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Previous studies on the relationship between the circulating level of interleukin-17 (IL-17) and disease activity in systemic lupus erythematosus (SLE) were contradictory. This study is aimed at quantitatively assessing the correlation between the circulating IL-17 level and disease activity in SLE patients. A systematic search for related literature was conducted via PubMed, Web of Science, EMBASE, and Cochrane Library (up to January 26, 2021). The relationship between circulating IL-17 levels and SLE activity was evaluated using Fisher’szvalue, which was then converted tor. The standardized mean difference (SMD) and its 95% confidence interval (CI) were used to describe the difference between the circulating IL-17 level in patients with active and inactive SLE. STATA 16.0 was used to perform statistical analysis. Random-effects model was performed to synthesize data. Twenty-six studies involving 1,560 SLE patients were included in this review. The pooledrvalue was 0.38 (95% CI: 0.25-0.50;I2=83.8%,P<0.001) between the SLE activity and circulating level of IL-17. Patients with active SLE had higher level of circulating IL-17 than that of inactive (pooled SMD=0.95, 95% CI: 0.38-1.53;I2=90.5%,P<0.001). The subgroup analysis suggested that the region and detection method of circulating IL-17 might not be a source of heterogeneity. No significant publication bias was found. In summary, circulating IL-17 level has a low positive relationship with SLE activity. It is necessary to carefully consider the use of circulating IL-17 as a biomarker of the disease activity in SLE patients. The relationship between the circulating level of IL-17 and SLE activity should be further confirmed in randomized controlled studies.

Background Currently, there is no consistent understanding of the relationship between depression and sleep quality in patients with systemic lupus erythematosus (SLE). This study aimed to explore the correlation between depression and sleep quality in SLE patients. Methods Five English (PubMed, Web of Science, EMBASE, Cochrane Library, and CINAHL) databases were systematically searched from inception to January 12, 2021. Two authors independently screened publications and extracted data according to set inclusion and exclusion criteria. Statistical analyses were performed with STATA 16.0. Data were pooled using a random-effects model. Results A total of 9 identified studies matched the inclusion criteria, reporting on 514 patients with SLE in the analysis. A moderate correlation of depression with sleep quality was found (pooled r = 0.580 [0.473, 0.670]). Compared to good sleepers, patients with SLE and poor sleep quality had higher levels of depression (standardized mean difference = − 1.28 [− 1.87, − 0.69]). Depression was associated with subjective sleep quality (r = 0.332 [0.009, 0.592]), sleep latency (r = 0.412 [0.101, 0.649]), sleep disturbances (r = 0.405 [0.094, 0.645]), daytime dysfunction (r = 0.503 [0.214, 0.711]), the four dimensions of Pittsburgh Sleep Quality Index (PSQI), while no significant correlation was found in the other three PSQI dimensions. Conclusion Depression had a moderate correlation with sleep quality in patients with SLE. Patients with poor sleep quality tended to have higher level of depression than that of good sleepers. Awareness of the correlation may help rheumatology physicians and nurses to assess and prevent depression and improve sleep quality in patients with SLE.

We conducted a cross-sectional study with 350 gout patients to investigate serum urate acid (sUA) goal attainment (sUA < 360 μmol/L) and associated factors in Chinese gout patients in the Affiliated Hospital of Nantong University from August 2015 to September 2017. Descriptive statistics, health assessment questionnaire, global visual analog scale for general health and Gout Knowledge Questionnaire were calculated comparing patients at sUA goal or not at sUA goal. Univariate analysis and logistic regression models were applied to analyze data. The proportion of urate-lowering therapy (ULT) use was 61.2% (211/350). The mean ± standard deviation sUA of the participants was 475.07 ± 121.53 μmol/L. Only 17.4% of gout patients attain the serum urate goal, which also means 289(82.6%) patients cannot keep their sUA below the target of 360 μmol/L. The factors associated with sUA goal attainment including age, education level and ULT use. Among these, age, waist hip ratio, ULT, family history of cardiovascular disease was the predictor of sUA goal attainment. In conclusion, more than 80% of gout patients did not achieve sUA goal. Younger and fatter patients were more difficult to control the serum urate level.

