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Elevated Salivary Alpha-Amylase Level, Association Between Depression and Disease Activity, and Stress as a Predictor of Disease Flare in Systemic Lupus Erythematosus: A Prospective Case-Control Study.

Jung JY, Nam JY, Kim HA, Suh CH - Medicine (Baltimore) (2015)

Bottom Line: However, salivary cortisol levels and Perceived Stress Scale (PSS) scores did not differ between the groups.SLE patients with the highest-quartile PSS scores had significantly increased SLEDAI scores compared to those with the lowest-quartile PSS scores after 4 to 5 months' follow-up.Also, patients with SLE were more depressed, which correlated with disease activity.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Rheumatology, Ajou University School of Medicine, Suwon, Republic of Korea.

ABSTRACT
Psychological stress has been shown to trigger systemic lupus erythematosus (SLE). However, objective evidence of symptom aggravation due to mental stress is difficult to identify. We aimed to investigate the relationship between SLE disease activity and mental stress, and the usefulness of saliva as an assessment index for stress in patients with SLE.We prospectively assessed the salivary stress hormone and disease-related biomarkers, and questionnaire data regarding stress and depression in 100 patients with SLE and 49 sex- and age-matched normal controls (NCs).Patients with SLE had higher mean salivary α-amylase levels (5.7 ± 4.6 U/mL vs 2.7 ± 2.5 U/mL, P < 0.001), anti-chromatin antibody levels (25.3 ± 22.9 U/mL vs 15.9 ± 10.9 U/mL, P < 0.001), and Beck Depression Index (BDI) scores (11.1 ± 9.2 vs 5.3 ± 5.1, P < 0.001) than NCs. However, salivary cortisol levels and Perceived Stress Scale (PSS) scores did not differ between the groups. The BDI scores correlated with the SLE disease activity index (SLEDAI) scores (r = 0.253, P = 0.011) and erythrocyte sedimentation rates (r = 0.234, P = 0.019). SLE patients with the highest-quartile PSS scores had significantly increased SLEDAI scores compared to those with the lowest-quartile PSS scores after 4 to 5 months' follow-up. Moreover, SLE patients with elevated SLEDAI scores had higher baseline PSS scores.Patients with SLE showed uncoupling of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis; higher salivary α-amylase and no different cortisol levels compared with NCs. Also, patients with SLE were more depressed, which correlated with disease activity. Furthermore, perceived stress was not correlated with disease activity; however, disease activity worsened several months later with elevated perceived stress levels.

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Correlation between changes of disease activity and the PSS scores in patients with SLE. It showed that changes of SLEDAI levels were positively correlated with the PSS scores (r = 0.212, P = 0.034). They were determined using the Spearman's rank correlation technique. PSS = Perceived Stress Scale; SLE = systemic lupus erythematosus; SLEDAI = SLE disease activity index.
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Figure 1: Correlation between changes of disease activity and the PSS scores in patients with SLE. It showed that changes of SLEDAI levels were positively correlated with the PSS scores (r = 0.212, P = 0.034). They were determined using the Spearman's rank correlation technique. PSS = Perceived Stress Scale; SLE = systemic lupus erythematosus; SLEDAI = SLE disease activity index.

Mentions: In order to find out changes in disease activity according to mental distress or depression status, patients were divided into groups according to SLEDAI changes during 4 or 5 months’ follow-up. One group consisted of patients with increased SLEDAI score, and the other group consisted of patients with decreased or unchanged SLEDAI score. The SLE patients with increased SLEDAI score had higher initial PSS scores (18.9 ± 5.4) than those with decreased or unchanged SLEDAI score (16.3 ± 4.7, P = 0.029; Table 4). The higher PSS scores at baseline were associated with the increased SLEDAI score at 4 or 5 months’ follow-up (r = 0.212, P = 0.034; Figure 1). Moreover, SLEDAI scores and SLEDAI changes were analyzed between the patient groups that were divided according to quartile of salivary markers and questionnaire scores. Although disease activity and disease activity changes did not differ between the lowest- and highest-quartile groups of salivary markers, SLEDAI scores were significantly higher in the patients with the highest BDI scores than in the patients with the lowest BDI scores (5.6 ± 3.1 vs 3.2 ± 2.4, P = 0.006). SLEDAI changes increased significantly in the patients with the highest PSS scores than in the patients with the lowest PSS scores (0.7 ± 1.6 vs −0.9 ± 2.4, P = 0.014; Table 5).


