aspek psikiatrik pada penderita sle

8/11/2019 Aspek Psikiatrik Pada Penderita SLE

1/119

Aspek psikiatrik pada penderita SLEJurnal 1Clin Dev Immunol. 2013; 2013: 270878.

Published online 2013 June 20. doi: 10.1155/2013/270878

PMCID: PMC3705842

The Correlations of Disease Activity,

Socioeconomic Status, Quality of Life,

and Depression/Anxiety in Chinese

Patients with Systemic Lupus

rythematosus

i!u "hen#1 # 2$ei %&n#3'ui(u&n )en*#3+&n ,e#1Jin-ei iu#1$ei(un Chen#1i&oin

,u&n*#1h&n!un Du(u&n u#2,on* iu#3 &nd hien* 'u3 #

uho6 ino6m&ion 6ile noes Co9!6i*h &nd iense ino6m&ion

'o o:

A!stract

%he 96ev&lene o 9s!holo*i&l 96oblems is 6euen in s!semi lu9us e6!hem&osus

"< 9&iens &nd &99e&6s o be in6e&sin*. %he u66en sud! invesi*&ed he

6el&ionshi9 &mon* dise&se 9&6&mee6s# u&li! o lie# &nd he 9s!holo*i&l s&us in

Chinese 9&iens -ih ". sel=6e9o6 su6ve! desi*n -&s &dminise6ed o 170 "9&iens &nd 210 he&lh! individu&ls usin* he "el=>&in* n?ie! "&le# he "el=>&in*

De96ession "&le# &nd he "ho6 )o6m 3@ he&lh su6ve! ")=3@ dom&ins -e6e si*nii&nl! &ouned o6 &n?ie!. In summ&6!# he6e -e6e

si*nii&n 6el&ionshi9s &mon* dise&se 9&6&mee6s# u&li! o lie# &nd &n?ie!/de96ession

in Chinese " 9&iens. %he6eo6e# i is neess&6! o h&ve 9s!hi&6i &nd 9s!holo*i&lev&lu&ions &nd o6mul&e &n ine*6&ed &996o&h o6 m&n&*in* men&l he&lh in Chinese

lu9us 9&iens# es9ei&ll! hose -ho h&ve hi*h dise&se &ivi!# lo- ""# &nd 9oo6 u&li!

o lie.

'o o:

"# $ntroduction
http://dx.doi.org/10.1155%2F2013%2F270878http://www.ncbi.nlm.nih.gov/pubmed/?term=Shen%20B%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Tan%20W%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Tan%20W%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Feng%20G%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Feng%20G%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Feng%20G%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=He%20Y%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=He%20Y%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Liu%20J%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Liu%20J%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Chen%20W%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Chen%20W%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Huang%20X%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Huang%20X%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Huang%20X%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Da%20Z%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Da%20Z%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Xu%20X%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Xu%20X%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Liu%20H%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Liu%20H%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Gu%20Z%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Gu%20Z%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://www.ncbi.nlm.nih.gov/pubmed/?term=Shen%20B%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Tan%20W%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Feng%20G%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=He%20Y%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Liu%20J%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Chen%20W%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Huang%20X%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Huang%20X%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Da%20Z%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Xu%20X%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Liu%20H%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Gu%20Z%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://dx.doi.org/10.1155%2F2013%2F270878


2/119

"!semi lu9us e6!hem&osus "< is & h6oni inl&mm&o6! &uoimmune dise&se h&

m&! &e muli9le o6*&n s!sems# inludin* he en6&l ne6vous s!sem CE"< F1G.

Ps!hi&6i s!m9oms &6e 96esen in he m&(o6i! o 9&iens -ih "# &mon* -hihm&(o6 de96ession is he mos ommon 9s!hi&6i m&nies&ions F2G. De96ession

96esened in 11BH3B o 9&iens m&! be he inii&l s!m9om beo6e he di&*nosis o

" F3G. I -&s 6e9o6ed h& he6e -e6e 4 imes hi*he6 96ev&lene o de96ession in "om9&6ed o & m&hed# non=" 9o9ul&ion. In &ddiion# &n?ie! is uie ommon in

" 9&iens# oen &s & 6e&ion o he illness. ini&l& &nd olle&*ues h&ve 6e9o6ed h&

he &n?ie! diso6de6s -e6e -ie &s 96ev&len &mon* " 9&iens &s om9&6ed o heon6ols F4G.

ven hou*h " 96esens &om9&n! -ih & -ide v&6ie! o 6e&&ble 9s!hi&6i

s!m9oms# suh &s de96ession &nd &n?ie!# he! 6&6el! see &nd 6eeive &deu&e

6e&men F5G. Ave6looin* &n?ie! &nd de96ession m&! h&ve seve6e onseuenes o6 he9&iens# suh &s in6e&sed inidene o &6diov&sul&6 dise&se F@G# m!o&6di&l in&6ion

F7G# suiid&l ide&ion F8# G &nd de&h F10G# de6e&sed u&li! o lie F11#12G# dis&bili!#

&nd he loss o em9lo!men. n!one# in u6n# &n -o6sen &n?ie! &nd de96essions!m9oms F5G.

%he 9&ho*enesis o 9s!hi&6i s!m9oms in lu9us is sill no -ell unde6sood# bu in

-hih *enei &nd envi6onmen&l &o6s m&! 9l&! & 9ivo&l 6ole. De96ession &nd &n?ie!

m&! &lso be 96esen &s & 6e&ion o & se6ious 6eu66in*# 9&inul illness# -hih is&ssoi&ed -ih visible s!m9oms suh &s insomni &i*ue# &nd limied unionin* F13#

14G. "oioeonomi s&us ""< is b6o&dl! em9lo!ed in he&lh 6ese&6h# si*n&lin* he

im9o6&ne o soioeonomi &o6s o6 he&lh ouomes. o- "" is *ene6&ll!

&ssoi&ed -ih hi*h 9s!hi&6i mo6bidi!# de96ession F15G# &nd mo6&li! F1@G. $hehe6de96ession &nd &n?ie! &6e &ssoi&ed -ih lu9us &ivi! 6em&ins deb&&ble.

%he6e &6e seve6&l sudies ous on 9s!holo*i&l 96oblems in Chin& lu9us 9&iens.

sud! 6om ,on* on* h&s ound h& &n?ie! diso6de6 -&s 96esen in 22B " 9&iens#&nd 18.2B h&d de96ession F17G. sud! 6om nhui medi&l unive6si! h&s 6e9o6ed h&

he 96ev&lene o de96ession -&s 5.3B &nd o66el&ed -ih suiid&l ide&ion in "

9&iens F8G. u he6e &6e e- sudies h& ous on dise&se 9&6&mee6s# u&li! o lie#

&nd de96ession/&n?ie! in " 9&iens 6om Chin& m&inl&nd.

%hus# he &im o his sud! -&s o e?&mine he 6el&ionshi9 &mon* dise&se 9&6&mee6s#

u&li! o lie# &nd he 9s!holo*i&l s&us in Chinese 9&iens -ih ". Mo6eove6# -e

-ished o &se6&in he 9ossible 6iss o &n?ie! &nd de96ession.

'o o:

%# Patients and &ethods

%#"# Participants
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B4http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B5http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B7http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B8http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B9http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B10http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B11http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B5http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B13http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B14http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B15http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B16http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B17http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B8http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B4http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B5http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B7http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B8http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B9http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B10http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B11http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B5http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B13http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B14http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B15http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B16http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B17http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B8http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/


3/119

" 9&iens -e6e 6e6uied 6om ili&ed ,os9i&l o E&non* Knive6si! be-een

J&nu&6! 2010 &nd Jul! 2011. o&l o 170 " 9&iens &nd 210 he&lh! individu&ls

-e6e onseuivel! invied o 9&6ii9&e in & sin*le=ene6 6oss=seion&l sud!. ,e&lh!individu&ls -e6e used &s he on6ol *6ou9. ll 9&iens ulilled he 17 me6i&n

Colle*e o >heum&olo*! C>< 6evised 6ie6i& o6 he l&ssii&ion o ". P&iens

-e6e e?luded b&sed on he ollo-in*: 1< he! did no om9lee uesionn&i6e; 2< he!h&d omo6bidiies e.*.# se6ious ineions o6 &6di 6es9i6&o6!# *&s6oinesin&l#

neu6olo*i&l# o6 endo6ine dise&ses< h& ould inluene " &ivi!. Con6ol sub(es

-e6e e?luded i he! e?hibied u66en o6 hiso6! o ohe6 s!semi dise&ses o69s!hi&6i diso6de6s. %his sud! -&s &996oved b! he his Commiee o ili&ed

,os9i&l o E&non* Knive6si!# &nd -6ien ino6med onsen -&s ob&ined 6om &ll

9&6ii9&ns.

%#%# &easures of Clinical 'aria!les

%he "!semi u9us 6!hem&osus Dise&se ivi! Inde? "DI< -&s used o

me&su6e dise&se &ivi! F18G.

%#(# The )evised Self*)atin+ Anxiety Scale SAS- ."0

"" -&s used o ev&lu&e he level o &n?ie!=6el&ed s!m9oms du6in* he -ee 96io6 o

he su6ve!. %his sel=&dminise6ed es h&s 20 uesions# -ih 15 iems 6elein*in6e&sin* &n?ie! levels &nd 5 uesions 6elein* de6e&sin* &n?ie! levels. &h

uesion -&s so6ed on & s&le 6om 1 o 4 6&6el!# someimes# 6euenl!# &nd &l-&!s


4/119

summed# &nd 6&nso6med on & s&le 6om 0 -o6s 9ossible he&lh s&e me&su6ed b! he

uesionn&i6e< o 100 bes 9ossible he&lh s&e


5/119

%&ble 2

Co66el&ions be-een 9s!holo*i&l so6es# dise&se 9&6&mee6s# &nd u&li! o lie in "9&iens.

(#%# Correlations !etween Psycholo+ical Scores, Disease Parameters, and

Quality of Life in SL Patients

P6evious sudies h&ve sho-n h& lo- soioeonomi &o6s ""< -e6e *ene6&ll!

&ssoi&ed -ih hi*h 9s!hi&6i mo6bidi!# de96ession# &nd &n?ie! F22G. s sho- in%&ble 3# -e h&ve ound h& he6e -e6e si*nii&n o66el&ions be-een "" lo-

edu&ion# -o6 s&us# &nd inome< &nd &n?ie!/de96ession in " 9&iens. In &ddiion#

*ende6 &nd mens6u&l hiso6! -e6e some e?&m9les o de96ession 6is &o6s. %he6e -&s &si*nii&n 9osiive o66el&ion be-een &n?ie!/de96ession seve6i! &ssessed usin*

""/"D" so6e< &nd dise&se &ivi! "DI so6e


6/119

%&ble 4"e9-ise 6e*6ession &n&l!ses o medi&l &nd 9s!holo*i&l v&6i&bles &nd hei66el&ionshi9 o "" in " 9&iens.

