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狼疮发作的生活体验:澳大利亚女性队列中的特征、触发因素及管理

The Lived Experience of Lupus Flares: Features, Triggers, and Management in an Australian Female Cohort.

作者信息

Squance Marline L, Reeves Glenn E M, Bridgman Howard

机构信息

Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia ; Faculty of Science and Information Technology, University of Newcastle, Callaghan, NSW 2308, Australia ; Autoimmune Resource and Research Centre, 2nd Floor, HAPS Building, John Hunter Hospital, New Lambton, NSW 2305, Australia ; Hunter New England Health District, New Lambton, NSW 2305, Australia.

Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia ; Autoimmune Resource and Research Centre, 2nd Floor, HAPS Building, John Hunter Hospital, New Lambton, NSW 2305, Australia ; Hunter New England Health District, New Lambton, NSW 2305, Australia.

出版信息

Int J Chronic Dis. 2014;2014:816729. doi: 10.1155/2014/816729. Epub 2014 Nov 20.

Abstract

Individuals living with lupus commonly experience daily backgrounds of symptoms managed to acceptable tolerance levels to prevent organ damage. Despite management, exacerbation periods (flares) still occur. Varied clinical presentations and unpredictable symptom exacerbation patterns provide management and assessment challenges. Patient perceptions of symptoms vary with perceived impact, lifestyles, available support, and self-management capacity. Therefore, to increase our understanding of lupus' health impacts and management, it was important to explore lupus flare characteristics from the patient viewpoint. Lupus flares in 101 Australian female patients were retrospectively explored with the use of a novel flare definition. Qualitative methods were used to explore patient-perceived flare symptoms, triggers, and management strategies adopted to alleviate symptom exacerbations. A mean of 29.9 flare days, with 6.8 discrete flares, was experienced. The study confirmed that patients perceive stress, infection, and UV light as flare triggers and identified new potential triggers of temperature and weather changes, work, and chemical exposure from home cleaning. The majority of flares were self-managed with patients making considered management choices without medical input. Barriers to seeking medical support included appointment timings and past negative experiences reflecting incongruence between clinician and patient views of symptom impact, assessment, and ultimately flare occurrence.

摘要

狼疮患者通常每天都有症状,这些症状被控制在可接受的耐受水平,以防止器官损伤。尽管进行了管理,但病情加重期(发作)仍会出现。多样的临床表现和不可预测的症状加重模式给管理和评估带来了挑战。患者对症状的认知因感知到的影响、生活方式、可获得的支持和自我管理能力而有所不同。因此,为了增进我们对狼疮对健康的影响及管理的理解,从患者的角度探索狼疮发作的特征很重要。我们使用一种新的发作定义,对101名澳大利亚女性狼疮患者的发作情况进行了回顾性研究。采用定性方法来探究患者感知到的发作症状、诱因以及为缓解症状加重而采取的管理策略。患者平均经历了29.9天的发作期,发作次数为6.8次。该研究证实,患者认为压力、感染和紫外线是发作的诱因,并确定了温度和天气变化、工作以及家庭清洁中的化学物质接触等新的潜在诱因。大多数发作是患者自行管理的,患者在没有医疗干预的情况下做出了经过深思熟虑的管理选择。寻求医疗支持的障碍包括预约时间以及过去的负面经历,这些反映出临床医生和患者在症状影响、评估以及最终发作发生方面的观点不一致。

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