COVID-19 as a pandemic disease, till 18 May 2020, has infected more than 84,494 people in China and 4721,051 abroad. While countries around the world concentrate on controlling the pandemic to minimize damage to this country, the positive psychology brought to nurses and general public (GP) by COVID-19 should not be ignored. This study aims to assess post-traumatic growth (PTG) of Chinese nurses and GP during the COVID-19 pandemic. The study employed PTG in Chinese nurses and GP with Posttraumatic growth inventory questionnaire (PTGI) via a mobile app-based questionnaire, anxiety and ways to copy with stress in nurses were also employed. A total of 455 nurses and 424 GP were included in the statistical analysis. Results indicated that score of total PTGI and three dimensions, new possibilities, personal strength and spiritual change, were different between nurses and GP. Furthermore, score of total PTGI and all domains were significantly different between 178 front-line nurses (FLNs) and 277 non-front-line nurses (nFLNs). Importantly, sex, marriage status, professional titles, fertility, anxiety and ways to copy with stress were associated with PTG in nurses. Moreover, marriage status and ways to copy with stress were the predictors of PTG in nurses. Interestingly, this study found that WeChat network psychological counseling and phone app of application self-relaxation were good and effective coping strategies for nurses to relieve stress. Thus, the development of valid intervention programs for nurses to diminish job burnout and increase care quality was also important.

BackgroundThe prevalence of inter-nurse lateral violence (LV) reported in current studies is inconsistent, ranging from 7% to 83%. The purpose of this study is to quantify the prevalence of LV in nurses’ workplaces.MethodsSystematic review and meta-analysis. Cochrane, PubMed, Embase, CINAHL, CNKI and Wanfang databases were searched for relevant studies (up to 27 January 2021). We included cross-sectional, case–control or cohort studies in which both abusers and victims were nurses. Studies that did not provide specific data on abusers were excluded. Stata V.16.0 was used for statistical analysis. Fixed-effect or random-effect model was adopted according to heterogeneity, which was evaluated by Cochran’s Q and I2 values. The main indicator was LV prevalence. Sensitivity analysis, subgroup analysis and meta-regression were performed to investigate the sources of heterogeneity.ResultsA total of 14 studies with 6124 nurses were included. Further, 13 articles with 5745 nurses were included in the meta-analysis, and the pooled prevalence of LV among nurses was 33.08% (95% CI: 23.41% to 42.75%, pI2=99.0%). The remaining one study containing 370 samples reported that the prevalence of inter-nurse LV was 7.92%. Subgroup analysis showed that region, sample size, sampling, study’s quality, response rate and publication time might not be the sources of heterogeneity. Meta-regression indicated that sample size had the main influence on model heterogeneity. Egger’s test showed the existence of publication bias (p=0.03).DiscussionThe prevalence of inter-nurse LV is high in nurse workplace. It is suggested that scholars pay more attention to the cultural differences of inter-nurse LV between regions in the future. This study has the following limitations: there is a lack of studies on LV prevalence in many countries; lack of standard assessment tools; no grey literature was searched.

Supplemental material, Author_response_1 for Circulating angiopoietin-2 and the risk of mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis of 10 prospective cohort studies by Fengyuan Li, Rulan Yin and Qiang Guo in Therapeutic Advances in Respiratory Disease

Supplemental material, PRISMA-2009-Flow-Diagram-MS-Word for Circulating angiopoietin-2 and the risk of mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis of 10 prospective cohort studies by Fengyuan Li, Rulan Yin and Qiang Guo in Therapeutic Advances in Respiratory Disease

Supplemental material, Reviewer_2_v.1 for Circulating angiopoietin-2 and the risk of mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis of 10 prospective cohort studies by Fengyuan Li, Rulan Yin and Qiang Guo in Therapeutic Advances in Respiratory Disease

Supplemental material, PRISMA-2009-Checklist-MS-Word for Circulating angiopoietin-2 and the risk of mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis of 10 prospective cohort studies by Fengyuan Li, Rulan Yin and Qiang Guo in Therapeutic Advances in Respiratory Disease

Supplemental material, Supplement_Materials_1 for Circulating angiopoietin-2 and the risk of mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis of 10 prospective cohort studies by Fengyuan Li, Rulan Yin and Qiang Guo in Therapeutic Advances in Respiratory Disease