%&ble 5

"e9-ise 6e*6ession &n&l!ses o medi&l &nd 9s!holo*i&l v&6i&bles &nd hei66el&ionshi9 o "D" in " 9&iens.

'o o:

1# Discussion

%he 96esen sud! oni6med h& Chinese " 9&iens -e6e mo6e liel! o sue6 6om

&n?ie! &nd de96ession h&n he&lh! individu&ls. Ps!holo*i&l 96oblems si*nii&nl!

o66el&ed -ih ""# dise&se s&us# &nd u&li! o lie. " 9&iens -ih &n?ie! &ndde96ession -e6e in lo- "" &nd h&d -o6se dise&se s&us# lo-e6 u&li! o lie. mon*

he &ssessed 9&6&mee6s# %# P)# &nd >P s&les o ")=3@ -e6e m&(o6 on6ibuo6s o

&n?ie! in " 9&iens# -hile dise&se &ivi! &nd %# P)# ")# &nd > dom&ins o ")=3@on6ibued o de96ession.

"" is b6o&dl! em9lo!ed in he&lh 6ese&6h# si*n&lin* he im9o6&ne o soioeonomi

&o6s o6 he&lh ouomes. P6evious sud! h&s ound h& 9oo6e6 o9in* s!les# on*oin*

lie evens# s6ess e?9osu6e# &nd -e&e6 soi&l su99o6 -e6e some e?&m9les o de96ession6is &o6s h& -e6e mo6e 96ev&len in lo-e6 "" *6ou9s F23G. >e*&6din* he di6eion

o he &ssoi&ion o6 "" &nd de96ession# 6esuls mo6e onsisenl! su99o6ed he ide&

h& &us&ion lo- "" in6e&ses 6is o de96ession< ou-ei*hed seleion de96essionhinde6s soi&l mobili!


7/119

)em&le *ende6 &nd !oun*e6 &*e h&ve -ell=no-n &ssoi&ions -ih de96ession &nd

onound he "" &n?ie!/de96ession 6el&ionshi9 in " F28G. In he 96esen sud!#

*ende6 -&s inde9endenl! &ssoi&ed -ih de96ession in ". Ine6esin*l!# -e h&veound h& he6e -e6e si*nii&n o66el&ion be-een &bno6m&l mens6u&l hiso6! &nd

de96ession. $hehe6 &n?ie!/de96ession is &ssoi&ed -ih lu9us &ivi! 6em&ins

deb&&ble. $&le6 " &nd olle&*ues 6e9o6ed h& he &n?ie! seve6i! did o66el&e9osiivel! -ih " &ivi! F2G. Ee6! e &l. 6e9o6ed & si*nii&n 9osiive o66el&ion

be-een de96ession &nd dise&se &ivi! F30G. In on6&s# ohe6 sudies 6e9o6ed h& he6e

-&s no 6el&ionshi9 be-een lu9us &ivi! &nd 96esene o & m&(o6 de96essive e9isodeF31G. In he 96esen sud!# ou6 *6ou9 ound si*nii&n 9osiive o66el&ion be-een

&n?ie!/de96ession &nd dise&se &ivi!. ,e&lh=6el&ed u&li! o lie in lu9us -&s ound

o be si*nii&nl! -o6se in om9&6ison -ih on6ol *6ou9. >een sud! 6e9o6ed h&

" 9&iens -ho h&d si*nii&nl! 9oo6e6 he&lh=6el&ed u&li! o lie -e6e si*nii&nl!mo6e de96essed &nd &n?ious h&n hei6 he&lh! oune69&6s F11G. $e h&ve &lso ound he

PC" &nd MC" &nd &ll 8 dom&ins o ")=3@ e?e9 P -e6e si*nii&nl! -o6se h&n

on6ol sub(es. %he 6esuls -e6e simil&6 -ih he sud! 6om ,on* on*. $e h&ve &lso

ound h& he "DI so6es -e6e & s6on* 96edio6 o de96ession in 9&iens -ih ".

Eo&bl!# he 6esuls o he 96esen sud! demons6&ed h& &n?ie! in Chinese "

9&iens die6s 6om " 9&iens in ohe6 oun6ies. %his ould be e?9l&ined b! some

ulu6&l e&u6es -hih m&! inluene men&l dise&se di&*nosis &nd m&n&*emen inChin&. $e h&ve ound h& he 96ev&lene o de96ession -&s hi*he6 h&n ,on* on*# &nd

i mi*h be due o ulu6&l die6enes &nd "" suh &s inome &nd medi&l insu6&nes

9oli!.

In o6de6 o ideni! -hih v&6i&bles -e6e mos si*nii&nl! o66el&ed -ih &n?ie! &ndde96ession# se9-ise 6e*6ession &n&l!sis -&s used. $e h&ve ound h& %# P)# &nd >P

s&les o ")=3@ -e6e he mos 9o-e6ul 96edio6s o &n?ie! o " 9&iens.Me&n-hile# "DI# %# P)# ")# &nd > dom&ins o ")=3@ -e6e si*nii&nl! &ounedo6 &n?ie!. I ould be e?9l&ined h& im9&i6ed u&li! o lie &nd union&l dis&bili!

-e6e inde9enden 6is &o6s o6 9s!holo*i&l diso6de6s.

9ossible limi&ion o he 96esen sud! -&s h& &ll 9&iens involved in he su6ve! -e6e

6om onl! one ene6 &nd is &ilu6e o die6eni&e be-een men &nd -omen; he *ende6die6enes in " 9&iens 6eui6e u6he6 &n&l!sis in & uu6e sud!. nohe6 limi&ion

o he sud! -&s h& -e did no dee he im9& o 96oinl&mm&o6! !oines on

de96ession. >een sud! 6e9o6ed h& hi*he6 se6um %E)=level -&s inde9endenl!&ssoi&ed -ih 9oo6e6 he&lh=6el&ed u&li! o lie &nd mo6e seve6e de96essive

s!m9oms in " 9&iens in "in*&9o6e F11G.

In summ&6!# ou6 sud! indi&ed h& 9s!holo*i&l 96oblems -e6e 6euen in Chinese

" 9&iens. "eve6e dise&se s&us &nd 6edued u&li! o lie si*nii&nl! o66el&ed-ih &n?ie! &nd de96ession. Dise&se &ivi! -&s hi*he6 in &n?ious &nd de96essed

sub*6ou9s. Qu&li! o lie -&s de6e&sed in de96essed sub*6ou9s. Im9&i6ed men&l he&lh

&nd 9&in -e6e he mos 9o-e6ul 96edio6s o &n?ie! &nd de96ession. o- "" -&sinde9endenl! &ssoi&ed -ih 9oo6 men&l he&lh. %hese indin*s oni6med he
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B28http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B30http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B31http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B29http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B11http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B11http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B28http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B30http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B31http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B29http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B11http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705842/#B11


8/119

im9o6&ne o 9s!hosoi&l ine6venions in ombin&ion -ih medi&l he6&9! o6 "

9&iens.

'o o:

Authors5 Contri!ution

i!u "hen &nd $ei %&n on6ibue eu&ll! o his -o6.

'o o:

Ac6nowled+ments

%he &uho6s -&n o h&n i6en i# in*h&n* hu# 'en&i 'uo# Jie Qi&n# ,&i?i& C&o#&nd +unei i& o6 hei6 &ssis&ne -ih his 9&9e6. %his -o6 -&s su99o6ed b! he

E&ion&l E&u6&l "iene )ound&ion o Chin& '6&n no. 81172841# "hu&6d D$. Eeu6o9s!holo*i&l

im9&i6men in s!semi lu9us e6!hem&osus: & om9&6ison -ih muli9le sle6osis.Neuropsychology Review. 2008;182


9/119

@. '6eo CM# i %# "&&6 # e &l. ssoi&ion be-een de96ession &nd v&sul&6 dise&se

in s!semi lu9us e6!hem&osus.Journal of Rheumatology. 2012;32


10/119

22. ems6& M# Eeudo6 C# DT6! C# uns # $&66en M# enne E>. s!sem&i

6evie- o de96essed mood &nd &n?ie! b! "" in !ouh &*ed 10H15 !e&6s. Canadian

Journal of Pu&lic 'ealth. 2008;2J# lo!d D. %he s6ess 96oess &nd he soi&l dis6ibuion o de96ession.

Journal of 'ealth and #ocial (ehavior. 1;404


11/119

8!9ective

%he 9u69ose o his sud! -&s o esim&e he 96ev&lene &nd e?&mine he 96edio6s ode96ession in 9&iens -ih s!semi lu9us e6!hem&osus "&in* "&le ,M=D17eenl!# & sud! o 9&iens -ihs!semi sle6osis sho-ed h& 1=!e&6 &nd lieime 96ev&lene 6&es o MDD -e6e 11B

&nd 23B 6es9eivel!.2%hose 6&es &6e &996o?im&el! -ie h& o he *ene6&l

9o9ul&ion.2"imil&6l!# 6een evidene su**ess h& he 96ev&lene o de96ession in&ne6 9&iens is &s hi*h &s 30B &nd de96essive seve6i! is &ssoi&ed -ih seve6i! o

9h!si&l 9&in.3
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b1-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b1-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b2-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b2-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b2-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b3-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b1-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b2-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b2-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b3-ndt-9-799


12/119

"!semi lu9us e6!hem&osus "< is & h6oni &uoimmune dise&se -hih usu&ll!

&es muli9le o6*&n s!sems inludin* he en6&l ne6vous s!sem.4#5%he6eo6e# i &n

&use seve6&l neu6o9s!hi&6i s!nd6omes# inludin* de96ession.@#7>een evidenesu**ess h& he 96ev&lene o de96ession in " 9&iens is be-een 11.5B &nd 47B.8H

13In &ddiion# & 6een sud! su**ess h& seve6i! o de96ession in6e&ses -ih mo6e

seve6e dise&se &ivi! o ".14%he e?ended lie s9&n o " 9&iens 6om u66en&dv&nes in mediine le&ds hese 9&iens o enoune6 & 6el&9sin* &nd 6emiin* ou6se o

he dise&se &nd &dve6se evens 6om seve6&l 6e&mens h& m&! dee6io6&e hei6 u&li!

o lie &nd inim&e 6el&ionshi9s# &nd m&! 96ei9i&e de96ession.15#1@In &ddiion# hebu6den o " omo6bid -ih de96ession m&! in6e&se he 6is o suiide.17

lhou*h &-&6eness o 9s!hi&6i om9li&ions h&s in6e&sed &mon* 9h!sii&ns &nd

ohe6 he&lh 96oession&ls# lile 6ese&6h ouses on de96essive &s9es o ".

%he6eo6e# he &im o he u66en sud! -&s o dee6mine he 96ev&lene o de96essivediso6de6s in " 9&iens &nd o ideni! 6is &o6s.

