AB0982 SERUM ALBUMIN LEVELS AND DEPRESSION IN JSLE

Background:Albumin is a negative acute phase response protein synthesized in the liver, being an important marker of inflammation. Under inflammatory conditions, the transcapillary escape rate of albumin may increase, leading to hypoalbuminaemia. Systemic lupus erythematosus (SLE) is a chronic condition involving multiple organ systems, inducing functional disability and psychological burden responsible for noteworthy depressive symptoms1. Depression may be related with psychosocial, environmental and biological factors, disease activity and its severity, age and sex2. Several studies show that immune activation and increased concentrations of positive and decreased concentrations of negative acute phase proteins are involved in the pathogenesis of depression3. As albumin has the capacity to bind homocysteine, lowered serum albumin levels leads to hyperhomocysteinemia, a well-known risk factor for depression. Moreover, hypoalbuminaemia decrease the availability of tryptophan, an essential amino acid from which the neurotransmitter serotonin is derived, and induce oxidative stress, which further decreases antioxidant levels in people with depression.Objectives:To assess the association between serum albumin levels and depressive symptoms in juvenile-onset SLE (jSLE) patients.Methods:A cross-sectional sample of jSLE patients, currently aged ≥ 16 years, completed a psychosocial assessment including quality of life (SF-36) anxiety and depressive symptoms (HADS) and cognitive assessment (MMSE), between October 2018- May 2019. Local Ethics Committee approved the study. All patients fulfilled both 2012 and 2019 EULAR/ACR classification criteria for SLE. Juvenile-onset was defined as age at diagnosis <18 years. Demographics and clinical characteristics were collected. Statistical analysis was performed with SPSS®. Variables were compared with spearman correlations tests.Results:30 jSLE patients were included (90%female) in the study, with median (min-max) age of 21 (16-35) years, with mean (SD) age of diagnosis of 15.8 ± 2.1. Median albumin serum level was 41.7 (16.7-46.3) g/dL. Psychosocial assessment revealed a mean (SD) score in HADS - Depression of 3.9 (3.3), HADS - Anxiety of 9 (4.3), MMSE of 27.7 (1.8), Physical health SF-36 of 66.8 (9.9) and Mental health SF-36 of 68.9 (17.5). 23.3 % jSLE showed mild cognitive impairment, 63.3% anxiety and 13.3% depression. We observed significant inverse linear relationships between serum albumin levels and depressive symptoms score (p=0.042, ρ=-0.380) and with anxiety symptoms score ((p=0.029, ρ=-0.406). No significant correlations were detected between albumin serum concentrations and cognitive assessment.Conclusion:Our findings are consistent with studies previously reporting the potentially protective effect of high serum albumin levels on mental health in different populations. A possible inflammation related aetiology for depression in jSLE patients is highlighted, further explained through the protective roles played by albumin in inflammation, infection, and oxidative damage.References:[1]Zhang, L. et al. Prevalence of depression and anxiety in systemic lupus erythematosus: a systematic review and meta-analysis. BMC Psychiatry 17, 70 (2017)[2]Figueiredo-Braga M et al. Depression and anxiety in systemic lupus erythematosus: The crosstalk between immunological, clinical, and psychosocial factors. Medicine (Baltimore). 2018;97(28)[3]Livia Ambrus & Sofie Westling. Inverse association between serum albumin and depressive symptoms among drug-free individuals with a recent suicide attempt, Nordic Journal of Psychiatry, 73:4-5, 229-232Disclosure of Interests:None declared

Download Full-text

Kidney Function, Age, and Education as Contributors to Depression and Anxiety in Juvenile Systemic Lupus Erythematosus

European Journal of Investigation in Health, Psychology and Education ◽

10.3390/ejihpe11040107 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1503-1515

Author(s):

Margarida Figueiredo-Braga ◽

Beatriz Silva ◽

Sara Ganhão ◽

Francisca Aguiar ◽

Caleb Cornaby ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Depressive Symptoms ◽

