Objective:To objectively evaluate the effectiveness of psychological interventions for improving health-related quality of life in patients with systemic lupus erythematosus(SLE).Design and review methods:Databases in...Objective:To objectively evaluate the effectiveness of psychological interventions for improving health-related quality of life in patients with systemic lupus erythematosus(SLE).Design and review methods:Databases including Ovid-Medline,PubMed,Web of Science,EBSCOhost,the Cochrane Library and Embase were electronically searched to identify randomized controlled trials published from inception through November 2013 involving psychological intervention in SLE patients.Studies that measured physiological function,life vitality,depression,pain degree,disease activity,severity of fatigue,and physical and mental component summaries as outcomes were included.Trials involving patients with multiple diseases or received simultaneous psychological interventions or combinations of other interventions were excluded.Two independent investigators screened the identified articles,extracted the data,and assessed the methodological quality of the included studies.Qualitative descriptions were conducted and quantitative analysis was performed with RevMan software(version 5.2).Results:A total of six randomized controlled trials comprising 394 participants were included in the study.Meta-analyses showed that psychological interventions significantly reduced the degree of depression(standard mean difference=-0.44,95%confidence interval[CI]:-0.78-0.10;P=0.01]and improved the status of the physical health component summary(mean difference=8.85,95%CI:3.69-14.00;P=0.00]in SLE patients.However,there was no significant effect of psychological intervention on disease activity,degree of pain,fatigue or the mental health component summary.Conclusions:The results show that psychological interventions can effectively improve the health-related quality of life in patients with SLE.The full benefit and clinical performance of psychological care requires further investigation by a series of multicenter,large-sample size randomized controlled trails.展开更多
Rowell syndrome is a disease diagnosed by three major and three minor criteria. The major criteria include the presence of lupus erythematosus (systemic, discoid, or subacute lupus), EM-like lesions (with or without i...Rowell syndrome is a disease diagnosed by three major and three minor criteria. The major criteria include the presence of lupus erythematosus (systemic, discoid, or subacute lupus), EM-like lesions (with or without involvement of mucous membranes), and a speckled pattern of antinuclear antibodies. The minor criteria include chilblains, anti-Ro and/or anti-La antibodies, and positive RF. In this article, we present a patient whose manifestation indicated RS, because his diagnosis of Systemic lupus erythematosus was definite, and also onset with EM-like lesions and positive antinuclear antibodies. All these above are consistent with the three major criteria. In addition, his RF was positive, which was the complement for the minor criteria.展开更多
Recent advances in the management of lupus nephritis,together with earlier renal biopsy and selective use of aggressive immunosuppressive therapy,have contributed to a favorable outcome in children and adolescents wit...Recent advances in the management of lupus nephritis,together with earlier renal biopsy and selective use of aggressive immunosuppressive therapy,have contributed to a favorable outcome in children and adolescents with systemic lupus erythematosus(SLE).Nevertheless,we believe that a more effective and less toxic treatment is needed to attain an optimal control of the activity of lupus nephritis.Recent published papers and our experiences regarding treatment of young patients with lupus nephritis using calcineurin inhibitors are reviewed.Although it has been reported that intermittent monthly pulses of intravenous cyclophosphamide(IVCY)are effective for preserving renal function in adult patients,CPA is a potent immunosuppressive agent that induces severe toxicity,including myelo-and gonadal toxicity,and increases the risk of secondary malignancy.Thus,treatment for controlling lupus nephritis activity,especially in children and adolescents,remains challenging.Cyclosporine A(Cs A)and tacrolimus(Tac)are T-cell-specific calcineurin inhibitors that prevent the activation of helper T cells,thereby inhibiting thetranscription of the early activation genes of interleukin(IL)-2 and suppressing T cell-induced activation of tumor necrosis factor-α,IL-1βand IL-6.Therefore,both drugs,which we believe may be less cytotoxic,are attractive therapeutic options for young patients with lupus nephritis.Recently,a multidrug regimen of prednisolone(PDN),Tac,and mycophenolate mofetile(MMF)has been found effective and relatively safe in adult lupus nephritis.Since the mechanisms of action of MMF and Tac are probably complementary,multidrug therapy for lupus nephritis may be useful.We propose as an alternative to IVCY,a multidrug therapy with mizoribine,which acts very similarly to MMF,and Tac,which has a different mode of action,combined with PDN for pediatric-onset lupus nephritis.We also believe that a multidrug therapy including Cs A and Tac may be an attractive option for young patients with SLE and lupus展开更多