5o to:

&aterial and methods

Patients

%he sud! used he lini&l d&& 6om he 6oss=seion&l " sud!. P&iens -e6e

6e6uied 6om he >heum&olo*! Clini o Knive6si! ,os9i&l# Chi&n* M&i Knive6si!#%h&il&nd.18ll " 9&iens# &*ed 18H@0 !e&6s# ulillin* he inlusion 6ie6i& o6 hei6

di&*nosis b&sed on he 6evised me6i&n Colle*e o >heum&olo*! C>&in* "&le ,M=D17&in* "&le ,M=


14/119

inluded in muli9le line&6 6e*6ession &n&l!sis &s inde9enden v&6i&bles. Mo6eove6# ohe6

&o6s -hih h&d si*nii&n die6enes P 0.1< -e6e &lso inluded in he &n&l!ses

&*e# hiso6! o CE" involvemen &nd & numbe6 o lieime medi&ions su&6e W 0.7# Du6bin=$&son W 1.7@< see %&ble 3


15/119

96ev&len h&n h& o he *ene6&l 9o9ul&ion in -hih he 9oin &nd lieime 96ev&lene is

@.1B &nd 10.3B# 6es9eivel!.1%he hi*h mo6bidi! o de96ession in " -&66&ns

oninuin* 6ese&6h &nd e?9&nsion o eo6s in he lini&l sein* o o9imiSe 6e&mens.

Com9&6ed -ih he *ene6&l 9o9ul&ion# &n?ie! is &nohe6 ommon 9s!hi&6i

m&nies&ion in " 9o9ul&ions. 6een sud! ound h& he 30 d&! &nd lieime96ev&lene o6 &n?ie! in " 9&iens# inludin* &*o6&9hobi& -ihou 9&ni diso6de6#

*ene6&liSed &n?ie! diso6de6 &nd ohe6 &n?ie! diso6de6# -e6e [email protected] &nd 52.1B#6es9eivel!.28"imil&6l!# &nohe6 *6ou9 ound h& he 96ev&lene o &n?ie!# &s

me&su6ed b! he ,M=# -&s &s hi*h &s @5.7B.30e&use o he hi*h 96ev&lene o

&n?ie!# individu&l " 9&iens should unde6*o 9s!hi&6i &ssessmen o6 &n?ie!.

In *ene6&l# he 6el&ionshi9 be-een de96ession &nd &n?ie! in 9&iens &6oss die6en

&*es -ih h6oni som&i dise&se h&s been 6e9o6ed. >eenl!# he evidene su**ess h&

he &n?ie! 6&i is & si*nii&n dee6min&n o de96essive s!m9oms in 9&iens -ih

b6e&s &ne6.31%he 6een sud! o 9&iens -ih 9&in s!m9oms &lso su**ess h&

&n?ie! &nd de96ession m&! o66el&e 9osiivel!.32In &ddiion# he si*nii&n6el&ionshi9 be-een hem h&s been 6e9o6ed in he &dv&ned &ne6 9&iens -ih medi&n

&*e o 5 !e&6s 6&n*e 20H1 !e&6s&in* "&le MD>"e&sons o6 hese die6in* 6esuls &6e unle&6. ,o-eve6# one 9ossible e?9l&n&ion o6 he

die6en indin*s is he 9oeni&ll! onoundin* inluene o 96ednisolone# & medi&ion-hih &n indue de96ession.37Me&n doses o 96ednisolone in & 96evious sud! -e6e

18.28 m*/d&! o6 he m&(o6 de96essive diso6de6 MDD< *6ou9 &nd 15.0 m*/d&! o6 he

non=MDD *6ou9#3@-hile me&n doses o his medi&ion in ou6 sud! -e6e less h&n h&o & 96evious sud!.3@)u6he6 6ese&6h -ih & l&6*e6 s&m9le siSe &nd -ell=on6olled

sud! mehodolo*! m&! l&6i! hese 9henomen&.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b1-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b1-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b28-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b28-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b30-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b30-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b31-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b31-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b31-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b32-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b32-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b33-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b34-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b34-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b35-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b36-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b37-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b37-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b36-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b36-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b1-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b28-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b30-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b31-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b32-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b33-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b34-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b35-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b36-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b37-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b36-ndt-9-799http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/#b36-ndt-9-799


16/119

CE" involvemens in " m&! be one o he m&(o6 &uses o mo6bidi! &nd mo6&li!. I

is &lso &ssoi&ed -ih 9s!hi&6i m&nies&ions# 9&6iul&6l! in 9s!hosis 23B


17/119

2. "e/ett >, >a?y+o (, uso! &, *aro! &, Thobs *D, o! behal o the'a!aia! %cleroera >esearch 5. Preale!ce o curre!t, 12@o!th a!lietie aAor epressie isorer ao!- patie!ts /ith systeic sclerosis.>heuatolo-y. 2013;#24:))9)7#. , >obi!so! &, rstro!- , *ar!es H, Cilbour! C&, >ichars*. ati-ue i! systeic lupus erytheatosus: co!tributio!s o iseaseactiity, pai!, epressio!, a! perceie social support. " >heuatol.200#;329:1)99170#.


18/119

17. Iie , 'he! P, Pa! , et al. Preale!ce a! correlates o suicialieatio! i! % i!patie!ts: 'hi!ese e6perie!ce. >heuatol (!t.2012;329:27072714. heuatol. 2004;3111:21#)21)2.


19/119

34. &a+ , Ta!- '%, 'ha! &, 'hea+ , o >'. Daa-e accrual, cuulatie-lucocorticoi ose a! epressio! preict a!6iety i! patie!ts /ith systeiclupus erytheatosus. 'li! >heuatol. 2011;30):79#803. , "oh!so! '>, et al. The i!cie!ce a! preale!ceo !europsychiatric sy!roes i! peiatric o!set systeic lupuserytheatosus. " >heuatol. 2002;297:1#3)1#42. heu.1981;2411:1389139#.


20/119

Deb6iein* ine6vie-s o sub(es -ih " *uided he l&n*u&*e modii&ions o he

ool. %he 96oess o &d&9&ion 96oeeded &o6din* o he *uideline &nd 96e=esin*

6esuls o u9usQo=Chin&. 220 " 9&iens om9leed u9usQo=Chin& &nd & *ene6i96ee6ene=b&sed me&su6emen o he&lh u6oQo s&le Q=5D< &nd es=6ees %>%< 6eli&bili!#

onve6*en &nd dis6imin&n v&lidi! -e6e e?&mined. )&o6 &n&l!sis &nd >&sh &n&l!sis-e6e 9e6o6med.

)esults

%he me&n "D< &*e o he 208 sub(es -ih " -&s 33.3 O.1< !e&6s. IC> &nd %>%o he ei*h dom&ins 6&n*ed 6om 0.811 o 0.@5 &nd 0.83@ o 0.74# 6es9eivel!. %he

u9usQo=Chin& dom&ins demons6&ed subs&ni&l evidene o ons6u v&lidi! -hen

om9&6ed -ih euiv&len dom&ins on he Q=5D 9h!si&l he&lh &nd usu&l &iviies 6 WX0.@3# 9&in &nd 9&in/disomo6 6 W X0.778# emoion&l he&lh &nd &n?ie!/de96ession 6 W

X0.7@1# 9l&nnin* &nd usu&l &iviies 6 W X0.5@0Qo< is desi6&ble. ,>Qo &ssessmen h& ev&lu&es 9&iensT he&lh s&us &nd

9e6son&l sense o -ell bein* m&! mo6e &u6&el! 6ele he bu6den o " dise&se

&mon* 9&iens. %he6eo6e &u6&e ,>Qo &ssessmen o 9&iens -ih " is desi6&ble&nd d6&-s in6e&sin*l! &enion.

ITs no-n h& ,>Qo &mon* 9&iens -ih " is -o6se h&n he *ene6&l 9o9ul&ion#

9&6iul&6l! hose &ll viim & &n e&6lie6 &*eF4G. P6io6 sudies o ,>Qo in " h&veem9lo!ed *ene6i ools# suh &s he "ho6 )o6m=3@ ")=3@< F5G# u6oQo s&le Q=5DQo ools h&ve been v&lid&ed in M&inl&nd Chinese. o6din* o oii&l

-ebsie o u9usQoh9://lu9usol.om/Qo o " 9&iens in M&inl&nd Chin& m&! benei 6om s9eiidie6enes 6om %&i-&n. Au6 ob(eive -&s o 6oss=ulu6&ll! &d&9 he u9usQo o

M&inl&nd Chinese# &nd ev&lu&e is me&su6emen 96o9e6ies.

5o to:

Patients and &ethods

Demo+raphic Data

%his sud! -&s &996oved b! he insiuion&l 6evie- bo&6d o "h&n*h&i Ji&oon*

Knive6si!# &nd &ll sub(es onsened o 9&6ii9&ion. $e inluded onseuive "

9&iens n W 220< -ho h&d been ollo-ed u9 & >en Ji ,os9i&l# "hool o Mediine#"h&n*h&i Ji&o %on* Knive6si! 6om M&6h o Eovembe6 o 2012. %he inlusion 6ie6i&

-e6e &s ollo-s: &*e be-een 18 &nd 75 !e&6s# &nd di&*nosis o " &o6din* o he

17 modiied C> 6ie6i& F11G. Demo*6&9hi ino6m&ion inluded se?# &*e# &*e &dise&se di&*nosis# edu&ion &nd m&6i&l s&us.

LupusQoL

u9usQo is & lu9us=s9eii ,>QA uesionn&i6e onsisin* o 34 iems *6ou9ed in

ei*h dom&ins: 9h!si&l he&lh P,


22/119

6om he sel=l&ssiie6# -he6e 1 6e96esens ull he&lh &nd 0 6e96esens de&d. "o6es o6

he ive dom&ins o he Q=5D -e6e *ene6&ed.

Disease Characteristics

Dise&se &ivi! -&s dee6mined usin* he " Dise&se ivi! Inde? "DI< ool F14G.

"ICC/C>=DI 6&s i66eve6sible o6*&n d!sunion &6oss 12 s!sems. %he d!sunionmus be 96esen o6 @ onseuive monhs in o6de6 o 6e*ise6 &s d&m&*e. %he so6e 6&n*es

6om 0 o 4@# -ih hi*he6 so6es si*ni!in* mo6e d&m&*e.

Statistical Analyses

$e used "P"" so-&6e# ve6sion 10.0 o &n&l!Se d&&. Des6i9ive s&isis -e6e6e9o6ed. %he oninuous v&6i&bles -e6e esed o6 no6m&li!; & non=9&6&me6i es

M&nn=$hine!< -&s used o6 om9&6in* oninuous d&&.

Content 'alidity

s u9usQo -&s modiied 6om & 96e=e?isin* %&i-&n ve6sion# i -&s &ssumed h& i

h&d & *ood onen v&lidi!. $e &sed he 96e=es s&m9le o 9&iens -hehe6 he iems-e6e unde6s&nd&ble# &nd m&de mino6 h&n*es o he e?96ession &o6din* he eedb&.

$nternal Consistency )elia!ility

C6onb&hTs Y -&s used o es o6 ine6n&l onsisen!# &nd -&s onside6ed s&is&o6!-hen Z0.7F15G.

