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Systemic lupus erythematosus (SLE) is a chronic autoimmune disease in which patients frequently experience pain. To improve treatments and advance pain management in SLE, we characterized pain in patients with SLE through a biopsychosocial lens, taking into account demographics, socioeconomic status, comorbidities, chronic overlapping pain conditions (COPCs), mental health, other pain conditions, distribution of pain regions, and other measurements of pain and well-being. We investigated two research questions: 1. What distinguishes patients with SLE who are seen at the pain clinics and are in CHOIR, the Collaborative Health Outcomes Information Registry, from patients with SLE who are not seen at the pain clinics? and 2. What are the biopsychosocial correlates of pain in the patients with SLE seen at the pain clinics (in CHOIR)? Our cross-sectional regression analyses indicated that patients with SLE at CHOIR are more likely to be on public health insurance, to be Black, and have COPCs, mental health conditions, and functional comorbidities compared to patients with SLE who were not in CHOIR. Further, within the cohort of patients with SLE in CHOIR, pain widespreadness was significantly associated with worse PROMIS measures, pain intensity, and pain catastrophizing. In addition, socioeconomic status was significantly associated with average pain intensity. Ultimately, this work will lay the foundation for developing more targeted interventions or informing clinical practice to minimize and treat chronic pain in patients with SLE.

This systematic review examines the representation in rheumatoid arthritis randomized clinical trials of racial/ethnic minority groups compared with the representation of these populations in the United States and the representation of women and elderly people with the prevalence of rheumatoid arthritis among these groups nationally., Key Points Question Is there equitable representation of racial/ethnic minority groups, women, and elderly people within rheumatoid arthritis (RA) randomized clinical trials (RCTs)? Findings In this systematic review of 240 RA RCTs including 77 071 participants, there was significant underrepresentation of racial/ethnic groups throughout 2008 to 2018 with no trend toward improved representation of minority racial/ethnic groups in US-based RCTs during the 10-year period. Additionally, men were underrepresented in US-based RA RCTs, and elderly people were often excluded from RA RCTs. Meaning Given the disproportionate burden of RA in racial/ethnic minority groups, it is imperative that policy makers better incentivize their inclusion in RA RCTs., Importance Racial/ethnic minority groups, women, and elderly people experience a disproportionate burden of disease in rheumatoid arthritis (RA), making it particularly important to examine drug therapies in these populations. Despite a national health agenda to improve representation of diverse populations in randomized clinical trials (RCTs), there have been few large-scale analyses examining RCT demographic characteristics within rheumatology and none focusing on RA. Objective To characterize the representation of racial/ethnic minority groups, women, and elderly people through a comprehensive systematic review of RA RCTs. Data Sources A literature search of PubMed’s MEDLINE database was conducted to identify RA RCTs in adults 19 years and older published in English between January 1, 2008, and January 1, 2018. Study Selection Randomized double-blind RCTs examining any systemic, disease-modifying therapy were included. Secondary analyses of previously published RCTs were excluded. Of 1195 identified records, 240 articles (20.1%) met final selection criteria. The analysis focused on RCTs with at least 1 US-based site. Data Extraction and Synthesis Data were extracted and synthesized according to the PRISMA guidelines for systematic reviews. Studies were screened for eligibility criteria. Demographic data on the age, sex, and race/ethnicity of RCT participants were extracted. Data analysis was conducted from October 25, 2018, to March 15, 2019. Main Outcomes and Measures Representation of race/ethnicity and sex, defined as the proportion of total participants that belonged to each racial/ethnic group or sex. Trends in proportions over time were examined and compared with US demographic data. Results A total of 240 RCTs with 77 071 participants were included. Of 126 RCTs with at least 1 US-based site (52.5%), the enrollment of minority racial/ethnic groups was significantly lower than their representation within the US Census population (16% vs 40%; P

AIMS Deaths attributable to diabetes may be underestimated using an underlying cause of death (COD) approach in U.S. death records. This study sought to characterize the burden of diabetes deaths using a multiple-cause of death approach and to identify temporal changes in co-reported causes of death among those with diabetes listed anywhere on their death records. METHODS COD were identified using data from the National Center for Health Statistics from 2003-2016. We calculated age-adjusted mortality rates for diabetes as the underlying or contributing COD by race/ethnicity. We used ICD-10 codes to identify leading causes of death among those with and without diabetes on their death records. We compared temporal changes in deaths due to cardiovascular disease, cerebrovascular disease, cancer, and other causes. RESULTS The study population included 34,313,964 decedents aged ≥25 from 2003-2016. Diabetes was listed as an underlying COD in approximately 3.0% (n=1,031,000) and 6.7% (n=2,295,510) of the death records, respectively. Decedents with diabetes listed as an underlying COD experienced a 16% decline in mortality, and the race/ethnicity-specific average annual percentage changes (AAPC) showed significant declining trends for most groups (AAPC ranged from 0.18 to -2.83%). Cardiovascular disease remained the leading underlying COD among diabetes-attributable deaths, although its proportion of deaths fell from 31 to 27% over time. Co-reported COD diversified, and were more likely to include hypertension and hypertensive renal disease among those with diabetes on their death records. CONCLUSIONS Our findings underscore the importance of using a multiple-cause-of-death approach for more completely characterizing diabetes' contribution to mortality.