Article Figures & Data
Figures
- Figure 1.
A representation of the proportion of variance in pain intensity and pain interference explained by 7 constructs in the biopsychosocial framework. * Corresponds to results of the sensitivity analysis that tested the model using the modified SLAQ. The modified SLAQ score removes stomach pain, chest pain, headache, joint swelling, joint pain, and muscle pain. SLAQ: Systemic Lupus Activity Questionnaire.
Tables
- Table 1.
Baseline characteristics of patients in the Georgians Organized Against Lupus cohort.
Overall, n = 766 Pain outcomes Pain intensity, 1-item score Mean ± SD 5.3 ± 2.9 Median (IQR) 6.0 (3.0–8.0) Range 0–10 PROMIS pain interference, t-score Mean ± SD 58.3 ± 9.7 Median (IQR) 60.3 (53.9–65.5) Range 41.6–75.6 Disease-related factors Disease activity (SLAQ score) Mean ± SD 16.2 ± 9.1 Median (IQR) 15.0 (9–22) Range 0–44 Organ damage (BILD score) Mean ± SD 2.5 ± 2.4 Median (IQR) 2.0 (1–4) Range 0–15 Mild-to-severe pain manifestations in past 3 months, n (%) Chest pain 367 (47.9) Stomach pain 421 (55.0) Headache 452 (58.9) Joint pain 658 (85.9) Muscle pain 573 (74.8) Current medications, n (%) Steroids 395 (51.6) HCQ 539 (70.4) Immunosuppressive drugs 280 (36.6) Biologics 44 (5.7) CYC 15 (2.1) Renal damage, n (%)a Yes 53 (6.9) No 713 (93.1) Demographic factors Age, yrs Mean ± SD 48.4 ± 13.6 Median (IQR) 48.6 (38.3–58.4) Range 17.1–89.5 Sex, n (%) Male 52 (6.8) Female 714 (93.2) Marital statusb, n (%) Single 478 (62.4) Not single 288 (37.6) Ethnicityc, n (%) Non-Black 138 (18.0) Black 628 (82.0) Socioeconomic factors Annual income level, n (%) < $40,000 511 (66.7) $40,000–69,000 120 (15.7) ≥ $70,000 135 (17.6) Education level, n (%) (1) High school or less 251 (32.8) (2) Some college 253 (33.0) (3) College or above 262 (34.2) Physical factors PROMIS sleep disturbance, t-score Mean ± SD 55.7 ± 9.9 Median (IQR) 56.1 (51–63) Range 32–73 BMI, kg/m2, n (%) Mean ± SD 29.4 ± 8.0 Median (IQR) 28.3 (24–34) Range 13–66 PROMIS physical health 1-item score Mean ± SD 2.5 ± 0.9 Median (IQR) 2.0 (2–3) Range 1–5 Psychological factors PROMIS anxiety, t-score Mean ± SD 54.8 ± 10.2 Median (IQR) 55.6 (47.9–61.7) Range 40.3–81.4 PROMIS depression, t-score Mean ± SD 51.8 ± 10.4 Median (IQR) 52.3 (44.4–58.9) Range 38.0–82.4 PROMIS anger, t-score Mean ± SD 52.8 ± 12.3 Median (IQR) 52.8 (44–61) Range 33–83 Behavioral health Cigarette smokingd, n (%) Current 100 (13.1) Not current 663 (86.9) Coping with spirituality and religion Mean ± SD 6.2 ± 2.0 Median (IQR) 7.0 (5.0–8.0) Range 2–8 Coping with substance and alcohol use Mean ± SD 2.4 ± 1.1 Median (IQR) 2.0 (2.0–2.0) Range 2.0–8.0 Coping with self-blame Mean ± SD 3.5 ± 1.8 Median (IQR) 3.0 (2.0–5.0) Range 2–8 Coping with denial Mean ± SD 3.1 ±1.6 Median (IQR) 2.0 (2.0–4.0) Range 2–8 Social factors PROMIS emotional support Mean ± SD 51.3 ± 9.3 Median (IQR) 49.9 (43.8–62.0) Range 25.8–62.0 PROMIS social isolation, t-score Mean ± SD 49.0 ± 10.9 Median (IQR) 49.0 (40.0–57.4) Range 34.4–76.2 Financial strain, unmet needs Mean ± SD 9.2 ± 3.3 Median (IQR) 9.0 (8.0–11.0) Range 4–16 Everyday discrimination scale Mean ± SD 1.8 ± 0.6 Median (IQR) 1.7 (1.2–2.1) Range 1.0–4.0 ↵a Renal disease was defined as either receiving a kidney transplant or dialysis for more than 6 months.