The aim of this study was to assess adherence rate and predictors of non-adherence with urate-lowering therapy (ULT) in Chinese gout patients. A cross-sectional study was administered to 125 gout patients using the Compliance Questionnaire on Rheumatology (CQR) for adherence to ULT. Patients were asked to complete the Treatment Satisfaction Questionnaire for Medication version II, Health Assessment Questionnaire, Confidence in Gout Treatment Questionnaire, Gout Knowledge Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and 36-Item Short Form Health Survey. Data were analyzed by independent sample t test, rank sum test, Chi-square analysis as well as binary stepwise logistic regression modeling. The data showed that the rate of adherence (CQR ≥80%) to ULT was 9.6% in our investigated gout patients. Adherence was associated with functional capacity, gout-related knowledge, satisfaction with medication, confidence in gout treatment and mental components summary. Multivariable analysis of binary stepwise logistic regression identified gout-related knowledge and satisfaction of effectiveness with medication was the independent risk factors of medication non-adherence. Patients unaware of gout-related knowledge, or with low satisfaction of effectiveness with medication, were more likely not to adhere to ULT. Non-adherence to ULT among gout patients is exceedingly common, particularly in patients unaware of gout-related knowledge, or with low satisfaction of effectiveness with medication. These findings could help medical personnel develop useful interventions to improve gout patients' medication adherence.

Background There have been no previous report of hand joint destruction prevalence in Chinese rheumatoid arthritis (RA) patients. Therefore, the aim of this study was to investigate the prevalence and potential factors of hand joint destruction among RA patients from Nantong China. In addition, we wanted to examine the differences between functional capacity, psychological status, and quality of life in patients with hand joint destruction compared to those without hand joint destruction. Methods A cross-sectional study was conducted from the Affiliated Hospital of Nantong University between July 2015 and June 2016. RA patients completed questionnaires for demographic or clinical variables, the 10-cm Visual Analog Scale for pain, the 28-joint Disease Activity Score-erythrocyte sedimentation rate for disease activity, the Health Assessment Questionnaire-disability index for physical function, the Hospital Anxiety and Depression Scale for anxiety and depression, and the Short Form 36 health survey for quality of life. Laboratory examinations were taken to obtain some biochemical indicators (e.g., rheumatoid factor, anti-cyclic citrullinated peptide antibody). X-ray assessment of hand was performed and hand joint destruction was defined as Sharp score > 0. Independent sample t-test, Mann–Whitney U-test, Chi-square test, and multivariate analysis using backward stepwise logistic regression model were used to analyze these data. Results One hundred and sixty-one RA patients were included in this study. Radiographic findings revealed that almost 47.2% (n = 76) of patients had hand joint destruction. Multivariate analysis found that education ≤ 9 years (p = 0.041), anti-cyclic citrullinated peptide antibody positive (p = 0.021), high disease activity (p = 0.020), and long disease duration (p

Background As an important outcome measure among rheumatoid arthritis (RA) patients, functional disability may contribute to unemployment, loss of work productivity, and impaired quality of life. However, little is known about the risk factors of functional disability in Chinese RA patients. This study aimed (1) to examine the prevalence of functional disability in Chinese RA patients; (2) to explore factors associated with the health assessment questionnaire-disability index (HAQ-DI). Methods A total of 101 RA patients in this cross-sectional study underwent standardized laboratory examinations and responded to the questionnaire for demographic data, the HAQ-DI for functional disability, the Compliance Questionnaire on Rheumatology (CQR) for medication adherence, the Hospital Anxiety and Depression Scale (HADS) for psychological status, and the Short Form 36 health survey (SF-36) for quality of life. Pain, grip/pinch strength, disease activity, and large joint mobility were recorded. Independent samples t-tests, chi-square analyses, and logistic regression modeling were used to analyze the data. Results The mean ± SD age of RA patients was 54.9 ± 11.9 years. Approximately 15.8% RA patients in mainland China experience functional disability (defined as a HAQ-DI score ≥ 1). Long disease duration, pain, high disease activity, a larger number of tender and swollen joints, high C-reactive protein (CRP) level, decreased grip strength, and limitation of shoulder, elbow, wrist, knee, and ankle motion were associated with the HAQ-DI. Participants with functional disability tended to have more severe depressive symptoms and a lower quality of life compared with individuals without functional disability. Stepwise logistic regression analyses found that limitation of wrist extension (P = 0.001) and lower body pain (BP) score (P = 0.001) explained higher HAQ-DI score. Conclusions The present study reported that functional disability was common in Chinese RA patients. A low quality of life and limitation of joint mobility had great impacts on functional disability in Chinese RA patients. Targeted and culturally sensitive interventions should be strengthened to delay the onset of disabilities of this population.

