the last 3 months they had unprotected sex "most of the time." No women reported having used emergency contraception after unprotected sex. A desire to "discuss birth control with a health care provider at the lupus center" was reported by 22 (10% of 212) respondents and 16 (17% of 94) women 相似文献   

Predictors of poor sleep quality in patients with systemic lupus erythematosus

Sleep problems are common in patients with systemic lupus erythematosus (SLE). This study aimed to examine the following: (1) predictors of sleep quality and (2) fluctuations in sleep quality in patients with SLE. Patients with SLE were recruited from three rheumatology centers in Japan. We collected demographic and clinical data and data on sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI), the Medical Outcome Study Short Form-12, and the Lupus Patient Reported Outcome Tool (LupusPRO). Fluctuations in sleep quality were examined by administering the PSQI a second time after a 2-week interval. We used multiple linear regression analysis to predict sleep quality. Of 205 patients who completed the survey, 62.9% showed poor sleep quality. The largest fluctuation in sleep quality was for “waking in the middle of the night or early morning.” “LupusPRO pain/vitality” was a major predictor of poor sleep. The other significant predictors were mostly LupusPRO subscales and clinical variables and SF-12 subscales were mostly non-predictive. The majority of the participants had poor sleep quality. A lupus-specific QoL scale is important for understanding poor sleep quality in SLE patients. Symptom management appeared to play a key role in improving sleep quality.     

The association between fcgammaRIIIB polymorphisms and systemic lupus erythematosus in Korea

Polymorphisms of FcgammaR have been proposed as genetic factors that influence susceptibility to SLE. FcgammaRIIIB polymorphism in systemic lupus erythematosus (SLE) have been studied in various populations, but the results were inconsistent. The aim of this study was to determine the association of FcgammaRIIIB polymorphism in Korean lupus patients. One-hundred and eighty-three SLE patients (166 female, 17 male) meeting 1982 ACR criteria and 300 Korean disease-free controls were enrolled. Genotyping for the FcgammaRIIIB NA1/NA2 was performed by PCR of genomic DNA using allele-specific primers. There was no significant skewing in the distribution of the three FcgammaRIIIB genotypes, and alleles between SLE and the controls. The frequency of FcgammaRIIIB genotypes in SLE patients and controls was FcgammaRIIIB NA1/NA1 27.9% versus 26%, NA1/NA2 55.2% versus 51.7%, NA2/NA2 16.9% versus 22.3%, respectively. The gene frequencies of NA1 allele were 0.56 in the SLE and 0.52 in controls, respectively. Among clinical manifestations, thrombocytopenia was more common in FcgammaRIIIB NA2/NA2 genotype (P = 0.04, OR 2.4, 95% CI 1.0-5.4), and NA2 allele (P = 0.03, OR 1.7, 95% CI 1.1-2.8). Although FcgammaRIIIB polymorphism was not associated with the development of SLE in Korean, thrombocytopenia was associated with FcgammaRIIIB NA2/NA2 genotype, and NA2 allele.     

Strong association between the major histocompatibility complex and systemic lupus erythematosus in southern Chinese

The distribution of HLA-A, B, and DR alleles has been studied in 100 Chinese patients with systemic lupus erythematosus and in 100 healthy Chinese controls. Complement components factor B, C4A and C4B were studied in 72 patients and 61 controls. There was no significant difference between patients and controls in the distribution of HLA-A, HLA-B, factor B and C4B alleles, but there was a significant excess of HLA-DR2 and C4A null in the patients. An unusual variant of C4B was found in 6 patients and 1 control. The possible role of haplotypes is considered in interpreting these results and relating them to previous findings in Chinese.     

Kikuchi-Fujimoto's disease and the association with systemic lupus erythematosus

Kikuchi-Fujimoto's disease (KFD), Histiocytic Necrotizing lymphadenitis, is a rare self-limiting condition characterized by lymphadenopathy, fever and neutropenia. The aetiology of KFD is controversial, and its diagnosis is confirmed histologically. Although KFD has rarely been reported associated to Systemic lupus erythemotosus (SLE) should be ruled out given its different prognosis and management. We present the clinical, histological and evolution the two cases of patients with Kikuchi's disease; one case had evolution classic and the other case were associated with SLE.     