↵b Marital status was defined as (1) single = never married, divorced, or widowed or (2) not single = married or living with a partner.
↵c This analysis was limited to non-Black and Black individuals. The original GOAL data set is multiethnic but the numbers of non-White and non-Black individuals were few.
↵d Smoking status is defined as (1) current = smokes every day or some days or (2) not current = does not smoke. BILD: Brief Index of Lupus Damage; CYC: cyclophosphamide; HCQ: hydroxychloroquine; PROMIS: Patient Reported Outcomes Measurement Information System; SLAQ: Systemic Lupus Activity Questionnaire.
- Table 2.
Factors associated with pain outcomes and disease-related measures in individuals with SLE in the unadjusted linear regression.
Pain Intensity Pain Interference Disease Activity Organ Damage Demographic factors Age at survey 0.006 (−0.009 to 0.022) 0.024 (−0.027 to 0.075) -0.072 (−0.119 to -0.025) 0.034 (0.021 to 0.046) Sex Male Ref Ref Ref Ref Female 0.396 (−0.433 to 1.226) −0.483 (−3.232 to 2.265) −2.382 (−4.965 to 0.201) 0.316 (−0.368 to 1.000) Marital status Not single Ref Ref Ref Ref Single 0.770 (0.342 to 1.199) 2.059 (0.635 to 3.483) 2.496 (1.169 to 3.823) 0.261 (−0.094 to 0.617) Ethnicity Non-Black Ref Ref Ref Ref Black 1.650 (1.117 to 2.182) 3.035 (1.243 to 4.827) 1.863 (0.172 to 3.553) 0.151 (−0.299 to 0.600) Socioeconomic factors Household income -0.439 (−0.514 to -0.365) -1.262 (−1.515 to -1.008) -1.139 (−1.376 to -0.902) -0.147 (−0.213 to -0.082) Education High school or less Ref Ref Ref Ref Some college −0.465 (−0.956 to 0.026) −0.776 (−2.422 to 0.870) 1.441 (−0.120 to 3.002) 0.134 (−0.293 to 0.560) College or above -2.133 (−2.619 to -1.647) -6.128 (−7.755 to -4.501) -3.593 (−5.132 to -2.054) −0.087 (−0.508 to 0.335) Physical factors PROMIS sleep disturbance 0.142 (0.123 to 0.160) 0.518 (0.459 to 0.579) 0.455 (0.397 to 0.512) 0.036 (0.018 to 0.053) BMI 0.083 (0.057 to 0.108) 0.237 (0.152 to 0.322) 0.112 (0.031 to 0.193) 0.010 (−0.011 to 0.033) PROMIS physical health -1.476 (−1.677 to -1.275) -5.602 (−6.237 to -4.967) -4.494 (−5.116 to -3.871) -0.625 (−0.806 to -0.444) Psychological factors PROMIS anxiety 0.089 (0.069 to 0.108) 0.379 (0.316 to 0.441) 0.388 (0.331 to 0.446) 0.018 (0.001 to 0.035) PROMIS depression 0.089 (0.070 to 0.108) 0.348 (0.287 to 0.410) 0.451 (0.398 to 0.505) 0.027 (0.010 to 0.043) PROMIS anger 0.092 (0.076 to 0.108) 0.360 (0.310 to 0.410) 0.338 (0.291 to 0.385) 0.011 (−0.000 to 0.024) Behavioral factors Smoking Not current Ref Ref Ref Ref Current 1.091 (0.476 to 1.707) 3.469 (1.431 to 5.507) 4.241 (2.340 to 6.142) 0.331 (−0.179 to 0.842) Coping with religion 0.133 (0.028 to 0.237) 0.443 (0.096 to 0.790) 0.182 (−0.145 to 0.510) 0.109 (0.027 to 0.196) Coping with substance and alcohol use 0.177 (−0.015 to 0.369) 0.634 (−0.001 to 1.270) 1.027 (0.434 to 1.620) 0.009 (−0.149 to 0.167) Coping with self-blame 0.256 (0.138 to 0.374) 1.281 (0.895 to 1.667) 1.475 (1.123 to 1.828) 0.109 (0.011 to 0.208) Coping with denial 0.474 (0.251 to 0.597) 1.387 (0.970 to 1.803) 1.467 (1.080 to 1.854) 0.083 (−0.024 to 0.190) Social factors PROMIS emotional support -0.044 (−0.067 to -0.022) -0.231 (−0.304 to -0.156) -0.242 (−0.310 to -0.175) −0.018 (−0.037 to 0.000) PROMIS social isolation 0.079 (0.061 to 0.097) 0.342 (0.283 to 0.401) 0.354 (0.300 to 0.408) 0.031 (0.015 to 0.047) Financial strain 0.354 (0.294 to 0.415) 1.139 (0.934 to 1.344) 1.114 (0.925 to 1.304) 0.102 (0.047 to 0.157) Discrimination score 0.640 (0.311 to 0.970) 2.401 (1.312 to 3.490) 3.658 (2.663 to 4.653) 0.249 (−0.025 to 0.524) Values indicate β coefficients (95% CI). Bolded values are statistically significant. PROMIS: Patient Reported Outcomes Measurement Information System; SLE: systemic lupus erythematosus.