The aim of this study was to determine the effects of psychological interventions (e.g. cognitive restructuring, relaxation) on physiological and psychological health in osteoarthritis patients. A systematic literature search was done using PubMed, Embase, PsycINFO, Web of Science, China National Knowledge Infrastructure, and Wanfang Database through November 2016. Studies were included if they used a randomized controlled trial designed to explore the effects of psychological interventions in osteoarthritis patients. Two independent authors assessed the methodological quality of the trials using criteria outlined by Jadad et al. Meta-analysis was done with the Revman5.0. Twelve randomized controlled trials, including 1307 osteoarthritis patients, met the study inclusion criteria. Meta-analysis showed that psychological interventions could reduce the levels of pain [standard mean difference (SMD) -0.28, 95% CI -0.48, -0.08, P-value 0.005)] and fatigue (SMD -0.18, 95% CI -0.34, -0.01, P-value 0.04). In addition, psychological interventions significantly improved osteoarthritis patients' self-efficacy (SMD 0.58, 95% CI 0.40, 0.75, P-value 0.00) and pain coping (MD 1.64, 95% CI 0.03, 3.25, P-value 0.05). Although the effects on physical function, anxiety, depression, psychological disability were in the expected direction, they were not statistically significant. In conclusion, the role of psychological interventions in the management of osteoarthritis remains equivocal. Some encouraging results were seen with regard to pain, pain coping, self-efficacy, and fatigue. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.

Background:Angiopoietin-2 (Ang-2), as one of the ligands of endothelial receptor Tie2, is known to be significant for vessel maturation and stabilization after birth. Previous studies showed the relationship between Ang-2 level and the risk of mortality in patients with acute respiratory distress syndrome (ARDS). However, the link between circulating Ang-2 and the risk of mortality in patients with ARDS varied in different investigations.Results:We performed a systematic review and meta-analysis of all available cohort studies regarding the association between baseline circulating Ang-2 and mortality in patients with ARDS. Among the 10 eligible studies, pooled odds ratio (OR) showed that high Ang-2 level contributed to ARDS mortality [OR = 1.56, 95% confidence interval (CI): 1.30–1.89, I2 = 76.2%]. Stratified analysis revealed that higher circulating Ang-2 was related to a 30% higher risk in the high-quality scores group (OR = 1.68, 95% CI: 1.33–2.68, I2 = 62.4%). The I2of the bad compliance group decreased from 76.2% to 8.5%, which suggested that compliance is a significant source of heterogeneity. This association may be blunted by potential bias, although the results was not meaningfully changed by omitting only one study at a time. Further subgroup analysis and meta-regression support that compliance of patients also affects the results significantly, compared with the publication year, follow-up duration, the samples, or population characteristics.Conclusion:Participants with higher baseline Ang-2 were at a higher risk for future risk of mortality in patients with ARDS. Higher circulating Ang-2 levels could independently predict the risk of mortality in patients with ARDS. However, further large scale prospective cohorts or even interventional studies are warranted to evaluate the diagnostic power of Ang-2 and its causative role on ARDS outcome. The reviews of this paper are available via the supplemental material section.

Background The wrist is often severely affected in rheumatoid arthritis (RA) patients; however, little is known about the potential risk factors of the reduced wrist range of motion. In this study, we explored a broad range of possible risk factors of wrist range of motion in RA patients. We also determined whether measurements of wrist range of motion reflect Sharp score for the wrists. Methods Active wrist volar flexion, dorsal flexion, radial deviation and ulnar deviation were assessed using a goniometer. RA patients underwent standardized laboratory and radiographic examinations and completed several questionnaires. A linear regression model was used to study association between the wrist range of motion and independent variables. In addition, Spearman and Pearson correlation analysis were used to compare influence factors and outcome measurements between the measurements of wrist range of motion and Sharp score for the wrists. Results In this study, lower socioeconomic status, longer disease duration, severe pain, higher disease activity and drug treatments were associated with reduced wrist range of motion in RA patients (n = 102, 86.3% female, mean ± SD age, 55.0 ± 11.7 years, and mean ± SD disease duration, 8.4 ± 8.7 years). Furthermore, wrist range of motion was highly correlated with Sharp score for the wrists (P