Test*retest )elia!ility

%es=6ees 6eli&bili! -&s dee6mined usin* &n in6&l&ss oeiien o &ssess he s&bili!o he me&su6e# om9&6in* u9usQo=Chin& dom&ins so6es & b&seline &nd 2 -ees

l&e6 in 9&iens n W 20< -hose sel=&ssessed u&li! o lie -&s 6&ed &s no h&n*e on &

15=9oin he&lh s&us h&n*e s&le X7 o [7


23/119

"ICC=DI so6e uo o 1. nd hen dis6imin&n ons6u v&lidi! usin* M&nn=

$hine! non=9&6&me6i ess -&s &essed.

Conver+ent 'alidity

$e me&su6ed he e?en o o66el&ion be-een obse6ved 6el&ionshi9s o he one9s&nd he h!9ohesiSed one9s o &ssess is onve6*en v&lidi!. s6on* o66el&ion -&s

deined &s Z0.70# mode6&e o subs&ni&l &s 0.30H0.70 &nd -e& &s 0.30.

:actor Analysis

$e ondued &n e?9lo6&o6! &o6 &n&l!sis )< F96ini9&l om9onen &n&l!sis P)&sh &n&l!ses# 6esuls in i &n&l!ses o iems -ihin e&h dom&in -e6e &e9&ble

me&n su&6e ouis -e6e &ll \0.@ &nd none -&s \2 %&ble 5QoF22GHF24G. %o ou6 no-led*e# he6e h&s been no "=

s9eii ,>Qo ools h& h&ve been v&lid&ed o6 use &mon* M&inl&nd Chinese 9&iens.Me&n-hile# *ene6i ools -e6e no desi*ned o6 " 9o9ul&ion# so he! m&! on&in

i66elev&n iems &nd/o6 l& iems deemed im9o6&n o hese 9&iens# &nd m&! be less

sensiive h&n & dise&se=s9eii me&su6e F25G# F2@G. o6din*l!# i is desi6&ble o ind &n"=s9eii ,>Qo ool v&lid&ed o6 use in Chinese 9&iens.

$e modiied he u9usQo=%&i-&n ins6umen o ev&lu&e in M&inl&nd Chinese 9&iens#

&nd &ssessed is me&su6emen 96o9e6ies. e&use he6e &6e no 9ublished d&& &bou

v&lidi! &nd 6eli&bili! o u9usQo=%&i-&n 9ublished# -e om9&6ed ou6 6esuls -ih heo6i*in&l ve6sion u9usQo=K< &nd u9usQo=K" in ou6 sud! F8G# FG.

Au6 6esuls 96ovide evidene h& he u9usQo=Chin& is & v&lid ool o &ssess he u&li!o lie o " 9&iens# &nd i is he i6s 96o9osed "=s9eii ,>Qo ool h& m&! be

&99lied o &ll Chinese 9&iens.

%he IC> esim&es o he u9usQo=Chin& -e6e simil&6 o hose o he u9usQo=K.

%he onve6*en &nd dis6imin&n v&lidi! o he ool -e6e *ood. In ou6 d& he dom&in

o inim&e 6el&ionshi9 -hih 6eles se?u&l he&lh &n &lso die6eni&e be-eendise&se seve6i! &s -ell &s ohe6 dom&ins. $e su**es h& his 6esul m&! be 6el&ed o he
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/table/pone-0063795-t005/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/table/pone-0063795-t005/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Cervera1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Li1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Daleboudt1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-NavarreteNavarrete1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Thumboo1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Murawski1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-McElhone1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Jolly1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/table/pone-0063795-t005/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/table/pone-0063795-t005/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/table/pone-0063795-t005/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Cervera1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Li1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Daleboudt1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-NavarreteNavarrete1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Thumboo1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Murawski1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-McElhone1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662722/#pone.0063795-Jolly1


27/119

Chinese &iude o-&6d se?u&l ine6ou6se. %6&diion&l one9s in Chinese ulu6e

onside6 ine6ou6se o be de6imen&l o he&lh. $hen Chinese 9&iens beome ill# he!

end o 6e96ess se?u&l desi6es &nd hoose o om96omise hei6 se? lie# es9ei&ll! in &seso seve6e dise&se.

Au6 e?9lo6&o6! &o6 &n&l!sis -ihou ons6&inin* &o6 numbe6s sho-ed & @=&o6lo&din* model; ho-eve6# he 6esuls o IC> &nd oni6m&o6! &o6 &n&l!sis h&n*ed

lile. o6din* o he des6i9ion o iems# -e believe he o6i*in&l 8=&o6 model isbee6.

%o ensu6e he v&lidi! o es=6ees 6eli&bili!# -e hoose -o -ees &s he ime ine6v&l

be-een -o ess# -hih is one -ee lon*e6 h&n in he o6i*in&l ve6sion o u9usQo.%his du6&ion -o -ees< -&s seleed be&use i -&s suiienl! lon* enou*h o6

9&iens o o6*e hei6 o6i*in&l 6es9onses &nd sho6 enou*h o6 he dise&se s&e o 6em&in

unh&n*ed F27G. %he >&sh model &n&l!sis &lso su**esed h& he u9usQo -&s -ell=

unde6sood o6 ou6 9&ien oho6.

ITs im9o6&n o noe h& be&use he *ene6&ion 9h&se o iems -&s ondued in he

K# -hih inluded 96edomin&nl! C&u&si&n 9&iens# he h&6&e6isis o Chinese

9&iens -ih " m&! no be 6eleed om9leel!. In &ddiion# he die6ene be-een

-o oun6! in soioeonomi s&us &nd medi&l &6e se6vies# -hih m&! im9& he&lhs&us# m&! oune6 he &e v&lidi! o he ool -hen used &mon* Chinese " 9&iens

F28G.

Conclusions

In summ&6!# ou6 6ese&6h 96ovides evidene o v&lidi! &nd 6eli&bili! o he modiied

u9usQo ve6sion u9usQo=Chin&< &mon* M&inl&nd Chinese 9&iens -ih ".ddiion&l l&6*e6 sudies &6e sill 6eui6ed o u6he6 &ssess he 9s!home6i 96o9e6ies&nd o9im&l &o6 s6uu6e# &nd 6esolve is 6ole in lini&l 6i&ls &nd 6ouine 96&ie. $e

ho9e h& his sud! -ill 96om9 u6he6 &enion o me&su6emen o ,>Qo in "

9&iens# -hih -ill ulim&el! le&d o mo6e eiien lini&l m&n&*emen o "9o9ul&ion.

5o to:

Supportin+ $nformation

Ta!le S"

xploratory :actor Analysis with < factor constraints#?6&ion Mehod: P6ini9&l

Com9onen n&l!sis. >o&ion Mehod: &6im&? -ih &ise6 Eo6m&liS&ion.

DACheu #1: 4)#474.


29/119

). %ullia! P, 5hushchya! H 200) Preere!ce@*ase L@#D i!e6 scoresor chro!ic co!itio!s i! the E!ite %tates. &e Decis &a+i!- 2): 410420., Teh %, et al. 2010 upus@speciBc health outcoe easure or E% patie!ts: the upusLo@E% ersio!.!! >heu Dis )9: 2933. heu 39: 3)33)9. , >eic+i D 200# >eliability a! aliity i!clui!-respo!sie!ess. (!: ayers P, eitor. ssessi!- Juality o lie i! cli!ical trials.M6or: M6or E!iersity Press. 2#39.1). or! " 19)# >atio!ale a! Test or the Nuber o actors i! actor!alysis. Psychoetri+a 30: 17918#. 2009 >eporti!- practices i!co!Bratory actor a!alysis: a! oerie/ a! soe recoe!atio!s.Psychol &ethos 14: )23. asch a!alysiso the Juality o lie a! isio! u!ctio! Juestio!!aire. Mpto His %ci 8):83)844. heuatolo-y M6or #1: 721729.


30/119

22. Dalebout 5&, *er-er %P, *roabe!t , Captei! 2011 ealth@relateJuality o lie i! patie!ts /ith systeic lupus erytheatosus a! prolieratielupus !ephritis. Psychol ealth &e 1): 393404. heuatol 39: 73#742. aire? &(, %abio "&, &arti!e?@-ea (,%a!tos@>ui? , et al. 2010 Luality@o@lie preictor actors i! patie!ts /ith% a! their oiBcatio! ater co-!itie behaioural therapy. upus 19:1)321)39. heuatol 2): 1#121#17. es 7: 1122. heu #9: 10471048; author reply 10481049.


31/119

"!semi lu9us e6!hem&osus "< is & muli=s!sem inl&mm&o6! diso6de6

h&6&e6iSed b! he 96esene o seve6&l &uo&nibodies# inludin* &ni=double=s6&nded

DE. Eeu6o9s!hi&6i EP2 &nibod!# 6es9eivel!. In &(MC Medicine6ese&6h &6ile#ivi! e &l. demons6&ed novel -o6 sho-ed h& he 1@/@ Id &nibod! im9&i6ed visu&l

memo6! &nd s9&i&l memo6! b! &usin* hi99o&m9&l in(u6! in mie. 'iven die6enes in

he 6oss=6e&ivi! o e&h &uo&nibod! -ih he ne6vous s!sem# he lini&l e&u6es

mi*h be die6en &nd dive6se in EP. Idenii&ion o &uo&nibod! &6*es ould le&do he develo9men o novel he6&9ies. Invesi*&o6s &nd linii&ns should onside6 no

onl! he inhibiion o &uo&nibod! s!nhesis bu &lso he 96oeion o neu6on&l ells in

he 6e&men s6&e*! o6 EP.

"ee 6el&ed >ese&6h &6ile: h9://---.biomeden6&l.om/1741=7015/11/0

>eywords7 "!semi lu9us e6!hem&osus# uo&nibod!# C6oss=6e&ivi!#

Eeu6o9s!hi&6i s!m9oms

'o o:

$ntroduction

"!semi lu9us e6!hem&osus "< is & muli=s!sem inl&mm&o6! diso6de6

h&6&e6iSed b! he 96esene o &uo&nibodies di6eed &*&ins double=s6&nded dseen novel sudies h&ve ideniied some &s9es o he 9&ho9h!siolo*! o EP.

"ome &ni=dsDE &nibodies 6oss=6e& -ih heN=meh!l=D=&s9&6&e EMD2< in " F3G. EMD 6ee9o6s &6e li*&nd=*&ed ion h&nnels h&9l&! 6ui&l 6oles in s!n&9i 6&nsmission &nd CE" 9l&sii!. EMD 6ee9o6

d!sunion h&s been im9li&ed in muli9le b6&in diso6de6s# inludin* s6oe# h6oni

neu6ode*ene6&ion# e9ile9s!# &nd shiSo9h6eni&. ni=E>2 &nibodies b6e&hin* hebloodHb6&in b&66ie6 < &n &use neu6on&l d&m&*e vi& &n &9o9oi 9&h-&! F4#5G.

