Non-pharmacologic therapies in treatment of childhood-onset systemic lupus erythematosus: A systematic review

Abstract

Background Childhood-onset systemic lupus erythematosus (cSLE) is a complex multisystem autoimmune disease often associated with pain, fatigue, and mood-related disturbances. cSLE is associated with increased disease severity and higher rates of mortality as compared to adult onset SLE. Therefore, a multi-faceted approach to care, including the use of non-pharmacologic therapies, is essential to ensure optimal patient outcomes. The use of non-pharmacologic therapies as adjunctive treatments has been shown to be beneficial in adults with SLE, yet, their use and effect is less well understood in cSLE. This is the first systematic review to explore the use and quality of evidence of non-pharmacologic approaches to treat cSLE. Methods A literature review was performed using PRISMA guidelines. Studies until March 2021 with participants diagnosed with cSLE were included. The quality of the evidence was graded via OCEBM levels of evidence guidelines and bias assessed using Cochrane guidelines. Completed clinical trials (via clinicaltrials.gov ) were also searched to identify unpublished results. Results Eleven published studies consisting of 1152 patients met inclusion criteria for this review, as well as three additional studies with unpublished data on clinicaltrial.gov . Of the published trials, four studies used patient education/support, three studies used dietary supplementation, three used forms of psychotherapy (e.g., Cognitive behavioral therapy), and 1 used aerobic exercise to target the following issues: treatment adherence ( n = 3), quality of life ( n = 3), fatigue ( n = 2), pain ( n = 2), depressive symptoms ( n = 1), anxiety ( n = 1), and health-related outcomes including disease severity ( n = 3), cardiovascular disease risk (Cardiovascular disease; n = 3), and muscle function ( n = 1). Across investigations, the quality of the evidence based on study design was moderate/low. In terms of potential outcomes, dietary supplementation methods were successful in 2 of 3 studies and were associated with improvements in disease activity and fatigue. Aerobic exercise was effective in decreasing resting heart rate and increasing cardiorespiratory capacity. Patient education/support was related to significantly increased treatment adherence and decreased cardiovascular risk markers. Two of the three studies examining the impact of psychotherapy showed improvements (e.g., in treatment adherence, depression and fatigue). Conclusion This review identifies several promising non-pharmacologic therapies to use as adjunctive treatments to traditional pharmacologic regimens in health and mental health-related outcomes in patients with cSLE. Future well controlled clinical trials would be beneficial to more rigorously evaluate the effects of non-pharmacologic therapies in pediatric populations.

Evaluation of depressive and anxiety symptoms in childhood-onset systemic lupus erythematosus: Frequency, course, and associated risk factors

“…Improved provision of psychological support, including community-based care, which is proportionate to the patient’s needs is required for children with SLE, and could bridge this gap in mental healthcare in this population. 49 Improved supports may include psychoeducation/self-help resources for some, or further counseling for others. For those with depressive or anxiety disorders, cognitive behavioral therapy is the preferred psychological therapy.…”

A multi-site pilot randomized clinical trial of the Treatment and Education Approach for Childhood-onset Lupus (TEACH) program: study design and COVID-19 adaptations

“…cSLE is commonly associated with fatigue, mood issues, and pain, which contribute to poor health-related quality of life [ 2 , 3 ]. Given these common symptoms are modifiable with nonpharmacological therapies, CBT may optimize patient outcomes as part of a multi-disciplinary approach to care [ 50 ]; however, there is mixed evidence to date that CBT manages mood and related symptoms in children [ 18 , 51 ] and adults [ 13 ] with SLE. A tailored intervention such as TEACH using evidence-based cognitive behavioral and mindfulness meditation techniques to manage fatigue, depressive symptoms and pain may be needed to address concerns specific to this population.…”

Mental disorders in children with rheumatic diseases

“…Ross и соавт. [43] опубликовали систематический обзор, посвященный применению немедикаментозных методов в терапии СКВ с ювенильным дебютом, в том числе различных форм психотерапии (включая КПТ). В двух из трех исследований она обеспечивала улучшение приверженности лечению, уменьшение симптомов депрессии и хронической усталости.…”