Outcome Model 1 Model 2 Model 3 Model 4 Model 5 Model 6 Model 7 Pain intensity R2 0.312 0.362 0.405 0.489 0.496 0.514 0.531 ΔR2 – 0.046 0.043 0.085 0.007 0.018 0.017 Pain interference R2 0.330 0.343 0.374 0.498 0.512 0.520 0.540 ΔR2 – 0.013 0.031 0.124 0.013 0.008 0.020 Pain intensity* R2 0.245 0.288 0.348 0.463 0.471 0.493 0.510 ΔR2 – 0.042 0.060 0.116 0.008 0.022 0.017 Pain interference* R2 0.254 0.264 0.307 0.479 0.500 0.509 0.524 ΔR2 – 0.010 0.043 0.172 0.018 0.012 0.015 Model 1: disease-related factors; Model 2: Model 1 + demographic factors; Model 3: Model 2 + socioeconomic factors; Model 4: Model 3 + physical factors; Model 5: Model 4 + psychological factors; Model 6: Model 5 + behavioral factors; Model 7: Model 6 + social factors.
↵* These models comprise the sensitivity analyses that include the modified Systemic Lupus Activity Questionnaire (SLAQ), which removes overt mentions of pain including stomach pain, chest pain, headache, joint swelling, joint pain, and muscle pain.
- Table 4.
Hierarchical linear regression analyses of 7 constructs with pain intensity as outcome.
Model 1 Model 2 Model 3 Model 4 Model 5 Model 6 Model 7 R2 0.312 0.362 0.405 0.489 0.496 0.514 0.531 ΔR2 – 0.046 0.043 0.085 0.007 0.018 0.017 Disease-related factors Disease activity 0.179 (0.159 to 0.199) 0.182 (0.163 to 0.202) 0.165 (0.144 to 0.185) 0.114 (0.092 to 0.136) 0.114 (0.091 to 0.137) 0.112 (0.088 to 0.135) 0.106 (0.081 to 0.130) Organ damage 0.018 (−0.057 to 0.092) −0.021 (−0.096 to 0.053) −0.027 (−0.101 to 0.046) −0.044 (−0.114 to 0.025) −0.042 (−0.111 to 0.028) −0.043 (−0.114 to 0.028) −0.026 (−0.098 to 0.046) Demographic factors Age at survey 0.024 (0.011 to 0.036) 0.024 (0.011 to 0.036) 0.021 (0.009 to 0.033) 0.023 (0.011 to 0.035) 0.021 (0.009 to 0.034) 0.021 (0.008 to 0.034) Sex Male Ref Ref Ref Ref Ref Ref Female -0.851 (−1.528 to -0.174) -0.676 (−1.333 to -0.019) -0.809 (−1.443 to -0.175) -0.817 (−1.449 to -0.185) -0.841 (−1.502 to -0.181) -0.932 (−1.607 to -0.257) Marital status Not single Ref Ref Ref Ref Ref Ref Single 0.072 (−0.293 to 0.437) −0.387 (−0.777 to 0.003) −0.310 (−0.679 to 0.06) −0.248 (−0.619 to 0.123) −0.208 (−0.591 to 0.174) −0.186 (−0.577 to 0.205) Ethnicity Non-Black Ref Ref Black 1.334 (0.874 to 1.794) 0.905 (0.44 to 1.37) 0.792 (0.353 to 1.232) 0.766 (0.325 to 1.207) 0.668 (0.212 to 1.125) 0.726 (0.251 to 1.201) Socioeconomic factors Household income -0.181 (−0.274 to -0.088) -0.139 (−0.227 to -0.052) -0.143 (−0.231 to -0.056) -0.148 (−0.238 to -0.058) -0.121 (−0.218 to -0.024) Education High school or less Ref Ref Ref Ref Ref Some college −0.457 (−0.876 to -0.038) −0.472 (−0.866 to -0.078) −0.452 (−0.848 to -0.056) −0.337 (−0.747 to 0.074) −0.356 (−0.786 to 0.073) College or above −0.853 (−1.338 to -0.369) −0.829 (−1.284 to -0.374) −0.792 (−1.248 to -0.336) −0.574 (−1.048 to -0.101) −0.630 (−1.119 to -0.142) Physical factors PROMIS sleep disturbance 0.060 (0.041 to 0.079) 0.056 (0.037 to 0.076) 0.057 (0.037 to 0.077) 0.051 (0.030 to 0.071) BMI 0.041 (0.021 to 0.061) 0.04 (0.020 to 0.060) 0.037 (0.017 to 0.058) 0.041 (0.019 to 0.063) PROMIS physical health -0.455 (−0.655 to -0.256) -0.456 (−0.659 to -0.253) -0.538 (−0.748 to -0.329) -0.637 (−0.855 to -0.419) Psychological factors PROMIS anxiety −0.015 (−0.038 to 0.008) −0.01 (−0.034 to 0.015) −0.006 (−0.032 to 0.019) PROMIS depression −0.016 (−0.036 to 0.005) −0.012 (−0.034 to 0.009) −0.010 (−0.032 to 0.012) PROMIS anger 0.028 (0.010 to 0.047) 0.028 (0.009 to 0.047) 0.026 (0.005 to 0.046) Behavioral factors Smoking Not current Ref Ref Current −0.024 (−0.516 to 0.469) 0.041 (−0.474 to 0.557) Coping with religion 0.015 (−0.068 to 0.098) 0.021 (−0.065 to 0.108) Coping with substance and alcohol use 0.002 (−0.151 to 0.155) 0.004 (−0.15 to 0.158) Coping with self-blame -0.178 (−0.294 to -0.063) -0.197 (−0.317 to -0.076) Coping with denial 0.152 (0.040 to 0.264) 0.159 (0.045 to 0.274) Social factors PROMIS emotional support 0.007 (−0.014 to 0.029) PROMIS social isolation 0.001 (−0.022 to 0.025) Financial strain 0.030 (−0.034 to 0.094) Discrimination score −0.196 (−0.494 to 0.102) Model 1: Disease-related factors; Model 2: Model 1 + demographic factors; Model 3: Model 2 + socioeconomic factors; Model 4: Model 3 + physical factors; Model 5: Model 4 + psychological factors; Model 6: Model 5 + behavioral factors; Model 7: Model 6 + social factors. Statistically significant variables in the final model are bolded. PROMIS: Patient Reported Outcomes Measurement Information System.
- Table 5.
Hierarchical linear regression analyses of 7 constructs with pain interference as outcome.