%he 1@/@ idio!9e Id< &nibod!# -hih -&s he ous o & 6een sud! b! ivi! e &l. F@G#

is onside6ed o be &n &ni=dsDE Id &nibod! in ". ImmuniS&ion o n&ive mie -ih

he hum&n 1@/@ Id monolon&l &nibod! indued &n "=lie dise&se h&6&e6iSed b!se6olo*i&l# lini&l# &nd 9&holo*i&l e&u6es. %his &nibod! 6oss=6e&s -ih

!osele&l 96oeins# *l!o96oeins# &nd b6&in *l!oli9ids# &s -ell &s -ih 9&ho*ens suh

&sMyco&acterium tu&erculosisF7G. De9osiion o 1@/@ Id &nibodies h&s been ound inhum&n issues# suh &s he sin# idne!# &nd b6&in F8G# &nd levels &6e hi*h in 9&iens -ih

&ive " o6 EP FG. %hese indin*s indi&e h& he 1@/@ Id &nibod! is 9oeni&ll!

one o he &o6s h& &use EP. ,o-eve6# he -&! in -hih hese neu6o9s!hi&6is!m9oms &6e indued b! he 1@/@ Id &nibod! 6e&hin* he CE" &nd he unde6l!in*

meh&nisms o his induion &6e unno-n. In hei6 sud!# ivi! e &l. sho-ed o6 he

i6s ime he ee o he 1@/@ Id &nibod! on he CE" b! in(ein* n&ive mie

in6&e6eb6oven6iul&6l! -ih he 1@/@ Id &nibod! F@G. In his ommen&6!# -e disusshei6 6esuls &nd he 9&ho9h!siolo*! &nd 6e&men s6&e*! o6 EP.

?eurolo+ical effects of the "4/4 $d anti!ody

%o unde6s&nd i he 1@/@ Id I*' &nibod! is &ble o indue neu6olo*i&l ees# ivi! e&l. om9&6ed he o*niive &nd beh&vio6&l 9e6o6m&ne o C3, em&le mie h& h&d

been in(eed -ih he hum&n 1@/@ Id I*' &nibod! 1@/@ Id mie subse< &nd hosein(eed -ih & omme6i&l hum&n I*' on6ol mie subse< F@G. isu&l=6eo*niionmemo6! -&s &ssessed b! usin* he novel=ob(e 6eo*niion es. %he &uho6s ound h&

he6e -&s & si*nii&n 96ee6ene o6 &enion o he ne- ob(e om9&6ed -ih he old

ob(e b! he on6ol mie# bu no die6ene in 96ee6ene -&s ound be-een he ne-&nd he old ob(es b! he 1@/@ Id mie. %his 6esul indi&es im9&i6men o visu&l=

6eo*niion memo6! in he 1@/@ Id mie. In he +=m&Se es# -hih &ssesses s9&i&l

memo6!# he 1@/@ Id mie -e6e &lso ound o h&ve im9&i6men o s9&i&l memo6!.

In &ddiion# he b6&in 9&holo*! o hese mie -&s e?&mined o es&blish he 9oeni&lmeh&nism b! -hih he 1@/@ Id I*' &nibod! is &ble o e?e6 is neu6olo*i&l ees. In

he b6&in issue# in6e&sed mi6o*li&l &iv&ion -&s seen in he hi99o&m9us &nd&m!*d&l bu no in he neu6oo6e? o6 9i6io6m o6e?. In &ddiion# he numbe6 o&s6o!es in he hi99o&m9us -&s ound o be in6e&sed. %&en o*ehe6# hese 6esuls

sho- h& in mie# he 1@/@ Id &nibod! &uses im9&i6men o boh visu&l &nd s9&i&l

memo6! h6ou*h hi99o&m9&l in(u6!# &nd mi*h seleivel! 6oss=6e& -ih some

&ni*ens in he hi99o&m9us.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B4http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B5http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B7http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B8http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B9http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B4http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B5http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B7http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B8http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B9http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B6


33/119

The "4/4 $d anti!ody is a novel anti!ody contri!utin+ to the

pathophysiolo+y of ?PL

ivi! e &l. &lso sho-ed h in &ddiion o he &ni=6ibosom&l P &nd &ni=E>2&nibodies# &nohe6 &uo&nibod!# &ni=1@/@ Id &nibod!# &n 6oss=6e& -ih hum&n b6&in

issue &nd &use EP s!m9oms in " F@G. 6&in issue=6e&ive &nibodies in EP&6e hou*h o be s!nhesiSed in he CE" o6 9e6i9he6&l o6*&ns# suh &s he l!m9h nodes

&nd bone m&66o- F10G. %he6eo6e# i EP is &ssoi&ed -ih &nibodies 6e&hin* heCE" h6ou*h he # 6e&mens h& no onl! elimin&e b6&in=issue=6e&ive &nibodies

bu &lso 96oe he ine*6i! o he should be onside6ed.

%he6&9! o EP is u66enl! diiul. lhou*h o6iose6oids &nd immunosu996essive

&*ens# suh &s !lo9hos9h&mide# &6e b6o&dl! eeive o6 EP# he ondiion iso&sion&ll! 6e6&o6! o hese 6e&mens. Mo6eove6# b6&in=issue=6e&ive

&uo&nibodies mi*h &use i66eve6sible neu6on&l de*ene6&ion vi& &9o9osis. )o6

ins&ne# &ni=6ibosom&l P &nibod! &6*es & neu6on&l su6&e 96oein# &usin* &lium

inlu? &nd &9o9osis F11G. %hese &nibodies s9eii&ll! bind o neu6ons in hehi99o&m9us# in*ul&e o6e?# &nd he 96im&6! ol&o6! 9i6io6m o6e?# &nd# in mie#

6esuled in he induion o de96ession. %hese 6esuls im9li&e he ol&o6! &nd limbi&6e&s in he 9&ho*enesis o de96ession in " F12G. %he &ni=E>2 &nibod! &lso &uses

neu6on&l ell &9o9osis# im9&i6s he hi99o&m9us=de9enden memo6! union in mie#

simul&es EMD 6ee9o6=medi&ed s!n&9i 6es9onses &nd e?ioo?ii! h6ou*henh&ned miohond6i&l 9e6me&bili! F13G. &nd de6e&ses ell vi&bili! h6ou*h in6e&sed

C&2[inlu? F5G. ivi! e &l. sho-ed h& he &ni=1@/@ Id &nibod! h&m9e6s visu&l=

6eo*niion &nd s9&i&l memo6!. %hei6 h!9ohesis &bou he 9&ho9h!siolo*! o &ni=1@/@

Id &nibod!=indued b6&in involvemen -&s h& b6&in inl&mm&ion indues modii&iono neu6on&l union &nd neu6on&l de*ene6&ion F@G. %he &uho6s &lso ound in6e&ses in

&s6o!e numbe6 &nd mi6o*li&l &iv&ion in he hi99o&m9us o &ni=1@/@ Id &nibod!=in(eed mie. %he! su**esed h& in6e&sed &s6o!es &nd &iv&ed mi6o*li&l ells-e6e involved in b6&in inl&mm&ion &nd he6eo6e# &n inl&mm&o6! 96oess m&! &e

o*niive im9&i6men in mie in(eed -ih &ni=1@/@ Id &nibod!. ! on6&s# he6e -&s

minim&l lo&l &iv&ion o &s6o!es &nd mi6o*li&l ells# &nd no l!m9ho!iinl&mm&ion in he b6&ins o &ni=E>2 &nibod!=in(eed mie F3G.

I is 9l&usible# he6eo6e# h& he -ide v&6ie! o EP s!nd6omes mi*h be &used b!

die6enes in he 6eo*niion o b6&in issue b! lu9us &uo&nibodies# suh &s &ni=

6ibosom&l P# &ni=E>2# &nd &ni=1@/@ Id &nibodies. Idenii&ion &nd ev&lu&ion o suhdie6enes -ould 9e6h&9s be useul in develo9in* he6&9ies o6 EP.

:uture directions and conclusions

In he uu6e# i is ho9ed h& ne- &*ens -ill be develo9ed o im96ove he 96o*nosis o6EP. %he ei&! o suh ne- &*ens should be dee6mined h6ou*h hei6 &bili! o

96oe neu6on&l ells# modul&e in6&ellul&6 C&2[# o6 6e*ul&e he de9osiion o

&uo&nibodies in EP. Mem&nine is & d6u* used o 6e& lSheime6Ts dise&se# -hihmodul&es in6&ellul&6 C&2[b! bloin* EMD 6ee9o6s. In &ddiion# he D$+"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B10http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B11http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B13http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B5http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B10http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B11http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B13http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B5http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B3


34/119

9en&9e9ide# -hih he &ni=E>2 &nibod! 6eo*niSes &s &n &ni*en# 96evens he &ni=

E>2 &nibod! 6om bein* de9osied in issues &nd medi&in* neu6on&l e?ioo?ii! in

mie F14G.

s ivi! e &l. h&ve sho-n# seve6&l &uo&nibodies &*&ins b6&in issue &6e involved in

EP. 'iven he die6enes in he 6oss=6e&ivi! o e&h &uo&nibod! -ih hene6vous s!sem# his m&! e?9l&in he die6ene &nd dive6si! o he lini&l e&u6es in

EP. Invesi*&o6s &nd linii&ns should onside6 no onl! inhibiion o &uo&nibod!s!nhesis bu &lso 96oeion o neu6on&l ells -hen invesi*&in* 6e&men s6&e*ies o6

EP.

'o o:

A!!reviations

C>: me6i&n olle*e o 6heum&olo*!; : loodHb6&in b&66ie6; CE": Cen6&l

ne6vous s!sem; ds: Double=s6&nded; EMD:N=meh!l=D=&s9&6&e; EP:Eeu6o9s!hi&6i lu9us e6!hem&osus; PE": Pe6i9he6&l ne6vous s!sem; ": "!semilu9us e6!hem&osus

'o o:

Competin+ interests

%he &uho6s del&6ed h& he! h&ve no om9ein* ine6es.

'o o:

Authors@ contri!utions

%' d6&ed he m&nus6i9# &nd + &nd ,+ 6e&d &nd 6evised i. ll &uho6s h&ve *iven

in&l &996ov&l o he in&l m&nus6i9 o be 9ublished.