Background Gout is a painful, inflammatory disease that may cause decreased function and health-related quality of life (HRQoL). Limited study did not take the influence of gout characteristics and anxiety on HRQoL into consideration and there are no studies associated with functional disability in individuals with gout from China. This study aims to investigate the related factors of functional disability and HRQoL in gout patients recruited from China. Methods A total of 226 consecutive gout patients and 232 age- and gender-matched healthy individuals were involved in the study. A series of questionnaires (the Short Form 36 health survey, the Patient Health Questionnaire, the Generalized Anxiety Disorder questionnaire, the 10 cm Visual Analog Scale, and the Health Assessment Questionnaire-Disability Index) were applied. Blood samples were taken to examine the level of serum uric acid. Independent samples t-tests, Chi square tests, U test, Spearman rank correlation, logistic regression modeling, and linear regression were used to analyze the data. Results After adjusted demographic variables, individuals with gout have poorer HRQoL compared to healthy controls. Univariate tests presented that patients with functional disability had longer disease duration, more frequent flares/last year, more severe total pain, more number of tophi, higher degree of depression and anxiety, with a trend toward diabetes, the treatment of colchicine and corticosteroids use, compared to patients without functional disability. Meanwhile, place of residence, hypertension, DM, disease duration, cardiovascular disease, number of flares/last year, total pain, more number of tophi, presence of tender joints, depression, anxiety, currently using colchicine and corticosteroids were correlated significantly with HRQoL. Additionally, multiple regression analysis identified severe pain, depression, and colchicine use as predictors of functional disability. Cardiovascular disease, total pain, number of flares/last year, presence of tender joints, depression, anxiety, colchicine and corticosteroids use contributed to low HRQoL. Conclusions After adjusted demographic variables, gout subjects have poorer HRQoL compared to healthy controls. Chinese gout population experiencing poor HRQoL and functional disability were likely to suffer from gout-related features and psychological problems. The results underscore the need of effective interventions including psychological nursing and appropriate treatment approaches to reduce their functional disability and improve their HRQoL.

This study aims to evaluate the prevalence of depression and anxiety and investigate the potential risk factors for depression and anxiety in Chinese gout patients. A self-report survey was administered to 226 gout patients and 232 age- and gender-matched healthy individuals. Patients were asked to complete a set of standardized self-report questionnaires. Univariate and mutiple regression were used to analyze the data. We found 15.0% of gout patients had depression, and 5.3% had anxiety. After adjusted demographic variables, the prevalence of depression was significantly higher than the healthy controls (6.0%). There were significant correlations among education, total pain, disease duration, stage of gout, functional disability, number of tophi, number of flares/last year, presence of tender joints, nephropathy comorbidity, health-related quality of life (HRQoL), and psychological status. Meanwhile, logistic regression analysis identified number of tophi, functional disability, and mental component summary (MCS) as predictors of depression in gout patients. Education and MCS were significantly accounted for anxiety. In summary, the prevalence of depressive symptoms among gout patients was higher than healthy individuals. Education, disability, tophi and HRQoL were important risk factors linked to depression/anxiety in Chinese gout population.

OBJECTIVE Disease activity of rheumatoid arthritis (RA) patients was often measured by the 28-joint count disease activity score (DAS-28), which consists of 28 swollen and tender joint counts, patient's assessment of disease activity (visual analog scale [VAS]) and erythrocyte sedimentation rate. C-reactive protein was also used to measure disease activity in RA patients. The aim was to explore the impact of medication adherence on disease activity in patients with RA. METHODS A systematic search was performed in major electronic databases (PubMed, Web of Science, the Cochrane Library, CNKI, VIP and Wan fang) to identify studies reporting medication adherence and disease activity in RA patients. Results were expressed as mean difference (MD) and 95% CI. RESULTS A total of seven identified studies matched the inclusion criteria, reporting on a total of 1,963 adult RA patients in the analysis. The total score of DAS-28 was significantly lower in adherent patients than in nonadherent subjects (MD =-0.42, 95% CI [-0.80, -0.03], P=0.03). Similarly, a significant difference was observed between medication adherent and nonadherent groups in erythrocyte sedimentation rate (MD =-7.39, 95% CI [-11.69, -3.08], P