Model 1 Model 2 Model 3 Model 4 Model 5 Model 6 Model 7 R2 0.330 0.343 0.374 0.498 0.512 0.520 0.540 ΔR2 – 0.013 0.031 0.124 0.013 0.008 0.020 Disease-related factors Disease activity 0.593 (0.528 to 0.659) 0.606 (0.539 to 0.672) 0.552 (0.483 to 0.620) 0.323 (0.252 to 0.394) 0.292 (0.217 to 0.368) 0.282 (0.205 to 0.360) 0.261 (0.180 to 0.341) Organ damage 0.248 (0.002 to 0.494) 0.15 (−0.102 to 0.402) 0.144 (−0.107 to 0.395) 0.042 (−0.187 to 0.271) 0.081 (−0.146 to 0.309) 0.094 (−0.142 to 0.330) 0.138 (−0.101 to 0.377) Demographic factors Age at survey 0.065 (0.022 to 0.109) 0.065 (0.022 to 0.107) 0.065 (0.026 to 0.104) 0.073 (0.034 to 0.112) 0.060 (0.018 to 0.101) 0.051 (0.008 to 0.095) Sex Male Ref Ref Ref Ref Ref Ref Female −1.111 (−3.388 to 1.166) −0.650 (−2.882 to 1.583) −1.541 (−3.618 to 0.536) −1.587 (−3.642 to 0.468) −1.439 (−3.613 to 0.735) −1.659 (−3.900 to 0.582) Marital status Not single Ref Ref Ref Ref Ref Ref Single 0.173 (−1.059 to 1.406) −1.104 (−2.432 to 0.225) −0.471 (−1.687 to 0.746) −0.182 (−1.395 to 1.03) −0.153 (−1.419 to 1.113) −0.286 (−1.579 to 1.007) Ethnicity Non-Black Ref Ref Ref Ref Ref Ref Black 1.864 (0.316 to 3.412) 0.630 (−0.954 to 2.214) 0.311 (−1.136 to 1.757) 0.304 (−1.136 to 1.744) −0.003 (−1.516 to 1.510) 0.184 (−1.394 to 1.762) Socioeconomic factors Household income −0.494 (−0.810 to -0.178) −0.257 (−0.546 to 0.032) −0.254 (−0.539 to 0.032) −0.301 (−0.599 to -0.004) −0.264 (−0.585 to 0.056) Education High school or less Ref Ref Ref Ref Ref Some college −1.003 (−2.427 to 0.422) −0.879 (−2.173 to 0.415) −0.703 (−1.995 to 0.588) −0.472 (−1.828 to 0.884) −0.388 (−1.808 to 1.031) College or above −2.508 (−4.156 to -0.861) −2.195 (−3.692 to -0.698) −2.082 (−3.569 to -0.595) −1.717 (−3.285 to -0.150) -1.687 (−3.306 to -0.067) Physical factors PROMIS sleep disturbance 0.254 (0.193 to 0.315) 0.216 (0.153 to 0.279) 0.216 (0.150 to 0.282) 0.200 (0.131 to 0.269) BMI 0.093 (0.028 to 0.159) 0.089 (0.023 to 0.154) 0.08 (0.011 to 0.148) 0.092 (0.021 to 0.164) PROMIS physical health −2.415 (−3.067 to -1.762) −2.226 (−2.885 to -1.566) −2.379 (−3.067 to -1.692) -2.647 (−3.369 to -1.925) Psychological factors PROMIS anxiety 0.012 (−0.063 to 0.087) 0.037 (−0.044 to 0.117) 0.016 (−0.069 to 0.101) PROMIS depression −0.047 (−0.115 to 0.021) −0.026 (−0.096 to 0.045) −0.017 (−0.091 to 0.057) PROMIS anger 0.125 (0.065–0.186) 0.125 (0.061–0.189) 0.137 (0.069–0.204) Behavioral factors Smoking Not current Ref Ref Current 0.179 (−1.441 to 1.798) 0.297 (−1.397 to 1.991) Coping with religion 0.087 (−0.186 to 0.360) 0.185 (−0.101 to 0.471) Coping with substance and alcohol use −0.305 (−0.804 to 0.194) −0.317 (−0.824 to 0.190) Coping with self-blame −0.307 (−0.689 to 0.075) -0.424 (−0.823 to -0.026) Coping with denial 0.046 (−0.325 to 0.418) 0.047 (−0.333 to 0.427) Social factors PROMIS emotional support −0.016 (−0.086 to 0.054) PROMIS social isolation 0.043 (−0.034 to 0.120) Financial strain −0.013 (−0.226 to 0.199) Discrimination score −0.595 (−1.581 to 0.392) Model 1: Disease-related factors; Model 2: Model 1 + demographic factors; Model 3: Model 2 + socioeconomic factors; Model 4: Model 3 + physical factors; Model 5: Model 4 + psychological factors; Model 6: Model 5 + behavioral factors; Model 7: Model 6 + social factors. Statistically significant variables in the final model are bolded. PROMIS: Patient Reported Outcomes Measurement Information System.