'o o:

Authors@ information

%' is &n &ssis&n 96oesso6 in he Insiue o >heum&olo*! IA>heum&olo*!# &nd &di6eo6 o he IA># %$MK. ll &uho6s &6e bo&6d=e6iied membe6s o he J&9&n

Colle*e o >heum&olo*!.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B14http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/#B14http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/


35/119

'o o:

Pre*pu!lication history

%he 96e=9ubli&ion hiso6! o6 his 9&9e6 &n be &essed he6e:

h9://---.biomeden6&l.om/1741=7015/11/1/96e9ub

'o o:

)eferences

1. %soos 'C. "!semi lu9us e6!hem&osus. E n*l J Med. 2011;11:2110H2121.

doi: 10.105@/EJM6&110035. FPubMedG FC6oss >eG2. %he &me6i&n olle*e o 6heum&olo*! nomenl&u6e &nd &se deiniions o6

neu6o9s!hi&6i lu9us s!nd6omes. 6h6iis >heum. 1;11:5H@08. FPubMedG3. De'io6*io # ons&ninov # ee "# ,&6din J# ol9e # Di&mond . subse o

lu9us &ni=DE &nibodies 6oss=6e&s -ih he E>2 *lu&m&e 6ee9o6 ins!semi lu9us e6!hem&osus. E& Med. 2001;11:118H113. doi:

10.1038/nm1101=118. FPubMedG FC6oss >eG

4. o-&l C# De*io6*io # ee J# d*&6 M# ,ue6& P# ol9e # Di&mond . ,um&nlu9us &uo&nibodies &*&ins EMD 6ee9o6s medi&e o*niive im9&i6men.

P6o E&l &d "i K " . 200@;11:1854H185. doi:

10.1073/9n&s.0@0837104. FPMC 6ee &6ileG FPubMedG FC6oss >eG5. 'ono %# %&&6&d& %# )uumo6i ># &-&*uhi +# &neo ,# ,&n&o& M#

&sum&& +# +oned& +# +&m&n&& ,. E>2=6e&ive &nibod! de6e&ses ell

vi&bili! h6ou*h &u*men&ion o C&2[< inlu? in s!semi lu9us e6!hem&osus.6h6iis >heum. 2011;11:352H35. doi: 10.1002/&6.30@1@. FPubMedG FC6oss>eG

@. ivi! "# &S&v # 6&n*o M%# &nd&u=>&bi M# &6i6 +# *mon=evin E#

l&n M# n&!& JM# MoSes # Ch&9m&n J# "hoeneld +. 1@/@=Idio!9e e?96essin*&nibodies indue b6&in inl&mm&ion &nd o*niive im9&i6men in mie: he

mos&i o en6&l ne6vous s!sem involvemen in lu9us. MC Med. 2013. FPMC

6ee &6ileG FPubMedG7. nd6^="h-&6S J# D&& "# "hoeneld +# Isenbe6* D# "oll&6 D# "h-&6S

>". indin* o !osele&l 96oeins b! monolon&l &ni=DE lu9us

&uo&nibodies. Clin Immunol Immuno9&hol. 184;11:2@1H271. doi:

10.101@/000=12284eG8. Isenbe6* D# Collins C. Deeion o 6oss=6e&ive &ni=DE &nibod! idio!9es

on 6en&l issue=bound immuno*lobulins 6om lu9us 9&iens. J Clin Inves.

185;11:287H24. doi: 10.1172/JCI1115. FPMC 6ee &6ileG FPubMedG FC6oss>eG

. Isenbe6* D# "hoeneld +# M&d&io MP# >&uh J# >eihlin M# "oll&6 D#

"h-&6S >". ni=DE &nibod! idio!9es in s!semi lu9us e6!hem&osus.&ne. 184;11:417H422. FPubMedG
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/http://www.biomedcentral.com/1741-7015/11/91/prepubhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/http://www.ncbi.nlm.nih.gov/pubmed/22129255http://dx.doi.org/10.1056%2FNEJMra1100359http://www.ncbi.nlm.nih.gov/pubmed/10211873http://www.ncbi.nlm.nih.gov/pubmed/11689882http://dx.doi.org/10.1038%2Fnm1101-1189http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1702320/http://www.ncbi.nlm.nih.gov/pubmed/17170137http://dx.doi.org/10.1073%2Fpnas.0608397104http://www.ncbi.nlm.nih.gov/pubmed/22012858http://dx.doi.org/10.1002%2Fart.30616http://dx.doi.org/10.1002%2Fart.30616http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616817/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616817/http://www.ncbi.nlm.nih.gov/pubmed/23556432http://www.ncbi.nlm.nih.gov/pubmed/6370522http://dx.doi.org/10.1016%2F0090-1229(84)90246-0http://www.ncbi.nlm.nih.gov/pmc/articles/PMC423767/http://www.ncbi.nlm.nih.gov/pubmed/3874881http://dx.doi.org/10.1172%2FJCI111959http://dx.doi.org/10.1172%2FJCI111959http://www.ncbi.nlm.nih.gov/pubmed/6147499http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/http://www.biomedcentral.com/1741-7015/11/91/prepubhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616809/http://www.ncbi.nlm.nih.gov/pubmed/22129255http://dx.doi.org/10.1056%2FNEJMra1100359http://www.ncbi.nlm.nih.gov/pubmed/10211873http://www.ncbi.nlm.nih.gov/pubmed/11689882http://dx.doi.org/10.1038%2Fnm1101-1189http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1702320/http://www.ncbi.nlm.nih.gov/pubmed/17170137http://dx.doi.org/10.1073%2Fpnas.0608397104http://www.ncbi.nlm.nih.gov/pubmed/22012858http://dx.doi.org/10.1002%2Fart.30616http://dx.doi.org/10.1002%2Fart.30616http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616817/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616817/http://www.ncbi.nlm.nih.gov/pubmed/23556432http://www.ncbi.nlm.nih.gov/pubmed/6370522http://dx.doi.org/10.1016%2F0090-1229(84)90246-0http://www.ncbi.nlm.nih.gov/pmc/articles/PMC423767/http://www.ncbi.nlm.nih.gov/pubmed/3874881http://dx.doi.org/10.1172%2FJCI111959http://dx.doi.org/10.1172%2FJCI111959http://www.ncbi.nlm.nih.gov/pubmed/6147499


36/119

10. "en^&l J# >&!mond +. %he 9&ho*enesis o neu6o9s!hi&6i m&nies&ions in

s!semi lu9us e6!hem&osus: & dise&se in se&6h o &uo&nibodies# o6

&uo&nibodies in se&6h o & dise&seR J >heum&ol. 2004;11:203H208.FPubMedG

11. M&us "# u6*os P# 6&vo=ehnde6 M# 6& ># Po66&s A,# )&6_&s P# &66os )#

%o66e&lb& )# M&ss&6do # J&obelli "# 'onS`leS . ni6ibosom&l=P &uo&nibodies6om 9s!hi&6i lu9us &6*e & novel neu6on&l su6&e 96oein &usin* &lium

inlu? &nd &9o9osis. J ?9 Med. 2007;11:3221H3234. doi:

10.1084/(em.20071285. FPMC 6ee &6ileG FPubMedG FC6oss >eG12. &S&v # "olodeev I# 6ods! A# Ch&9m&n J# Pi C'# l&n M# h&n* $#

>eihlin M# "hoeneld +. Induion o &uoimmune de96ession in mie b! &ni=

6ibosom&l P &nibodies vi& he limbi s!sem. 6h6iis >heum. 2007;11:38H48.

doi: 10.1002/&6.2241. FPubMedG FC6oss >eG13. )&us %$# Ch&n* ,# o-&l C# e6lin ># '&S&6!&n I'# e6ini # h&n* J#

"&nheS='ue66e6o J# )6&*oso=o!o ,# ol9e %# Di&mond # ,ue6& P%.

Eeu6oo?i lu9us &uo&nibodies &le6 b6&in union h6ou*h -o disin

meh&nisms. P6o E&l &d "i K " . 2010;11:185@H18574. doi:10.1073/9n&s.100@80107. FPMC 6ee &6ileG FPubMedG FC6oss >eG

14. loom A# Chen* )# ,e M# P&9&heodo6ou # ol9e %# Di&mond # l=bed +.'ene6&ion o & uniue sm&ll moleule 9e9idomimei h& neu6&liSes lu9us

&uo&nibod! &ivi!. P6o E&l &d "i K " . 2011;11:10255H1025. doi:

10.1073/9n&s.1103555108. FPMC 6ee &6ileG FPubMedG FC6oss >eG

Jurnal /

J >heum&ol. uho6 m&nus6i9; &v&il&ble in PMC 2013 96il 22.Published in in&l edied o6m &s:

J >heum&ol. 2012 )eb6u&6!; 32CA# PhD# %>C+ I# PhD# DK" "%%># PhD# M+ ,. A#

MD# MP,#E%+ DEC,EA# PhD# DEI DMKEDA$IC# M"# MD#

IM "K%%AE=%+>># D6P,#>K"" P. %>C+# PhD# $I" ,. K>#MD# D6P,# &nd "K"E MEI# MD# MP,
http://www.ncbi.nlm.nih.gov/pubmed/15517616http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2150977/http://www.ncbi.nlm.nih.gov/pubmed/18056288http://dx.doi.org/10.1084%2Fjem.20071285http://www.ncbi.nlm.nih.gov/pubmed/17328071http://dx.doi.org/10.1002%2Fart.22419http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2972998/http://www.ncbi.nlm.nih.gov/pubmed/20921396http://dx.doi.org/10.1073%2Fpnas.1006980107http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121823/http://www.ncbi.nlm.nih.gov/pubmed/21646518http://dx.doi.org/10.1073%2Fpnas.1103555108http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22174200http://dx.doi.org/10.3899%2Fjrheum.110327http://www.ncbi.nlm.nih.gov/pubmed/?term=GRECO%20CM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=LI%20T%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=SATTAR%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=KAO%20AH%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=DANCHENKO%20N%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=EDMUNDOWICZ%20D%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=SUTTON-TYRRELL%20K%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=TRACY%20RP%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=TRACY%20RP%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=KULLER%20LH%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=MANZI%20S%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/15517616http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2150977/http://www.ncbi.nlm.nih.gov/pubmed/18056288http://dx.doi.org/10.1084%2Fjem.20071285http://www.ncbi.nlm.nih.gov/pubmed/17328071http://dx.doi.org/10.1002%2Fart.22419http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2972998/http://www.ncbi.nlm.nih.gov/pubmed/20921396http://dx.doi.org/10.1073%2Fpnas.1006980107http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121823/http://www.ncbi.nlm.nih.gov/pubmed/21646518http://dx.doi.org/10.1073%2Fpnas.1103555108http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22174200http://dx.doi.org/10.3899%2Fjrheum.110327http://www.ncbi.nlm.nih.gov/pubmed/?term=GRECO%20CM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=LI%20T%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=SATTAR%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=KAO%20AH%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=DANCHENKO%20N%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=EDMUNDOWICZ%20D%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=SUTTON-TYRRELL%20K%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=TRACY%20RP%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=KULLER%20LH%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=MANZI%20S%5Bauth%5D


37/119

uho6 ino6m&ion Co9!6i*h &nd iense ino6m&ion

%he 9ublishe6Ns in&l edied ve6sion o his &6ile is &v&il&ble & J >heum&ol

"ee ohe6 &6iles in PMC h& iehe 9ublished &6ile.'o o:

A!stract

8!9ective

"!semi lu9us e6!hem&osus "< is & h6oni inl&mm&o6! &uoimmune dise&se -ih

in6e&sed 96ev&lene o &6diov&sul&6 dise&se CD< &nd de96ession. lhou*h

de96ession m&! on6ibue o CD 6is in 9o9ul&ion=b&sed sudies# is inluene on&6diov&sul&6 mo6bidi! in " h&s no been ev&lu&ed. $e ev&lu&ed he &ssoi&ion

be-een de96ession &nd v&sul&6 dise&se in ".