Lupus Erythematosus ◽

Psychological Status ◽

Creatinine Ratio ◽

Depression And Anxiety ◽

Systemic Lupus ◽

Juvenile Systemic Lupus Erythematosus ◽

Important Indicator ◽

Kidney Involvement

Juvenile systemic lupus erythematosus (JSLE) is diagnosed in children younger than 18 years of age. Depression and anxiety are common, but not well understood in JSLE. We investigated the clinical and psychological factors associated with the psychological manifestations of JSLE. Twenty-nine JSLE patients were recruited for the study. Patients completed surveys evaluating their psychological status and perceptions about their health. Medical records were used to obtain laboratory results. The JSLE patient population was compared with adult-onset SLE (ASLE) patients and unaffected controls. Kidney involvement was associated with depression in the JSLE patients. The BUN levels, BUN/creatinine ratio, and leukocyturia were all significantly associated with depressive symptoms. Multivariate analysis found that the BUN/creatinine ratio was the most predictive value for both depression and anxiety. Depressive symptoms in JSLE were less pronounced than in ASLE, although anxiety was not different. Age and education are likely to be protective against depression in the JSLE patients. These findings may indicate that symptomatology is an important indicator of whether the patient needs psychiatric care.

Download Full-text

Juvenile-Onset versus Adult-Onset Systemic Lupus Erythematosus: Different Clinical and Serological Patterns

Egyptian Journal of Rheumatology and Clinical Immunology ◽

10.21608/ejrci.2015.4471 ◽

2015 ◽

Vol 3 (1) ◽

pp. 9-14

Author(s):

Dalia Mohamed ◽

Amina Aziza ◽

Sameh Hassan ◽

Noha Shedid ◽

Rasha El-Owaidy ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Adult Onset ◽

Systemic Lupus ◽

Juvenile Onset ◽

Onset Systemic Lupus Erythematosus

Download Full-text

Bone impairment assessed by HR-pQCT in juvenile-onset systemic lupus erythematosus

Osteoporosis International ◽

10.1007/s00198-015-3461-y ◽

2015 ◽

Vol 27 (5) ◽

pp. 1839-1848 ◽

Cited By ~ 17

Author(s):

J. A. Paupitz ◽

G. L. Lima ◽

J. C. Alvarenga ◽

R. M. Oliveira ◽

E. Bonfa ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Juvenile Onset ◽

Onset Systemic Lupus Erythematosus

Download Full-text

Fatigue in patients with systemic lupus erythematosus and neuropsychiatric symptoms is associated with anxiety and depression rather than inflammatory disease activity

Lupus ◽

10.1177/09612033211005014 ◽

2021 ◽

pp. 096120332110050

Author(s):

Rory C Monahan ◽

Liesbeth JJ Beaart-van de Voorde ◽

Jeroen Eikenboom ◽

Rolf Fronczek ◽

Margreet Kloppenburg ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Neuropsychiatric Symptoms ◽

Anxiety And Depression ◽

Systemic Lupus ◽

Sf 36 ◽

Neuropsychiatric Sle ◽

Inflammatory Phenotype ◽

The Mean

Introduction We aimed to investigate risk factors for fatigue in patients with systemic lupus erythematosus (SLE) and neuropsychiatric symptoms in order to identify potential interventional strategies. Methods Patients visiting the neuropsychiatric SLE (NPSLE) clinic of the Leiden University Medical Center between 2007–2019 were included. In a multidisciplinary consensus meeting, SLE patients were classified as having neuropsychiatric symptoms of inflammatory origin (inflammatory phenotype) or other origin (non-inflammatory phenotype). Fatigue was assessed with the SF-36 vitality domain (VT) since 2007 and the multidimensional fatigue inventory (MFI) and visual analogue scale (VAS) since 2011. Patients with a score on the SF-36 VT ≥1 standard deviation (SD) away from the mean of age-related controls of the general population were classified as fatigued; patients ≥2 SD away were classified as extremely fatigued. Disease activity was measured using the SLE disease activity index-2000. The influence of the presence of an inflammatory phenotype, disease activity and symptoms of depression and anxiety as measured by the hospital anxiety and depression scale (HADS) was analyzed using multiple regression analyses corrected for age, sex and education. Results 348 out of 371 eligible patients filled in questionnaires and were included in this study . The majority was female (87%) and the mean age was 43 ± 14 years. 72 patients (21%) had neuropsychiatric symptoms of an inflammatory origin. Fatigue was present in 78% of all patients and extreme fatigue was present in 50% of patients with an inflammatory phenotype vs 46% in the non-inflammatory phenotype. Fatigue was similar in patients with an inflammatory phenotype compared to patients with a non-inflammatory phenotype on the SF-36 VT (β: 0.8 (95% CI −4.8; 6.1) and there was less fatigue in patients with an inflammatory phenotype on the MFI and VAS (β: −3.7 (95% CI: −6.9; −0.5) and β: −1.0 (95% CI −1.6; −0.3)). There was no association between disease activity and fatigue, but symptoms of anxiety and depression (HADS) associated strongly with all fatigue measurements. Conclusion This study suggests that intervention strategies to target fatigue in (NP)SLE patients may need to focus on symptoms of anxiety and depression rather than immunosuppressive treatment.