文摘Objective:To objectively evaluate the effectiveness of psychological interventions for improving health-related quality of life in patients with systemic lupus erythematosus(SLE).Design and review methods:Databases including Ovid-Medline,PubMed,Web of Science,EBSCOhost,the Cochrane Library and Embase were electronically searched to identify randomized controlled trials published from inception through November 2013 involving psychological intervention in SLE patients.Studies that measured physiological function,life vitality,depression,pain degree,disease activity,severity of fatigue,and physical and mental component summaries as outcomes were included.Trials involving patients with multiple diseases or received simultaneous psychological interventions or combinations of other interventions were excluded.Two independent investigators screened the identified articles,extracted the data,and assessed the methodological quality of the included studies.Qualitative descriptions were conducted and quantitative analysis was performed with RevMan software(version 5.2).Results:A total of six randomized controlled trials comprising 394 participants were included in the study.Meta-analyses showed that psychological interventions significantly reduced the degree of depression(standard mean difference=-0.44,95%confidence interval[CI]:-0.78-0.10;P=0.01]and improved the status of the physical health component summary(mean difference=8.85,95%CI:3.69-14.00;P=0.00]in SLE patients.However,there was no significant effect of psychological intervention on disease activity,degree of pain,fatigue or the mental health component summary.Conclusions:The results show that psychological interventions can effectively improve the health-related quality of life in patients with SLE.The full benefit and clinical performance of psychological care requires further investigation by a series of multicenter,large-sample size randomized controlled trails.
文摘Rowell syndrome is a disease diagnosed by three major and three minor criteria. The major criteria include the presence of lupus erythematosus (systemic, discoid, or subacute lupus), EM-like lesions (with or without involvement of mucous membranes), and a speckled pattern of antinuclear antibodies. The minor criteria include chilblains, anti-Ro and/or anti-La antibodies, and positive RF. In this article, we present a patient whose manifestation indicated RS, because his diagnosis of Systemic lupus erythematosus was definite, and also onset with EM-like lesions and positive antinuclear antibodies. All these above are consistent with the three major criteria. In addition, his RF was positive, which was the complement for the minor criteria.
文摘Recent advances in the management of lupus nephritis,together with earlier renal biopsy and selective use of aggressive immunosuppressive therapy,have contributed to a favorable outcome in children and adolescents with systemic lupus erythematosus(SLE).Nevertheless,we believe that a more effective and less toxic treatment is needed to attain an optimal control of the activity of lupus nephritis.Recent published papers and our experiences regarding treatment of young patients with lupus nephritis using calcineurin inhibitors are reviewed.Although it has been reported that intermittent monthly pulses of intravenous cyclophosphamide(IVCY)are effective for preserving renal function in adult patients,CPA is a potent immunosuppressive agent that induces severe toxicity,including myelo-and gonadal toxicity,and increases the risk of secondary malignancy.Thus,treatment for controlling lupus nephritis activity,especially in children and adolescents,remains challenging.Cyclosporine A(Cs A)and tacrolimus(Tac)are T-cell-specific calcineurin inhibitors that prevent the activation of helper T cells,thereby inhibiting thetranscription of the early activation genes of interleukin(IL)-2 and suppressing T cell-induced activation of tumor necrosis factor-α,IL-1βand IL-6.Therefore,both drugs,which we believe may be less cytotoxic,are attractive therapeutic options for young patients with lupus nephritis.Recently,a multidrug regimen of prednisolone(PDN),Tac,and mycophenolate mofetile(MMF)has been found effective and relatively safe in adult lupus nephritis.Since the mechanisms of action of MMF and Tac are probably complementary,multidrug therapy for lupus nephritis may be useful.We propose as an alternative to IVCY,a multidrug therapy with mizoribine,which acts very similarly to MMF,and Tac,which has a different mode of action,combined with PDN for pediatric-onset lupus nephritis.We also believe that a multidrug therapy including Cs A and Tac may be an attractive option for young patients with SLE and lupus
