Publications by authors named "Mithu Maheswaranathan"
Introduction: In the type 1 and 2 SLE model, inflammation mediates type 1 manifestations, but its role in type 2 manifestations (eg, fatigue, myalgias, mood disturbance, cognitive dysfunction) is less clear. Therapeutic hydroxychloroquine (HCQ) levels reduce type 1 activity, but their relationship with type 2 activity is unknown. Exploring this relationship may illuminate type 2 SLE pathophysiology.
View Article and Find Full Text PDFSystemic autoimmune rheumatic diseases (SARDs) consist of a broad range of immune-mediated multisystem diseases. They are chronic, incurable illnesses that often present in early to mid-life and can be associated with a high symptom burden, disability, and early mortality. Treatment guidelines for similar chronic, life-limiting conditions with uncertain disease courses now recommend palliative care (PC) assessment at the time of diagnosis.
View Article and Find Full Text PDFPerspectives of Rheumatologists on the Type 1 and 2 Systemic Lupus Erythematosus Model.
ACR Open Rheumatol
December 2024
Article Synopsis
- The Type 1 and 2 systemic lupus erythematosus (SLE) Model aims to capture all symptoms experienced by SLE patients and is based on prior qualitative research reflecting their lived experiences.
- A qualitative study involving 13 rheumatologists was conducted to gather their feedback on the model's relevance to their clinical practice, with most expressing approval and finding it helpful for treatment and patient education.
- While the model was generally well-received, some rheumatologists raised concerns about its potential to contribute to overdiagnosis of SLE, highlighting the need for further research on its effects on patient interactions and outcomes.
Objective: Health literacy is an important social determinant of health, with limited health literacy associated with worse health outcomes. This study examined the associations between limited health literacy with patient-reported outcomes and disease activity/damage among 267 Black women with active systemic lupus erythematosus (SLE) enrolled in the Peer Approaches to Lupus Self-Management (PALS) program.
Methods: The three-item Chew Health Literacy Screening was used to dichotomize those reporting in the "limited" range on any item with outcomes compared via generalized linear models.
Objective: Characterise the relationship between hydroxychloroquine (HCQ) blood levels and the number of missed doses, accounting for dosage, dose timing and the large variability in pharmacokinetics (PK) between patients.
Methods: We externally validated a published PK model and then conducted dosing simulations. We developed a virtual population of 1000 patients for each dosage across a range of body weights and PK variability.
Article Synopsis
- Type 2 systemic lupus erythematosus (SLE) symptoms like fatigue and brain fog negatively impact the health-related quality of life in lupus patients, and the study aimed to explore their relationship with Type 1 SLE activity and lupus nephritis (LN) severity.
- A cross-sectional analysis of 244 SLE patients revealed that 10% had active nephritis, while others had either historical or no nephritis, and those with active nephritis reported more severe Type 2 SLE symptoms than those with inactive nephritis.
- The findings indicate that while Type 2 SLE symptoms are prevalent, their intensity in patients with active nephritis may lessen as nephritis improves, and interestingly, non-neph
Objective: In the new Type 1 & 2 model for systemic lupus erythematosus (SLE), Type 1 SLE represents classic inflammatory manifestations, such as arthritis, while Type 2 SLE encompasses symptoms such as pain and fatigue where the relationship to inflammation is less clear. The objective of this study was to interview individuals living with SLE to determine the content and face validity of the Type 1 & 2 SLE model.
Methods: We conducted a qualitative study using semi-structured interviews with a purposeful sample of participants who met classification criteria for SLE.
Article Synopsis
- - The study aimed to create and evaluate a new physician-reported measure called the Type 2 Physician Global Assessment (Type 2 PGA) to better assess type 2 symptoms of Systemic Lupus Erythematosus (SLE), like fatigue and brain fog, which are not well captured by existing measures.
- - Six rheumatologists collaborated to develop the Type 2 PGA, and its effectiveness was tested on data from 263 patients, showing strong reliability among different doctors scoring the same symptoms.
- - Results indicated that the Type 2 PGA correlates well with specific patient-reported issues, suggesting it could enhance patient care by highlighting important symptoms that usual assessments overlook.
Objective: Systemic lupus erythematosus (SLE) flares are associated with increased damage and decreased health-related quality of life. We hypothesized that there is discordance between physicians' and patients' views of SLE flare. In this study, we aimed to explore patient and physician descriptions of SLE flares.
View Article and Find Full Text PDFObjective: The COVID-19 pandemic resulted in rapid adoption of telemedicine in rheumatology. We described perspectives of patients with rheumatic diseases related to telemedicine use.
Methods: An anonymous online survey for people with rheumatic diseases was launched in January 2021.
Article Synopsis
- A new model called the Type 1 and 2 SLE Model was created to classify the symptoms of Systemic Lupus Erythematosus (SLE), distinguishing between inflammatory symptoms (Type 1) and fatigue and cognitive issues (Type 2).
- In-depth interviews with 42 SLE patients revealed two patterns of Type 2 SLE: Intermittent, where symptoms improve when Type 1 is inactive, and Persistent, where symptoms remain constant regardless of Type 1 activity.
- The study highlights the importance of patient experiences, showing that understanding these patterns can help better address the diverse symptoms that SLE patients face.
Article Synopsis
- - The study aimed to address medication nonadherence in patients with systemic lupus erythematosus (SLE) by refining and validating the DOSE-Nonadherence tool, which assesses both the extent and reasons for nonadherence.
- - Patient feedback and rheumatologist input helped modify the tool, and results showed good reliability and validity compared to other adherence measures, identifying nearly half of participants as nonadherent.
- - Common barriers to adherence included forgetfulness, physical fatigue, and "pill fatigue," indicating areas for potential intervention to improve medication adherence in SLE patients.
Association of Hurried Communication and Low Patient Self-Efficacy With Persistent Nonadherence to Lupus Medications.
Arthritis Care Res (Hoboken)
January 2023
Article Synopsis
- Medication nonadherence is a significant issue for patients with systemic lupus erythematosus (SLE), particularly among underrepresented racial minorities who face more severe disease manifestations.* -
- A study found that 48% of 77 patients with SLE had persistent nonadherence to their medication, with trends showing this group was younger, more likely to be Black, and faced economic challenges.* -
- To improve adherence, the study suggests enhancing patient-provider communication and building patient self-efficacy, particularly targeting younger Black patients with lower incomes.*
Objective: Limited health literacy and numeracy are associated with worse patient-reported outcomes and higher disease activity in systemic lupus erythematosus (SLE), but which factors may mediate this association is unknown. We sought to determine the association of health literacy and numeracy with SLE knowledge.
Methods: Patients with SLE were recruited from an academic center clinic.
Objective: Despite high rates of medication nonadherence among patients with systemic lupus erythematosus (SLE), effective interventions to improve adherence in SLE are limited. We aimed to assess the feasibility of a pilot intervention and explore its effect on adherence.
Methods: The intervention used pharmacy refill data to monitor nonadherence and prompt discussions surrounding SLE medications during clinic encounters.
Objective: Myositis autoantibody panel results can offer diagnostic and prognostic information in patients with concern for idiopathic inflammatory myopathy (IIM). However, there has been widespread utilization of myositis autoantibody testing clinically, often in situations where concern for an IIM is unclear. We sought to determine ordering practices and factors predicting positive results on ordered myositis antibody panels.
View Article and Find Full Text PDFA 79-Year-Old Female Patient With Altered Mental Status and Anemia.
Arthritis Care Res (Hoboken)
April 2022