Download Full-text

Impact of depression on quality of life in systemic lupus erythematosus patients

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00343-y ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Eman M. Khedr ◽

Rania M. Gamal ◽

Sounia M. Rashad ◽

Mary Yacoub ◽

Gellan K. Ahmed

Keyword(s):

Quality Of Life ◽

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Short Form ◽

Systemic Lupus ◽

Positive Correlation ◽

Depressed Patients ◽

Sf 36 ◽

The Impact

Abstract Background Depression is common in systemic lupus erythematosus (SLE) and is an unmeasured risk factor, yet its symptoms can be neglected in standard disease evaluations. The purpose of this study was to assess the frequency and the impact of depression on quality of life in SLE patients. We recruited 32 patients with SLE and 15 healthy control volunteers in the study. The following investigations were undertaken in each patient: clinical and rheumatologic assessment, SLE Disease Activity Index-2k (SLEDAI-2k), Beck Depression Inventory (BDI), Short-Form Health Survey (SF-36) questionnaire, and routine laboratory tests. Results There was a high percentage of depression (46.9%) in the SLE patients. Regarding quality of life (SF-36), there were significant affection of the physical and mental composite summary domains (PCS and MCS) scores in lupus patients compared with controls (P < 0.000 for both) with the same significant in depressed compared with non-depressed patients. SF-36 subscales (physical function, limit emotional, emotional wellbeing, and social function) were significantly affected in depressed lupus patients compared with non-depressed patients. There was a significant negative correlation between the score of MCS domain of SF-36 with BDI (P < 0.000) while positive correlation between SLEDAI score with depression score. In contrast, there were no significant correlations between MCS or PCS with age, duration of illness, or SLEDAI-2K. Conclusions Depression is common in SLE patients and had a negative impact on quality of life particularly on MCS domain and positive correlation with disease severity score. Trial registration This study was registered on clinical trial with registration number: NCT03165682 https://clinicaltrials.gov/ct2/show/NCT03165682 on 24 May 2017.

Download Full-text

HLA-DRB1 antigens in Taiwanese patients with juvenile-onset systemic lupus erythematosus

Rheumatology International ◽

10.1007/s00296-001-0139-x ◽

2001 ◽

Vol 21 (3) ◽

pp. 103-105 ◽

Cited By ~ 10

Author(s):

Huang J.-L. ◽

Shaw C.-K. ◽

Lee A. ◽

Lee T.-D. ◽

Wu Chou ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Juvenile Onset ◽

Onset Systemic Lupus Erythematosus

Download Full-text

AB0383 EXTREME FATIGUE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND NEUROPSYCHIATRIC SYMPTOMS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.941 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1491.2-1492

Author(s):