&ethods

6oss=seion&l sud! -&s ondued 6om 2002H2005 in 1@1 -omen -ih " &nd

-ihou CD. %he 96im&6! ouome me&su6e -&s & om9osie v&sul&6 dise&se m&6e6

onsisin* o he 96esene o o6on&6! &6e6! &lium &nd/o6 &6oid &6e6! 9l&ue.

)esults

In o&l# 101 -omen me 6ie6i& o6 v&sul&6 dise&se. In un&d(used &n&l!ses# seve6&l

6&diion&l &6diov&sul&6 6is &o6s# inl&mm&o6! m&6e6s# &di9osi!# " dise&se=6el&ed &o6s# &nd de96ession -e6e &ssoi&ed -ih v&sul&6 dise&se. In he in&l

muliv&6i&ble model# he 9s!holo*i&l v&6i&ble de96ession -&s &ssoi&ed -ih ne&6l! 4=

old hi*he6 odds o6 v&sul&6 dise&se A> 3.85# 5B CI 1.37# 10.87< -hen &d(used o6ohe6 6is &o6s o &*e# lo-e6 edu&ion level# h!9e6ensive s&us# -&is=hi9 6&io# &nd

C=6e&ive 96oein.

Conclusion

In "# de96ession is inde9endenl! &ssoi&ed -ih v&sul&6 dise&se# &lon* -ih 9h!si&l

&o6s.

>ey $ndexin+ Terms7 "+"%MIC KPK" >+%,M%A"K"# C>DIA"CK>

DI""# DP>""IAE CCI)IC%IAE# C>A%ID PQK# P"+C,A"ACI)C%A>"

De96ession &nd &6diov&sul&6 dise&se CD< &6e &mon* he mos 96ev&len &nd

dis&blin* ondiions -o6ld-ide# on6ibuin* o he *lob&l 9ubli he&lh bu6den1. P&iens

di&*nosed -ih he&6 dise&se &6e & in6e&sed 6is o6 develo9in* de96ession u9 o 8 !e&6s&e6 medi&l di&*nosis2. In 9o9ul&ions inii&ll! 6ee o &6di& dise&se# de96ession

in6e&ses 6is o6 sublini&l &he6osle6osis b! *6e&e6 h&n 2=old3#4#&nd 6is o6 iniden
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22174200http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R4http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R4http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R4http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22174200http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R4


38/119

&6di& evens b! 50B o6 mo6e5#@# inludin* & 4.5=old in6e&sed 6is o6 m!o&6di&l

in&6ion MI


39/119

%he 9&6ii9&ns in his sud! -e6e -omen -ih " en6olled in he ,e&6 es on

he6osle6osis &nd >is o %h6ombosis in " ,>%"< invesi*&ion# unded b! he

E&ion&l Insiues o ,e&lh >01 >4@588%" sud! -&s oom9&6e 96ev&lene &nd 6is &o6s o6 o6on&6! &6e6! &lii&ion in -omen -ih "

&nd he&lh! on6ols. %he 9&6ii9&ns h&d no hiso6! o CD evens 28&nd -e6e

nonseleivel! 6e6uied 6om he Pisbu6*h u9us >e*is6!# -hih & he ime oen6ollmen inluded 83 livin* 9&6ii9&ns. %he 6e*is6! inludes 9&iens seen &

in9&ien o6 ou9&ien &iliies & he Knive6si! o Pisbu6*h Medi&l Cene6 o6 b!

96&iin* 6heum&olo*iss -ihin he Pisbu6*h me6o9oli&n &6e&. ll -omen -ih "-e6e 6eui6ed o ulill 182 o6 17 me6i&n Colle*e o >heum&olo*! C>< 6evised

6ie6i& o6 he l&ssii&ion o deinie o6 96ob&ble "2#30&nd be ove6 he &*e o 18

!e&6s.

ll 9&6ii9&ns om9leed ino6med onsen 96oedu6es. %he sud! -&s &996oved b! heKnive6si! o Pisbu6*h Insiuion&l >evie- o&6d.

Procedures

%he sud! 96oedu6es inluded &n ine6vie-# om9leion o & v&lid&ed de96essionuesionn&i6e Fhe Cene6 o6 9idemiolo*i "udies De96ession "&le C"=D


40/119

K"# P&6si99&n!# EJ# K".P. %6&!# Knive6si! o e6monheum&olo*iss s9ei&liSin* in " ,# "M< &ssessed dise&se &ivi! &ndumul&ive o6*&n d&m&*e due o " & he sud! visi. Me&su6es inluded he 6evised

"!semi u9us ivi! Me&su6e "M=>


41/119

9l&ue e?en# &lled he 9l&ue inde?. %he 9l&ue inde? h&s been ound o be &

6e96oduible &nd v&lid me&su6e o &6oid &he6osle6osis in & numbe6 o 9o9ul&ions 4@.

)o6 he u66en sud!# he 96esene o &6oid 9l&ue -&s deined &s 9l&ue inde? Z 1.

Data analysis

$e heed he u&li! o he d&& b! ev&lu&in* he 6euen! dis6ibuion o &ll 6elev&n

v&6i&bles# &nd &ssessed o6 muliolline&6i! &mon* he v&6i&bles. Coninuous v&6i&bles-e6e summ&6iSed &s me&n "D< &nd &e*o6i&l v&6i&bles &s 9e6en&*es n


42/119

de96essive s!m9oms. A & 9ossible 6&n*e o 0H@0# he C"=D so6e 6&n*ed 6om 0 o 45

in he s&m9le ove6&ll. $e ev&lu&ed &ssoi&ions be-een de96ession &nd ohe6

h&6&e6isis usin* lo*isi 6e*6ession. Alde6 &*e &nd bein* in he seond u&6ile o-&is=hi9 6&io -e6e m&6*in&ll! &ssoi&ed -ih de96ession 9 W 0.05@# 9 W 0.078#

6es9eivel!


43/119


44/119

9ossible biolo*i&l meh&nisms# &nd m&! &lso 6ele beh&vio6&l &nd envi6onmen&l

inluenes on he&lh.

De96ession is &ssoi&ed -ih in6e&ses in 96oinl&mm&o6! !oines4#50&nd hein6e&sed CD 6is in de96essed 9e6sons m&! be 6el&ed o &dded inl&mm&o6! bu6den.

6een &se=on6ol sud! ound &n elev&ion in he 96oinl&mm&o6! !oineine6leuin @ I=@< in "# &nd his inl&mm&o6! &o6 -&s &ssoi&ed -ih CC20. %he

&ssoi&ion be-een de96ession &nd inl&mm&ion is liel! bidi6eion&l51. ninl&mm&o6! envi6onmen# -hih is !9i&ll! 96esen in 9&iens -ih "# m&! 6esul in

lo- mood &nd m&l&ise52.

De96essed mood# 9&6iul&6l! -hen h6oni# m&! h&ve & ne*&ive inluene on lies!le&nd beh&vio6 hoies. )o6 e?&m9le# de96ession is & 6is &o6 o6 9oo6 medi&ion

&dhe6ene in "25&nd in &duls -ih he&6 dise&se53. De96ession m&! ine6& -ih

9h!si&l in&ivi! o inluene CD. Mu6ine sudies indi&e h& de96essed beh&vio6

indued b! h6oni ine6mien s6ess led o 6edued e?e6ise &nd ulim&el! o e&6l!

&he6osle6oi h&n*es

54

.In & 9o9ul&ion sud! o elde6l! men# b&seline de96essives!m9oms -e6e &ssoi&ed -ih 9h!si&l in&ivi!. %en=!e&6 6is o &6di& mo6&li! -&s

in6e&sed &bou 50B b! he ombined ee o de96essive s!m9oms -ih in&ivi!55.

$e onside6ed &di9osi! &s & 9oeni&l 9&h-&! linin* de96ession &nd v&sul&6 dise&se.di9osi! h&s 6eeived &enion in CD 6ese&6h be&use &di9ose issue# 9&6iul&6l!

vise6&l &di9ose issue# is no-n o 96odue inl&mm&o6! &o6s. In & medi&ll! he&lh!

*6ou9# de96ession -&s ound o inluene -ei*h &umul&ion# -hih led o in6e&sed96oduion o inl&mm&o6! [email protected] "# obesi! -&s 6el&ed o in6e&sed levels

o C>P &nd I=@# &s -ell &s 6edued union&l &9&i!57. Au6 *6ou9 6eenl! ound h&

MI medi&ed &n &ssoi&ion be-een de96essive s!m9oms &nd CC in "58.

,o-eve6# in ou6 u66en sud! -e ound h& even &e6 &d(usin* o6 -&is=hi9 6&io# isel&n im9o6&n 6is &o6# de96ession -&s s6on*l! &ssoi&ed o v&sul&6 dise&se.

In "# de96ession &n be & m&nies&ion o en6&l ne6vous s!sem CE"< involvemen.

lhou*h he l&ssii&ion 6ie6i& o6 " inlude onl! hiso6! o seiSu6es o6 9s!hosis&s he indi&o6s o neu6olo*i involvemen30#de96ession is & om9onen o

neu6o9s!hi&6i lu9us5. Mood diso6de6s &6e inluded &mon* he 1 en6&l &nd

9e6i9he6&l neu6o9s!hi&6i s!nd6omes lised in he 1 C> nomenl&u6e o6neu6o9s!hi&6i lu9us@0.

$hehe6 de96ession is lined o CD in " h6ou*h beh&vio6&l 9&h-&!s# biolo*i&l

9&h-&!s# o6 boh 6em&ins un6esolved. De96ession m&! 6esul 6om he s6u**le o o9e

-ih & &i*uin*# 9&inul# &nd un96edi&ble h6oni ondiion. " 6euenl! is&ssoi&ed -ih -o6 dis&bili! &nd loss o inome# -hih ould on6ibue o de96ession

&s -ell &s o 6edued &bili! o &ess he&lh&6e. De96ession &nd lo- &ess o he&lh&6e

m&! boh on6ibue o lo- &dhe6ene -ih medi&l 6e&men# 9ossibl! 6esulin* inin6e&sed 6is o CD. An he ohe6 h&nd# de96ession m&! be & 96odu o he

inl&mm&o6! milieu o ". %o he e?en h& inl&mm&ion on6ibues no onl! o

CD 6is di6el! bu &lso# on &n individu&l level# o eelin*s o m&l&ise &nd lo-
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R49http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R50http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R50http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R20http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R51http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R52http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R52http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R53http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R54http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R54http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R55http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R56http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R56http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R57http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R58http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R30http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R30http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R59http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R60http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R49http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R50http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R20http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R51http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R52http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R53http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R54http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R55http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R56http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R57http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R58http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R30http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R59http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632335/#R60


45/119

moiv&ion# de96ession m&! be & di6e onseuene o inl&mm&ion. ,o-eve6#

de96ession m&! &lso &dd o inl&mm&o6! bu6den h6ou*h in6e&sed seden&6! beh&vio6#

le&din* o in6e&sed &di9ose issue# -hih is &n &ddiion&l sou6e o inl&mm&ion. I isliel! h& 9&hs linin* de96ession -ih CD in " &6e muli&o6i&l &s -ell &s

bidi6eion&l# &nd u6he6 invesi*&ion o hese issues is needed.

