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Partners play a crucial role in patients' adaptation to a chronic illness, yet very little is known about the impact of partners' representations on rheumatic patients' coping behaviors. The aim of the present cross-sectional study was to examine the relation of partners' representations of control/cure, consequences and emotional representations to patients' coping behaviors through patients' representations, and to assess the impact of the potential interactions between patients' and partners' representations. The study was conducted at the Rheumatology Clinic, University of Crete Hospital in Heraklion, Greece. One hundred three heterosexual patients with Rheumatoid Arthritis (RA) or Systemic Lupus Erythematosus (SLE) and their spouses (patients' mean age = 53.87 years; SD = 9.6; partners' mean age = 51.23; SD = 7.2; 91.3% women) participated in the study. All of them completed the Revised Illness Perception Questionnaire. Patients' behaviors were assessed with the Coping with Health Injuries and Problems Scale. Structural Equation Modeling and mediation analysis were conducted. Partners' illness representations were only indirectly related to patients' coping behaviors through patients' representations ([chi].sup.2 = 20.39, df = 16, p < 0.05). Furthermore, the negative relation of patients' representations of personal control to palliative coping was stronger when partners perceived the rheumatic disease as less controllable (b = -0.07, t(82) = -2.36, p < 0.05). The findings emphasize the importance of partners' representations for patients' coping process and provide support to the need for partners to participate in relevant interventions., Author(s): Georgia Dimitraki [sup.1] , Emmanouil Papastefanakis [sup.1] [sup.2] , Georgia Ktistaki [sup.3] , Antonis Fanouriakis [sup.4] [sup.5] , Christina Adamichou [sup.6] , Nikolaos Kougkas [sup.6] , Argyro Repa [sup.6] [...]

ObjectiveTo develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR).MethodsThis international initiative had four phases. 1) Evaluation of antinuclear antibody (ANA) as an entry criterion through systematic review and meta-regression of the literature and criteria generation through an international Delphi exercise, an early patient cohort, and a patient survey. 2) Criteria reduction by Delphi and nominal group technique exercises. 3) Criteria definition and weighting based on criterion performance and on results of a multi-criteria decision analysis. 4) Refinement of weights and threshold scores in a new derivation cohort of 1,001 subjects and validation compared with previous criteria in a new validation cohort of 1,270 subjects.ResultsThe 2019 EULAR/ACR classification criteria for SLE include positive ANA at least once as obligatory entry criterion; followed by additive weighted criteria grouped in 7 clinical (constitutional, hematologic, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and 3 immunologic (antiphospholipid antibodies, complement proteins, SLE-specific antibodies) domains, and weighted from 2 to 10. Patients accumulating ≥10 points are classified. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%, compared with 82.8% sensitivity and 93.4% specificity of the ACR 1997 and 96.7% sensitivity and 83.7% specificity of the Systemic Lupus International Collaborating Clinics 2012 criteria.ConclusionThese new classification criteria were developed using rigorous methodology with multidisciplinary and international input, and have excellent sensitivity and specificity. Use of ANA entry criterion, hierarchically clustered, and weighted criteria reflects current thinking about SLE and provides an improved foundation for SLE research.

Objective: Skin involvement is common in systemic lupus erythematosus (SLE), but may be resistant to conventional treatment. We sought to evaluate the efficacy of anifrolumab (ANI) in refractory cutaneous manifestations of SLE. Methods: Case series of patients with refractory cutaneous SLE from three Rheumatology Departments in Greece. Outcome measures were improvement in Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), physician global assessment (PGA) and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Clinically relevant improvement in skin was defined as decrease ≥50% (CLASI50) from baseline values. Results: Eighteen patients received ANI; all had active skin involvement at baseline. Mean (SD) SLEDAI and PGA at ANI initiation were 7.4 (2.7) and 1.4 (0.5), respectively, with a mean prednisone dose 4.9 (4.5) mg/day. Mean CLASI (Activity/Damage) at baseline was 13.9 (9.7)/2.9 (4.6). Patients were refractory to a mean 6.3 (1.5) immunomodulatory agents (including hydroxychloroquine and glucocorticoids) before the initiation of ANI. After a mean 8.5 (4.6) months, 89% (n = 16/18) of patients demonstrated significant improvement in general lupus and cutaneous disease activity, and glucocorticoid tapering. Mean SLEDAI and mean CLASI at last visit were 3.4 (1.9) and 2.1 (2.4)/1.4 (2.2), respectively, and mean daily prednisone dose decreased to 2.4 (2.2). Of note, in this group of highly refractory patients CLASI50 was achieved in 16/18 (89%) patients. One patient discontinued ANI after 4 infusions due to a varicella-zoster virus infection and one patient, who initially responded to treatment with ANI, experienced a skin flare due to temporary discontinuation due to Covid 19 infection. DORIS remission and LLDAS were attained in two (11.1%) and eleven (61.1%) patients, respectively. Conclusion: Anifrolumab is highly effective in various skin manifestations of SLE, even after prior failure to multiple treatments. [ABSTRACT FROM AUTHOR]

Glucocorticoids (GCs) have revolutionized the management of SLE, providing patients with rapid symptomatic relief and preventing flares when maintained at low dosages. However, there are increasing concerns over GC-associated adverse effects and organ damage, which decrease patients' quality of life (QOL) and increase healthcare costs. This highlights the need to balance effective GC use and minimize toxicity in patients with SLE. Herein, we provide an overview of the theoretical considerations and clinical evidence, in addition to the variations and similarities across nine national and eight international recommendations regarding the use of GCs across SLE manifestations and how these compare with real-world usage. In line with this, we propose possible actions toward the goal of GC Stewardship to improve the QOL for patients with lupus while managing the disease burden. [ABSTRACT FROM AUTHOR]

Patients with an inflammatory rheumatic disease (IRD), are often faced with significant limitations in physical functioning. Illness representations are a key-factor of their illness-related experience. Our aim was to examine (a) whether illness representations can predict or only reflect IRD patients' physical functioning over time, and (b) the specific pathways through which representations and physical functioning at baseline are associated with representations and functioning at follow-up. Patients with rheumatoid arthritis (N = 54) or systemic lupus erythematosus (N = 58) participated in the two phases of the study, 1 year apart. According to the results, illness representations were rather predicted by physical functioning than the other way around. At the same time, illness representations at baseline and at follow-up seemed to form a chain that mediated the relation between physical functioning at baseline and 1 year later. These findings may help us better delineate the interplay between the ways patients understand their condition and adaptation to illness., Author(s): Evangelos C. Karademas [sup.1] , Georgia Dimitraki [sup.1] , Emmanouil Papastefanakis [sup.1] , Georgia Ktistaki [sup.2] , Argyro Repa [sup.2] , Irini Gergianaki [sup.2] , George Bertsias [sup.2] , [...]