Non-pharmacologic therapies in treatment of childhood-onset systemic lupus erythematosus: A systematic review.
Non-pharmacologic therapies in treatment of childhood-onset systemic lupus erythematosus: A systematic review.
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DOI：
10.1177/09612033221094704
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发表时间：
2022-06
期刊：
影响因子：
2.6
通讯作者：
Cunningham, Natoshia
中科院分区：
文献类型：
--
作者：
Ross, Elizabeth;Abulaban, Khalid;Kessler, Elizabeth;Cunningham, Natoshia
关键词：
儿童期系统性红斑狼疮（cSLE）是一种复杂的多系统自身免疫性疾病，通常伴有疼痛、疲劳和情绪相关障碍。与成人发病的SLE相比，cSLE与疾病严重程度增加和死亡率升高相关。因此，多方面的护理方法，包括使用非药物治疗，对于确保最佳的患者结果至关重要。使用非药物治疗作为辅助治疗已被证明对成人SLE患者有益，然而，其在cSLE中的使用和效果尚不清楚。这是第一个探讨非药物方法治疗cSLE的使用和证据质量的系统综述。采用PRISMA指南进行文献综述。截至2021年3月的研究纳入了被诊断为cSLE的参与者。证据质量通过OCEBM证据指南分级，并使用Cochrane指南评估偏倚。完成的临床试验（通过clinicaltrials.gov）也被检索以确定未发表的结果。11项已发表的研究（包括1152名患者）符合本综述的纳入标准，另外3项研究的数据未在clinicaltrial.gov上发表。在已发表的试验中，4项研究使用患者教育/支持，3项研究使用膳食补充，3项研究使用心理治疗形式（例如，CBT）， 1项研究使用有氧运动来针对以下问题：治疗依从性（n=3）、生活质量（n=3）、疲劳（n=2）、疼痛（n=2）、抑郁症状（n=1）、焦虑（n=1）和健康相关结局，包括疾病严重程度（n=3）、心血管疾病风险（CVD; n=3）和肌肉功能（n=1）。在所有调查中，基于研究设计的证据质量为中等/低。就潜在结果而言，膳食补充方法在3项研究中有2项是成功的，并且与疾病活动度和疲劳的改善有关。有氧运动能有效降低静息心率，增加心肺功能。患者教育/支持与显著提高治疗依从性和降低心血管风险标志物相关。三项关于心理治疗效果的研究中，有两项显示出了改善（例如，在治疗依从性、抑郁和疲劳方面）。本综述确定了几种有希望的非药物治疗方法，可作为传统药物治疗方案的辅助治疗，用于cSLE患者的健康和精神健康相关结局。未来对照良好的临床试验将有助于更严格地评估非药物治疗在儿科人群中的效果。
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. 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 Completed clinical trials (via clinicaltrials.gov) were also searched to identify unpublished results. Eleven published studies consisting of 1,152 patients met inclusion criteria for this review, as well as 3 additional studies with unpublished data on clinicaltrial.gov. Of the published trials, four studies used patient education/support, 3 studies used dietary supplementation, 3 used forms of psychotherapy (e.g., CBT), 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 (CVD; 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). 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.
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影响因子：
2.6
作者：
Donnelly C;Cunningham N;Jones JT;Ji L;Brunner HI;Kashikar-Zuck S
通讯作者：
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影响因子：
4.7
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通讯作者：
Silverman, Earl D.
影响因子：
3.4
作者：
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通讯作者：
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