Ane limi&ion o ou6 sud! is h& -e did no invesi*&e 96eisel! -hehe6 de96essive

s!m9oms -e6e di6el! 6el&ed o " e.*.# & m&nies&ion o CE" lu9us< o6 indi6el!6el&ed# suh &s & 9s!hosoi&l onseuene o he lie h&n*es b6ou*h &bou b! ".

%he 6oss=seion&l desi*n is & limi&ion h& 6es6is ou6 &bili! o ine6 h& de96ession

o6 ohe6 6is &o6s &6e &us&ll! 6el&ed o v&sul&6 dise&se in ". P6esum&bl!# v&sul&6h&n*es &e 9l&e ove6 & lon* ime. Ce6&in 6is &o6s suh &s &di9osi! &nd

h!9e6ension m&! be 96esumed o be lon*s&ndin*# bu u66en de96essive s!m9oms m&!

be 6&nsien 6&he6 h&n h6oni. %he C"=D is -idel! used o6 u&ni!in* de96essives!m9oms# in " &s -ell &s ohe6 *6ou9s. ,o-eve6# -e &no-led*e h& he6e &6e ohe6

mehods o &ssess de96ession# suh &s he "6uu6ed Clini&l Ine6vie- o6 he

*iagnostic and #tatistical Manual of Mental *isorders

@1

. %he &ddiion o & di&*nosiine6vie- -ould h&ve he &dv&n&*e o doumenin* lini&l di&*nosis &s -ell &s

h6onii! o de96ession. Ide&ll!# uu6e sudies o he biolo*i&l &nd 9s!holo*i&l 6iss

o6 CD in " -ill inlude 96os9eive d&& olleion# mood diso6de6 di&*nosis in

&ddiion o sel=6e9o6 s!m9oms# &nd mo6e 96eise invesi*&ion ino 9ossiblemeh&nisms linin* de96ession &nd CD.

De96ession m&! be &ssoi&ed -ih 96em&u6e &he6osle6oi dise&se in " h6ou*h

beh&vio6&l o6 biolo*i&l 9&h-&!s# o6 boh. In -omen -ih "# de96ession is 96ev&len

&nd is &n im9o6&n inluene on 9h!si&l he&lh &nd omo6bidi! in &ddiion o is eeon u&li! o lie. De96ession is 6e&&ble 9h&6m&olo*i&ll! &nd h6ou*h 9s!hohe6&9!.

enion should be 9&id o di&*nosin* &nd 6e&in* de96ession in "# &s his should noonl! on6ibue o im96oved u&li! o lie# bu 9ossibl! im96ove &dhe6ene o medi&l6e*imens &nd 9h!si&l &ivi! 6eommend&ions. %hus# im96ovin* m&n&*emen o

de96ession m&! di6el! o6 indi6el! inluene 9h!si&l he&lh &nd ove6&ll CD 6is in

9&iens -ih ".

'o o:

Ac6nowled+ments

"u99o6ed b! he E&ion&l Insiues o ,e&lh H E&ion&l Insiue o 6h6iis#

Musulosele&l &nd "in Dise&ses 23 >051314# >01 >4@588=01# 24 >02213=01# 23 >051044ese&6h >esou6es/'ene6&l Clini&l >ese&6hCene6 M01 >>00005@heum&olo*! >ese&6h &nd du&ion

)ound&ion ,e&lh P6oession&l Invesi*&o6 -&6d# Ph!sii&n "ienis Develo9men

-&6d


46/119


47/119

10. M&nSi "# Meil&hn # >&i6ie J# Cone C# Meds*e6 %# J&nsen=M$illi&ms # e &l. *e=

s9eii inidene 6&es o m!o&6di&l in&6ion &nd &n*in& in -omen -ih s!semi

lu9us e6!hem&osus: Com9&6ison -ih he )6&min*h&m "ud!. m J 9idemiol.17;145:408H15. FPubMedG

11. $&6d M. P6em&u6e mo6bidi! 6om &6diov&sul&6 &nd e6eb6ov&sul&6 dise&ses in

-omen -ih s!semi lu9us e6!hem&osus. 6h6iis >heum. 1;42:338H4@. FPubMedG12. >om&n M# "h&ne6 # D&vis # oshin M# "&mm&6i&no # "im&nov ># e &l.

P6ev&lene &nd o66el&es o &ele6&ed &he6osle6osis in s!semi lu9us e6!hem&osus.

E n*l J Med. 2003;34:23H40@. FPubMedG13. s&num& +# Aese6 # "hin&i # %u6ne6 # Alsen E# )&Sio "# e &l. P6em&u6e

o6on&6!=&6e6! &he6osle6osis in s!semi lu9us e6!hem&osus. E n*l J Med.

2003;34:2407H15. FPubMedG

14. llio J># M&nSi "# "&&6 # "&nelies C# v6&m # "h&- P# e &l. C&6oid inim&=medi& hiness &nd 9l&ue 96edi uu6e &6diov&sul&6 evens in -omen -ih s!semi

lu9us e6!hem&osus F&bs6&G 6h6iis >heum. 2008;58 "u99lheum&ol. 2004;31:713H.

FPubMedG1@. M&nSi "# "elSe6 )# "uon=%!66ell # )iS*e6&ld "'# >&i6ie J# %6&! >P# e &l.

P6ev&lene &nd 6is &o6s o &6oid 9l&ue in -omen -ih s!semi lu9us

e6!hem&osus. 6h6iis >heum. 1;42:51H@0. FPubMedG17. M&simo-iS=Minnon # M&*de6 "# Pe6i M. P6edio6s o &6oid

&he6osle6osis in s!semi lu9us e6!hem&osus. J >heum&ol. 200@;33:2458H@3.

FPubMedG

18. i&ni E# M&*de6 # Pe6i M. Co6on&6! &lium in s!semi lu9us e6!hem&osus is&ssoi&ed -ih 6&diion&l &6diov&sul&6 6is &o6s# bu no -ih dise&se &ivi!. J

>heum&ol. 2008;35:1300H@. FPubMedG

1. sd&ile J# b6&h&mo-iS M# '6odSi! %# i +# P&n&6iis C# du e6*e6 ># e &l.%6&diion&l )6&min*h&m 6is &o6s &il o ull! &oun o6 &ele6&ed &he6osle6osis in

s!semi lu9us e6!hem&osus. 6h6iis >heum. 2001;44:2331H7. FPubMedG

20. s&num& +# Chun* CP# Aese6 # "hin&ni # "&nle! # >&**i P# e &l. In6e&sedonen6&ion o 96o&he6o*eni inl&mm&o6! !oines in s!semi lu9us

e6!hem&osus: 6el&ionshi9 o &6diov&sul&6 6is &o6s. J >heum&ol. 200@;33:53H45.

FPubMedG

21. oSo6& # llison MC# $es ". De96ession# &i*ue# &nd 9&in in s!semi lu9use6!hem&osus "heum&olo*! "

neu6o9s!holo*i&l b&e6!. 6h6iis >heum. 200@;55:@28H35. FPubMedG

22. "unduis # i # ,emmini # "unduis J. "ubseuen 6is o hos9i&liS&ion o6neu6o9s!hi&6i diso6de6s in 9&iens -ih 6heum&i dise&ses. 6h Ine6n Med.

2008;@5:501H7. FPubMedG

23. &hen # Chesne! M# C6is-ell . P6ev&lene o mood &nd &n?ie! diso6de6s in-omen -ih s!semi lu9us e6!hem&osus. 6h6iis C&6e >es. 200;@1:822H. FPMC

6ee &6ileG FPubMedG
http://www.ncbi.nlm.nih.gov/pubmed/9048514http://www.ncbi.nlm.nih.gov/pubmed/10025929http://www.ncbi.nlm.nih.gov/pubmed/14681505http://www.ncbi.nlm.nih.gov/pubmed/14681506http://www.ncbi.nlm.nih.gov/pubmed/15088296http://www.ncbi.nlm.nih.gov/pubmed/9920014http://www.ncbi.nlm.nih.gov/pubmed/17014002http://www.ncbi.nlm.nih.gov/pubmed/18484694http://www.ncbi.nlm.nih.gov/pubmed/11665973http://www.ncbi.nlm.nih.gov/pubmed/16463434http://www.ncbi.nlm.nih.gov/pubmed/16874786http://www.ncbi.nlm.nih.gov/pubmed/18458201http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763591/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763591/http://www.ncbi.nlm.nih.gov/pubmed/19479699http://www.ncbi.nlm.nih.gov/pubmed/9048514http://www.ncbi.nlm.nih.gov/pubmed/10025929http://www.ncbi.nlm.nih.gov/pubmed/14681505http://www.ncbi.nlm.nih.gov/pubmed/14681506http://www.ncbi.nlm.nih.gov/pubmed/15088296http://www.ncbi.nlm.nih.gov/pubmed/9920014http://www.ncbi.nlm.nih.gov/pubmed/17014002http://www.ncbi.nlm.nih.gov/pubmed/18484694http://www.ncbi.nlm.nih.gov/pubmed/11665973http://www.ncbi.nlm.nih.gov/pubmed/16463434http://www.ncbi.nlm.nih.gov/pubmed/16874786http://www.ncbi.nlm.nih.gov/pubmed/18458201http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763591/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763591/http://www.ncbi.nlm.nih.gov/pubmed/19479699


48/119

24. Ee6! )'# o6b& )# ,&h JP# "o&6es JC# on& # Eeo ). M&(o6 de96essive

diso6de6 &nd dise&se &ivi! in s!semi lu9us e6!hem&osus. Com96 Ps!hi&6!.

2007;48:14H. FPubMedG25. Juli&n J# +elin # +&Sd&n! J# P&no9&lis P# %6u9in # C6is-ell # e &l. De96ession#

medi&ion &dhe6ene# &nd se6vie uiliS&ion in s!semi lu9us e6!hem&osus. 6h6iis

>heum. 200;@1:240H@. FPMC 6ee &6ileG FPubMedG2@. ,&! M# ,udd! # l& D# Mb&!& P# %omenson # e6nsein >M# e &l.

96os9eive sud! o 9s!hi&6i diso6de6 &nd o*niive union in s!semi lu9us

e6!hem&osus. nn >heum Dis. 14;53:28H303. FPMC 6ee &6ileG FPubMedG27. %omieo P# nnese # DT*osini "# enu6ini P# & %o66e '# De i& "# e &l. 'ene6&l

&nd s9eii &o6s &ssoi&ed -ih seve6i! o o*niive im9&i6m

aspek psikiatrik pada penderita sle

Documents