Decreased sleep quality in patients with systemic lupus erythematosus: a meta-analysis

Clinical Rheumatology - To obtain a reliable estimation on the sleep quality in patients with systemic lupus erythematosus (SLE) and identify the main sleep problems, a meta-analysis was performed....     

The association between single-nucleotide polymorphisms of NCF2 and systemic lupus erythematosus in Chinese mainland population

Systemic lupus erythematosus (SLE) is a complex immune disease. The genetic variation in the NCF2 gene was found to associate with SLE in US and European populations. However, the association of rs10911363 with SLE was not extensively studied in Chinese mainland population. A total of 488 SLE patients and 380 controls were recruited. Unlabeled probe-based high-resolution melting analysis (HRMA) was used in genotyping. HRMA with unlabeled probe successfully distinguished all genotypes. Neither genotype nor allele frequencies of single-nucleotide polymorphism (SNP) rs10911363 showed statistically significant differences between SLE patients and controls. The association of SNP rs10911363 with the diagnostic criteria of SLE was also examined. Minor allele (G) of rs10911363 was found to significantly associate with the incidence of arthritis (p?=?0.024, odds ratio (OR)?=?1.35, and 95% confidence interval (CI)?=?1.04?C1.75) and increased abnormalities of antinuclear antibody (p?=?0.002, OR?=?1.51, and 95%CI?=?1.17?C1.95) and anti-DNA (p?=?0.013, OR?=?1.40, and 95%CI?=?1.07?C1.82). Polymorphisms of rs13277113 in NCF2 gene were associated with arthritis and autoantibody production, but not disease risk, of SLE in Chinese population.     

几种趋化性细胞因子及受体基因多态性与系统性红斑狼疮的关联研究

目的探讨基质衍生因子1-3'A(stromalcell-derivedfactor1-3'A,SDF1-3'A)、趋化性细胞因子受体2-64I(chemoattractantcellreceptor2-64I,CCR2-64I)190位点、单核趋化蛋白1(monocytechemoattractantprotein-1promoter-2518polymorphism,-2518MCP-1)基因多态性及其交互作用与系统性红斑狼疮(SLE)的相关性。方法以143例SLE病人和157名健康对照为对象进行病例对照研究。应用聚合酶链反应—限制性内切酶片段长度多态性(polymerasechainreaction/restrictionfragmentlengthpolymor-phism,PCR-RFLP)方法确定SDF1-3'A和-2518MCP-1基因多态性,应用突变特异性扩增系统(amplifica-tionrefractorymutationsystem,ARMS)确定CCR2-64I基因多态性。结果-2518MCP-1、CCR2-64I、SDF1-3'A等位基因及基因型频率在SLE和健康对照组之间差异无显著性。但-2518MCP-1A/G基因型对照组高于病例组(χ2=4.11,P=0.04)。基因间交互作用分析发现,当SDF1-3'A、-2518MCP-1、CCR2-64I基因型分别为G/G、A/G和G/G时,对SLE发病可能具有保护作用(P<0.05)。其他基因型间均未见交互作用(P>0.05)。结论单个-2518MCP-1、CCR2-64I、SDF1-3'A基因多态性与SLE易感性无关联,但他们之间可能存在交互作用。     

The association between adipokines and stigmata of atherosclerosis in patients with systemic lupus erythematosus