R. Monahan ◽

R. Fronczek ◽

J. Eikenboom ◽

H. Middelkoop ◽

L. J. J. Beaart- van de Voorde ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Nervous System ◽

Standard Deviation ◽

Lupus Erythematosus ◽

Neuropsychiatric Symptoms ◽

Systemic Lupus ◽

System Involvement ◽

Vas Score ◽

Age Related ◽

Sf 36

Background:Fatigue is commonly described in chronic illnesses, especially auto-immune disorders such as systemic lupus erythematosus (SLE).Objectives:We aim to study the prevalence of fatigue in SLE patients with NP symptoms and compare fatigue in SLE patients with NP symptoms attributed to major organ involvement due to SLE (NPSLE) with SLE patients with NP symptoms not caused by major nervous system involvement (non-NPSLE).Methods:All patients visiting the tertiary referral center for NPSLE in the LUMC between 2007-2019 with the clinical diagnosis of SLE and age >18 years that signed informed consent were included in this study. Patients underwent a standardized multidisciplinary assessment, including two questionnaires: SF-36 (2007-2019) and multidimensional fatigue index (MFI, 2011-2019). Patients were classified as NPSLE in this study if NP symptoms were attributed to SLE and immunosuppressive or anticoagulant therapy was initiated, otherwise patients were classified as non-NPSLE. The vitality (VT) domain of the SF-36 domain was used to assess fatigue, which generates a score from 0-100, 100 representing the complete absence of fatigue. Patients with a score more than 1 standard deviation (SD) removed from age-related controls of the Dutch general population were classified as fatigued; patients more than 2 SD removed were classified as extremely fatigued1. The MFI was also used, which consists of 5 subdomain scores between 0-20, leading to a total score between 0-100, 100 representing the most extreme fatigue. All scores are presented as mean and standard deviation.Results:373 patients fulfilled the inclusion criteria and SF-36 questionnaires of 328 patients were available (88%). The majority of these patients was female (87%) and 98 were classified as NPSLE (30%). In NPSLE patients, average age was 41 ± 13 years and in non-NPSLE the average age was 45 ± 14 years. The average score of the SF-36 vitality domain was 36.0 ± 20.7 in NPSLE vs 33.9 ± 18.8. in non-NPSLE. Overall, 73.5% of the patients were fatigued and 46.9% extremely fatigued in NPSLE vs 77.8% fatigued and 45.7% extremely fatigued in non-NPSLE.The MFI questionnaire and VAS score were available for 222 patients, of which 65 patients were classified as NPSLE (29.3%). Table 1 depicts the scores of NPSLE and non-NPSLE patients on the MFI subdomains and the VAS score.Table.Patient characteristics at registry entry.NPSLE(N = 65)Non-NPSLE (N = 157)MFI(mean, sd)General Fatigue10.8 (1.8)11.1 (1.5)Physical Fatigue11.4 (2.4)12.3 (1.9)Reduced Activity9.6 (2.9)10.7 (2.2)Reduced Motivation10.7 (2.6)11.1 (1.9)Mental Fatigue9.5 (3.0)9.8 (2.7)Total score51.8 (9.9)54.9 (6.9)SF-36 Vitality (mean, sd)35 (20.7)32.7 (18.2)Conclusion:Nearly half of patients with SLE and NP symptoms are as extremely fatigued as only 2.5% of the general Dutch population. Extreme fatigue is not influenced by major nervous system involvement.References:[1]Aaronsonet al.J Clin Epidemiol. Vol. 51, No. 11, pp. 1055–1068, 1998Disclosure of Interests:Rory Monahan: None declared, Rolf Fronczek: None declared, Jeroen Eikenboom: None declared, Huub Middelkoop: None declared, L.J.J. Beaart- van de Voorde: None declared, Gisela Terwindt: None declared, Nic van der Wee: None declared, Thomas Huizinga Grant/research support from: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Consultant of: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Margreet Kloppenburg: None declared, G.M. Steup-Beekman: None declared

Download Full-text

Serum Albumin as a Marker for Disease Activity in Patients with Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.091028 ◽

2010 ◽

Vol 37 (8) ◽

pp. 1667-1672 ◽

Cited By ~ 17

Author(s):

JONATHAN YIP ◽

ELAHEH AGHDASSI ◽

JIANDONG SU ◽

WENDY LOU ◽

HEATHER REICH ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Serum Albumin ◽

Disease Activity ◽

Lupus Erythematosus ◽

Mixed Model ◽

Activity Index ◽

Surrogate Marker ◽

Disease Activity Index ◽

Systemic Lupus ◽

University Of Toronto

Objective.To determine whether serum albumin reflects disease activity in patients with systemic lupus erythematosus (SLE) with and without nephritis (LN, LNN), and whether serum albumin could be a surrogate marker of SLE disease activity overall. There is currently no clinical “gold standard” in the assessment of disease activity in SLE.Methods.Patients with ≥ 3 clinic visits within a maximum followup period of 10 years were selected from the University of Toronto Lupus Clinic database. Subjects were divided into 3 groups: LN-B, those with nephritis defined by histological findings on renal biopsies; LN-L, those with nephritis defined by laboratory abnormalities in the absence of biopsy; and LNN, those without nephritis. In a subanalysis, the renal groups were further stratified by proteinuria status. The associations of SLE-Disease Activity Index (SLEDAI-2K) with serum albumin and dsDNA were examined using the mixed model regression analysis.Results.A total of 1078 patients were studied: 89.1% female, 71.5% white, mean age 33.6 (SD 12.6) years, and with median baseline SLEDAI-2K of 8. Serum albumin was more significantly associated with SLEDAI in LN-B and LN-L. The association was also present but weaker in the LNN group. In all LN, the associations between serum albumin and SLEDAI-2K were stronger in those with proteinuria.Conclusion.In patients with SLE, higher SLEDAI was associated with lower serum albumin levels.

Download Full-text