There is substantial uncertainty regarding the prevalence of depression in Primary Sjögren's syndrome (pSS). We conducted a systematic review aiming to evaluate the association of pSS with depression. PubMed, Web of Science, VIP, CNKI and Wanfang database were searched to find the published literatures (from these databases established to October 2016). Studies were screened according to inclusion and exclusion criteria and the qualities of included studies were evaluated. The data was analyzed using Revman5.2 software. A total of 12 studies including 1917 patients were eligible for inclusion in the systematic review and meta-analysis. In this meta-analysis, Severity of depression was assessed using psychometric measures, such as PHQ-9; HADS; CES-D; Zung depression scale and BDI. The result revealed that pSS was associated with an increased prevalence of depression (summary odds ratio (OR) = 5.36, 95% CI: 4.05-7.09, P 0.01). The depression score in pSS patients (standardized mean difference (SMD) = 1.47, 95% CI: 0.81-2.12, P 0.01) were higher than in the control group. Depression is highly prevalent in pSS than in healthy controls. Early recognition and appropriate intervention are therefore essential to reduce the negative impact of depression on the patient's quality of life and outcome of their disease.

Background Gout is a chronic rheumatic disease caused by deposition of monosodium urate crystals in and around the joint, with a reported prevalence of 1.1% in mainland China and 6.24% in Taiwan, making it the most common form of inflammatory arthritis. With the disease progression, gout can cause permanent joint destruction, bone erosion, and organ damage. Urate-lowering therapy (ULT) is necessary to lower and maintain serum urate (sUA) levels at a therapeutic target of Objectives The current study aimed to investigate knowledge related to gout and it9s risk factors, and the relationship with adherence to urate-lowering therapy in patients with gout in east China. Methods A cross-sectional study of 229 gout patients recruited from the Affiliated Hospital of Nantong University between August 2015 and November 2016 was conducted with two questionnaire, Gout Knowledge Questionnaire (GKQ) and Compliance Questionnaire on Rheumatology (CQR). Chi-square analysis, t-test, rank sum test, as well as logistic regression analysis were used to analyze data. Results 21.5% (49/228) of gout patients in east China had knowledge of gout, and 9.1% (13/143) adhered to ULT. Age, employment, income, alcohol use, family history, acute flares in preceding 1 year, and colchicine use were associated with awareness of gout-related knowledge, and age, income, alcohol use, and colchicine use were the predictors. Among patients with ULT, patients adherent to ULT tended to have gout-related knowledge, compared with non-adherent patients. Awareness of the cause of gout attack, flare prevention induced by ULT and comorbidity were correlated with medication adherence, and the cause of gout attack as well as flare prevention induced by ULT were predictors of adherence to ULT in gout patients in east China. Conclusions In this study, 78.5% of patients in east China didn9t have gout-related knowledge. Patients9 knowledge on gout is a significant independent determinant of adherence to ULT. Acknowledgements This study was supported by grants from the Cultivative Distinguished Young Scholars Project of Nantong University (2nd);the 2015 Graduate Innovation Project of Nantong University (YKC15075); and College graduate research and innovation of Jiangsu Province (KYZZ15–0353). Disclosure of Interest None declared