Aim of the workEarly cardiovascular disease is an important cause of morbidity and mortality in systemic lupus erythematosus (SLE). The study was designed to assess the relationship between the serum levels of adipokines and atherosclerotic risk factors in SLE patients.Patients and methods56 patients and 31 control were included. Serum levels of leptin, adiponectin, traditional and new risk factors for atherosclerosis including plasma glucose levels, lipid profile, high-sensitivity C-reactive protein (hs-CRP), vascular cell adhesion molecule-1 (VCAM-1) and homocysteine were measured. The intima-media thickness (IMT) of the carotid was measured by ultrasonography. The SLE disease activity index (SLEDAI-2k) was assessed.ResultsThe patients mean age was 30.8 ± 9.9 years, disease duration was 55.7 ± 59.3 months and were 54 (91.5%) females and 5 (8.5%) males. Serum adiponectin levels were significantly lower in patients (3.58 ± 0.4 ng/ml) compared to control (3.9 ± 0.26 ng/ml) (p < 0.001) while leptin levels were comparable. Serum adiponectin levels correlated with triglyceride (r = 0.3, p = 0.003) and high-density lipoprotein (HDL) (r = 0.2, p = 0.04). Serum leptin significantly correlated with the BMI and total cholesterol (r = 0.43, p = 0.002 and r = 0.3, p = 0.04 respectively) as well as with the anti-double stranded deoxyribonucleic acid (anti-dsDNA) (r = 0.28, p = 0.04). There was lack of a meaningful relationship between serum adiponectin and leptin levels and disease duration or risk factors such as hsCRP, VCAM, homocysteine and IMT as well as with the SLEDAI-2k or complement.ConclusionsSerum adiponectin levels inversely correlate with HDL. A significant correlation of leptin with BMI and total cholesterol was found in SLE. None of the two adipokines were associated with atherosclerosis as assessed with the carotid IMT or with the disease activity.     

趋化因子CXCL9基因SNPrs2276886与系统性红斑狼疮相关性研究

目的 分析趋化因子CXCL9基因SNPrs2276886在中国汉族人群中的分布情况以及与系统性红斑狼疮(SLE)遗传易感性的关系.方法 ①抽提482例SLE患者[其中包括253例狼疮肾炎(LN)患者]外周血DNA,经聚合酶链反应(PCR)扩增后,通过Pyrosequeneing法进行等位基因分型.②80例患者同时留取RNA样本并反转录为cDNA,以实时荧光定量PCR方法检测NCXCL9基因的表达水平.结果 SLE组和LN组等位基因T的频率高于正常对照组(OR分别为1.346和1.347,P＜0.05),TT基因型的频率也显著高于正常人群(x2分别是6.397和3.941,P＜0.05).CXCL9 mRNA在rs2276886 TT型个体中的表达(3.9±2.0)高于CC型纯合子(2.5±2.1),P＜O.05.结论 证实了中国人群中CXCL9基因SNPrs2276886作为一种遗传因素影响对疾病的易感性,等位基因T对于SLE是一种遗传易感标记.该SNP可能从转录水平上决定了基因的分泌水平,从而参与SLE的发病.     

维生素D缺乏与系统性红斑狼疮的相关性研究

目的 探讨系统性红斑狼疮（SLE）患者维生素D缺乏现象与疾病活动性的相关性.方法 选取60例SLE患者及30例健康志愿者,收集研究对象临床资料;ELISA法检测血清25-羟基维生素D[25-（OH）D]水平;采用Pearson相关分析法分析血清25-（OH）D水平与SLE疾病活动指数（SLEDAI）、抗ds-DNA抗体滴度、补体C3、补体C4、尿蛋白定量、血清免疫球蛋白G（IgG）的相关性.结果 （1）SLE患者血清25-（OH）D水平[36.8（23.4,53.2）nmol/L]较健康志愿者[58.8（51.1,65.3） nmol/L]明显降低（P＜0.01）;（2）SLE患者中维生素D缺乏比例为53.3％,严重维生素D缺乏比例为15.0％,健康志愿者中维生素D缺乏比例为23.3％,严重维生素D缺乏比例为6.7％,两组比较差异具有统计学意义（P＜0.01）.（3）SLE患者血清25-（OH）D水平与SLEDAI（r=-0.35,P＜0.05）及抗ds-DNA抗体滴度（r=-0.42,P＜0.05）呈负相关,与补体C3（r=0.25,P＜0.05）、补体C4（r=0.28,P＜0.05）呈正相关,与尿蛋白定量、血清IgG水平无明显相关性（P＞0.05）.结论 SLE患者中维生素D缺乏现象普遍存在,血清维生素D水平与疾病活动性具有一定相关性.     