Elevated Salivary Alpha-Amylase Level, Association Between Depression and Disease Activity, and Stress as a Predictor of Disease Flare in Systemic Lupus Erythematosus: A Prospective Case-Control Study.

Jung JY, Nam JY, Kim HA, Suh CH - Medicine (Baltimore) (2015)

Correlation between changes of disease activity and the PSS scores in patients with SLE. It showed that changes of SLEDAI levels were positively correlated with the PSS scores (r = 0.212, P = 0.034). They were determined using the Spearman's rank correlation technique. PSS = Perceived Stress Scale; SLE = systemic lupus erythematosus; SLEDAI = SLE disease activity index.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554125&req=5

Figure 1: Correlation between changes of disease activity and the PSS scores in patients with SLE. It showed that changes of SLEDAI levels were positively correlated with the PSS scores (r = 0.212, P = 0.034). They were determined using the Spearman's rank correlation technique. PSS = Perceived Stress Scale; SLE = systemic lupus erythematosus; SLEDAI = SLE disease activity index.
Mentions: In order to find out changes in disease activity according to mental distress or depression status, patients were divided into groups according to SLEDAI changes during 4 or 5 months’ follow-up. One group consisted of patients with increased SLEDAI score, and the other group consisted of patients with decreased or unchanged SLEDAI score. The SLE patients with increased SLEDAI score had higher initial PSS scores (18.9 ± 5.4) than those with decreased or unchanged SLEDAI score (16.3 ± 4.7, P = 0.029; Table 4). The higher PSS scores at baseline were associated with the increased SLEDAI score at 4 or 5 months’ follow-up (r = 0.212, P = 0.034; Figure 1). Moreover, SLEDAI scores and SLEDAI changes were analyzed between the patient groups that were divided according to quartile of salivary markers and questionnaire scores. Although disease activity and disease activity changes did not differ between the lowest- and highest-quartile groups of salivary markers, SLEDAI scores were significantly higher in the patients with the highest BDI scores than in the patients with the lowest BDI scores (5.6 ± 3.1 vs 3.2 ± 2.4, P = 0.006). SLEDAI changes increased significantly in the patients with the highest PSS scores than in the patients with the lowest PSS scores (0.7 ± 1.6 vs −0.9 ± 2.4, P = 0.014; Table 5).

Bottom Line: However, salivary cortisol levels and Perceived Stress Scale (PSS) scores did not differ between the groups.SLE patients with the highest-quartile PSS scores had significantly increased SLEDAI scores compared to those with the lowest-quartile PSS scores after 4 to 5 months' follow-up.Also, patients with SLE were more depressed, which correlated with disease activity.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Rheumatology, Ajou University School of Medicine, Suwon, Republic of Korea.

ABSTRACT
Psychological stress has been shown to trigger systemic lupus erythematosus (SLE). However, objective evidence of symptom aggravation due to mental stress is difficult to identify. We aimed to investigate the relationship between SLE disease activity and mental stress, and the usefulness of saliva as an assessment index for stress in patients with SLE.We prospectively assessed the salivary stress hormone and disease-related biomarkers, and questionnaire data regarding stress and depression in 100 patients with SLE and 49 sex- and age-matched normal controls (NCs).Patients with SLE had higher mean salivary α-amylase levels (5.7 ± 4.6 U/mL vs 2.7 ± 2.5 U/mL, P < 0.001), anti-chromatin antibody levels (25.3 ± 22.9 U/mL vs 15.9 ± 10.9 U/mL, P < 0.001), and Beck Depression Index (BDI) scores (11.1 ± 9.2 vs 5.3 ± 5.1, P < 0.001) than NCs. However, salivary cortisol levels and Perceived Stress Scale (PSS) scores did not differ between the groups. The BDI scores correlated with the SLE disease activity index (SLEDAI) scores (r = 0.253, P = 0.011) and erythrocyte sedimentation rates (r = 0.234, P = 0.019). SLE patients with the highest-quartile PSS scores had significantly increased SLEDAI scores compared to those with the lowest-quartile PSS scores after 4 to 5 months' follow-up. Moreover, SLE patients with elevated SLEDAI scores had higher baseline PSS scores.Patients with SLE showed uncoupling of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis; higher salivary α-amylase and no different cortisol levels compared with NCs. Also, patients with SLE were more depressed, which correlated with disease activity. Furthermore, perceived stress was not correlated with disease activity; however, disease activity worsened several months later with elevated perceived stress levels.

Show MeSH
Related in: MedlinePlus