Background Poor sleep quality is common in patients with chronic diseases and may lead to disease aggravation and decreased quality of life. The increasing prevalence of poor sleep in individuals with chronic medical conditions is associated with adverse demographic, clinical, and psychological characteristics. However, there are currently no known reported studies related to the sleep quality of gout patients. Objectives This study aims to evaluate the prevalence of poor sleep quality and investigate the contributors of poor sleep in Chinese gout patients. Methods A self-report survey was administered to 226 gout patients and 232 healthy individuals using the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, the Patient Health Questionnaire (PHQ-9) for depression, and the Generalized Anxiety Disorder (GAD-7) questionnaire for anxiety. Gout patients completed the 10 cm Visual Analog Scale (VAS) for total pain, and the Health Assessment Questionnaire-Disability Index (HAQ-DI) for functional capacity. Blood samples were taken to examine the level of uric acid (UA). Independent samples t-tests, Chi square analyses, and logistic regression were used to analyze the data. Results Our results found that the prevalence of poor sleep (PSQI≥5) was 55.3% and the mean global score of PSQI was 6.69 (SD 3.48) in patients, which were significantly higher than the controls (17.7% and 3.83 (SD 1.88), respectively). There were significant correlations among alcohol use, HAQ-DI, PHQ-9, GAD-7 and sleep quality in gout patients. Patients with yellow rice wine and wine use preferred to have better sleep quality. While, disease stage was associated with hypertension, total pain, number of tophi, presence of tender joints and swollen joints. Meanwhile, logistic regression models identified alcohol use and depression as predictors of poor sleep quality. Conclusions More than half of Chinese gout population suffered from poor sleep, which significantly higher than healthy individuals. These findings suggested medical personnel should pay more attention to the sleep quality of gout patients, especially those with depression. Additionally, it is beneficial for the patients with normal UA level to take moderate yellow rice wine and wine to improve their sleep quality. Acknowledgements This study was supported by Grants from the Chinese National Natural Science Foundation (no. 81671616 and 81471603). Disclosure of Interest None declared

Background Depression and anxiety are common worldwide and may lead to disease aggravation and decreased health-related quality of life (HRQoL). The increasing prevalence of depression and anxiety in gout patients is associated with demographic and gout characteristics. However, there are currently no known reported studies related to the association between HRQoL and depression/anxiety. Objectives This cross-sectional study aims to evaluate the prevalence of depression and anxiety and investigate the potential risk factors for depression and anxiety in Chinese gout patients. Methods A self-report survey was administered to 193 gout patients and 208 healthy individuals from September 2015 to September 2016. Patients were asked to complete a set of standardized self-report questionnaires [Visual Analog Scale (VAS), Health Assessment Questionnaire-Disability Index (HAQ-DI), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) questionnaire, Short Form 36 health survey (SF-36)]. Independent samples t-tests, χ2 analyses, and logistic regression were used to analyze the data. Results We found 15% of gout patients had depression, and 5.2% had anxiety, which were significantly higher than the healthy controls (1.4 and 1.0%, respectively). There were significant correlations among education, pain, disease duration, stage of gout, disability, number of tophi, presence of tender joints, HRQoL, and psychological status. Meanwhile, logistic regression analysis identified number of tophi, HAQ-DI, and MH scale as predictors of depression in gout patients. Education, GH, and VT domains were significantly accounted for anxiety. Conclusions The prevalence of depressive and anxious symptoms among gout patients was higher than healthy individuals. Education, disability, tophi and HRQoL were important risk factors linked to this disorder in Chinese gout population. These findings suggested medical personnel should pay more attention to the psychological health of gout patients and make objective interventions to relieve their depression and anxiety, especially those with low education level, more than two tophi, severe disability, and poor HRQoL. Acknowledgements This study was supported by Grants from the Chinese National Natural Science Foundation (no. 81671616 and 81471603). Disclosure of Interest None declared

Background As the most common arthritis in adults, gout is a painful, inflammatory disease that may cause functional disability and decreased health-related quality of life (HRQoL). However, there are currently no known reported studies related to functional disability and HRQoL of gout patients from China. Objectives This cross-sectional study aims to investigate the effect of demographic variables, disease parameters, and psychological status on functional disability and HRQoL of Chinese gout patients. Methods A self-report survey was administered to 226 gout patients and 232 healthy individuals using the Short Form 36 health survey (SF-36) for HRQoL and the Health Assessment Questionnaire-Disability Index (HAQ-DI) for functional disability. Gout patients were asked to complete the 10 cm Visual Analog Scale (VAS) for total pain, the Patient Health Questionnaire (PHQ-9) for depression, and the Generalized Anxiety Disorder (GAD-7) questionnaire for anxiety. Blood samples were taken to examine the level of uric acid (UA). Independent samples t-tests, Chi square tests, spearman and/or pearson correlation and multiple linear regression were used to analyze the data. Results Our results found that individuals with gout have poorer HRQoL compared to healthy controls and the mean disability score was 0.32 (SD 0.54), representing mild disability. SF-36 and almost all components of the SF-36 score were associated with place of residence, hypertension, DM, cardiovascular disease, disease duration, number of flares/last year, total pain, number of tophi, presence of tender joints, colchicines use, corticosteroids use, depression, and anxiety (p Conclusions Chinese gout patients experienced mild disability and poor HRQoL. Disease status and psychological status were important risk factors linked to functional disability and HRQoL in Chinese gout population. These data suggest medical personnel should pay more attention to functional disability and HRQoL of gout patients and make suitable interventions to relieve their psychological disorders and finally to reduce their functional ability and improve their HRQoL. Acknowledgements This study was supported by Grants from the Chinese National Natural Science Foundation (no. 81671616 and 81471603). Disclosure of Interest None declared