系统性红斑狼疮与自身免疫性甲状腺病发病的相关性探讨

目的探讨系统性红斑狼疮(SLE)与自身免疫性甲状腺病(AITD)的发生是否存在相关性。方法以住院或门诊就诊同时接受过甲状腺功能检查(包括甲状腺球蛋白抗体和甲状腺微粒体抗体)的80例SLE患者为研究对象,并以62名普通人群为对照,采用χ2检验的方法比较SLE患者和普通人群间AITD患病率和自身抗体阳性率,同时比较甲状腺自身抗体阳性的SLE患者与甲状腺自身抗体阴性的SLE患者间AITD患病率。结果在SLE患者中AITD的患病率(40%)和甲状腺自身抗体的阳性率(55%)与普通人群比较(分别为20%和27%)均有增高趋势(P<0.05)。甲状腺自身抗体阳性的SLE患者AITD的患病率(64%)与甲状腺自身抗体阴性的SLE患者(11%)比较明显增高(P<0.05)。结论SLE患者存在较高的AITD的患病率,甲状腺自身抗体阳性者对AITD更加易感,SLE患者在随访过程中有必要定期检测甲状腺功能。     

Illness intrusiveness explains race-related quality-of-life differences among women with systemic lupus erythematosus

Our objective was to investigate whether quality of life in systemic lupus erythematosus (SLE) differs across ethnoracial groups and to identify factors that may explain race-related differences. Self-administered questionnaire data from 335 White, 40 Black, and 30 Asian women with SLE were obtained from a multi-center database. Measures assessed illness intrusiveness, psychological well-being, depressive symptoms, musculoskeletal pain, and learned helplessness. Extent of SLE disease activity was indexed by self-reported functional-system involvement. Educational attainment was indicated by number of years in school. Principal-components analysis reduced the four psychosocial measures to a single factor score. This represented psychosocial well-being In path analysis. Psychosocial well-being differed significantly across the three groups, with Whites reporting the highest, and Blacks the lowest, levels. Path analysis indicated that illness intrusiveness accounted for this race-related difference. Although disease activity was significantly associated with psychosocial well-being, it did not differ across ethnoracial groups. Illness intrusiveness and educational attainment emerged as independent mediators of the race-related difference in psychosocial well-being. We conclude that race-related quality-of-life differences exist among women with SLE and are mediated independently by illness intrusiveness and educational attainment.     

Association between depression and sleep quality in patients with systemic lupus erythematosus: a systematic review and meta-analysis

Background

Currently, there is no consistent understanding of the relationship between depression and sleep quality in patients with systemic lupus erythematosus (SLE). This study aimed to explore the correlation between depression and sleep quality in SLE patients.

Methods

Five English (PubMed, Web of Science, EMBASE, Cochrane Library, and CINAHL) databases were systematically searched from inception to January 12, 2021. Two authors independently screened publications and extracted data according to set inclusion and exclusion criteria. Statistical analyses were performed with STATA 16.0. Data were pooled using a random-effects model.

Results

A total of 9 identified studies matched the inclusion criteria, reporting on 514 patients with SLE in the analysis. A moderate correlation of depression with sleep quality was found (pooled r?=?0.580 [0.473, 0.670]). Compared to good sleepers, patients with SLE and poor sleep quality had higher levels of depression (standardized mean difference?=????1.28 [??1.87,???0.69]). Depression was associated with subjective sleep quality (r?=?0.332 [0.009, 0.592]), sleep latency (r?=?0.412 [0.101, 0.649]), sleep disturbances (r?=?0.405 [0.094, 0.645]), daytime dysfunction (r?=?0.503 [0.214, 0.711]), the four dimensions of Pittsburgh Sleep Quality Index (PSQI), while no significant correlation was found in the other three PSQI dimensions.

Conclusion

Depression had a moderate correlation with sleep quality in patients with SLE. Patients with poor sleep quality tended to have higher level of depression than that of good sleepers. Awareness of the correlation may help rheumatology physicians and nurses to assess and prevent depression and improve sleep quality in patients with SLE.

     

Erratum to: Predictors of poor sleep quality in patients with systemic lupus erythematosus

Clinical Rheumatology -