Background Patients with systemic lupus erythematosus (SLE) are at risk for cardiovascular disease (CVD) due to increased prevalence of risks factors. Objective To evaluate the effect of patient-centered nutrition counseling on changes in nutrient, anthropometric, and lipids in SLE patients enrolled in a CVD prevention counseling program (CVD PCP). Methods From March 2009 to June 2011, a subgroup of SLE patients enrolled in our CVD PCP were referred for nutrition counseling. A primary analysis evaluated the 6-month changes in nutrient intake, weight, body mass index (BMI), waist circumference, and lipid levels. A secondary analysis compared the same measurements between the nutrition counseling patients and patients who were referred but did not attend. Results Of 71 referrals, 41 (58%) attended nutrition counseling (female: 88%, African American/Hispanic: 73%, mean age of 40.7 ± 12.6 years, and mean disease duration of 12.2 ± 8.2 years). Over a 6-month period, nutritional counseling patients: a) reduced sodium intake (p = 0.006), total calories (p = 0.07), percent calories from fat (p = 0.011) and saturated fat (p = 0.068); b) had decreased weight (−1.64 kg, p = 0.025); and c) were more likely to report increases in fruits and vegetables (p < 0.001), a high fiber diet (p = 0.011), ≥ 2 servings of fish/week (p = 0.002), and a low cholesterol diet (p = 0.034). There were no significant changes in lipid levels over the 6 months among nutrition counseling patients. When comparing nutrition counseling patients to those who were referred but did not attend, we found at 6 months a higher percentage of nutrition counseling patients followed a high-fiber diet (p=0.03), consumed 2 or more servings of fish per week (p=0.01), followed a low-cholesterol diet (p = 0.03), and achieved a greater weight loss (p = 0.04) compared to the group that did not attend. Conclusion At six months we found that patient-centered nutrition counseling appears to be effective for promoting changes in nutrient intake, diet habits and weight in SLE patients. However, the counseling did not show a significant improvement in lipid levels, possibly due to short follow-up and/or lupus related factors.

Objective Gout patient self-management knowledge and adherence to treatment regimens are poor. Our objective was to assess the feasibility and acceptability of a multidisciplinary team-based pilot program for the education and monitoring of gout patients. Methods Subjects completed a Gout Self-Management Knowledge Exam, along with gout flare history and compliance questionnaires, at enrollment and at 6 and 12 months. Each exam was followed by a nursing educational intervention via a structured gout curriculum. Structured monthly follow-up calls from pharmacists emphasized adherence to management programs. Primary outcomes were subject and provider program evaluation questionnaires at 6 and 12 months, program retention rate and success in reaching patients via monthly calls. Results 40/45 subjects remained in the study at 12 months. At 12 months, on a scale of 1 (most) to 5 (least), ratings of 3 or better were given by 84.6% of subjects evaluating the usefulness of the overall program in understanding and managing their gout, 81.0% of subjects evaluating the helpfulness of the nursing education program and 50.0% of subjects evaluating the helpfulness of the calls from the pharmacists. Knowledge Exam questions that were most frequently answered incorrectly on repeat testing concerned bridge therapy, the possibility of being flare-free, and the genetic component of gout. Conclusion Our multidisciplinary program of gout patient education and monitoring demonstrates feasibility and acceptability. We identified variability in patient preference for components of the program and persistent patient knowledge gaps.

Objective To determine if a cardiovascular disease prevention (CVD) counseling program for lupus patients decreases the prevalence of CVD risk factors. Methods The assessment phase of three-year CVD prevention counseling program included the evaluation of CVD risk factors, diet, exercise habits, and medications. The education phase included discussion of the above risk factors as well as CVD and thrombosis prevention strategies. Patients were prospectively followed every 3–6 months for risk assessment and continued education by a nurse practitioner and a medical doctor. Results Between March 2009 and December 2014, 121 patients were included. At baseline, abnormal blood pressure, blood glucose, cholesterol profile, and body mass index were found in 50 (41%), 7 (6%), 82 (68%), and 77 (64%) of patients, respectively. During the three-year follow-up, among those with abnormal baseline values: a) prevalence of abnormal blood pressure significantly decreased (OR: 0.94, 95% CI: 0.92–0.96, p<0.0001) with significant mean systolic blood pressure improvement (−6.12 ± 2.16 mmHg, p<0.05); b) prevalence of abnormal cholesterol profile significantly decreased (OR: 0.90; 95% CI: 0.92–0.96) with significant improvements in mean high-density lipoprotein (+5.4 ± 0.36 mg/dl, p<0.0001) and mean triglyceride levels (−12.6 ± 0.81 mg/dl, p<0.05); and c) no significant change in blood glucose and body mass index were observed. At baseline, 100 (83%) and 95 (79%) patients had poor diet and physical activity; during the follow-up, both significantly improved in the entire population. Conclusion Our data suggest that a CVD prevention counseling program decreases the prevalence of some CVD risk factors in lupus patients.

Lupus nephritis is one of the most devastating complications of systemic lupus erythematosus. New treatment approaches and recommendations aim to decrease mortality and improve quality of life and outcomes. The role of the primary care provider is essential to help manage complications of treatment and avoid organ damage.