Background Gout, which is characterised by deposition of monosodium urate monohydrate (MSU) in synovial fluid and other tissues, is the most common form of inflammatory arthritis in man and older women. In addition to recurrent acute arthritis, subcutaneous tophi and chronic painful arthritis, gout also affects morbidity and premature mortality. Previous studies have reported that effective ULT can decrease sUA levels enough to prevent further crystal formation, dissolve existing urate crystals and eliminate the causative agent, thus reducing the frequency of acute gout attacks and preventing urate nephropathy, uric acid nephrolithiasis, and the deposition of tophi: a common cause of progressive joint damage, deformity and functional impairment, making gout the only chronic arthritis that can be “cured”. However, gout patents9 adherence rate to ULT is low, ranged from 10 to 46%. Emerging data suggest that poor adherence to long-term ULT use may be an important contributor to the suboptimal outcomes seen in gout and nonadherence may be worse in gout than in any other chronic disease. This suggests that there is a strong need to make a further study on drug adherence and its risk factors. Objectives Non-adherence in gout patients using urate-lowering therapy (ULT) may lead to joint destruction and permanent disability. Purpose of this cross-section survey was to explore Chinese gout patients9 adherence rates and investigate potential risk factors for medication non-adherence. Methods A total of 129 gout patients were recruited from the Affiliated Hospital of Nantong University from August 2015 to September 2016. Patients were asked to complete a standardized self-report questionnaires (Compliance Questionnaire on Rheumatology, Treatment Satisfaction Questionnaire for Medication version II, Health Assessment Questionnaire, Confidence in gout treatment questionnaire, Gout Knowledge Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and 36-Item Short Form Health Survey). Data was analyzed by independent sample t-test, rank sum test, chi-square analysis as well as logistic regression modeling. Results Based on CQR, 9.6% of gout patients were adherent to ULT. Adherence was associated with HAQ, GKQ, treatment satisfaction for medication, confidence in gout treatment and MCS. Other demographic, clinical and psychological characteristics were not related to adherence. Logistic regression models identified HAQ, GKQ and MCS as predictors of medication non-adherence. Conclusions In the current study, 90.4% of gout patients didn9t adhere to their ULT prescription. HAQ, GKQ, treatment satisfaction for medication, confidence in gout treatment and MCS were relevant to medication adherence, and HAQ, GKQ and MCS were independent predictors of medication non-adherence in patients with gout. These findings could help medical personnel develop useful interventions to improve gout patients9 medication adherence and quality of life. Acknowledgements This study was supported by grants from the Cultivative Distinguished Young Scholars Project of Nantong University (2nd); the 2015 Graduate Innovation Project of Nantong University (YKC15075); and College graduate research and innovation of Jiangsu Province (KYZZ15–0353). Disclosure of Interest None declared

Background There have been no previous report of hand joint destruction prevalence in Chinese rheumatoid arthritis (RA) patients. Therefore, the aim of this study was to investigate the prevalence and potential factors of hand joint destruction among RA patients from Nantong China. In addition, we wanted to examine the differences between functional capacity, psychological status, and quality of life in patients with hand joint destruction compared to those without hand joint destruction. Methods A cross-sectional study was conducted from the Affiliated Hospital of Nantong University between July 2015 and June 2016. RA patients completed questionnaires for demographic or clinical variables, the 10-cm Visual Analog Scale for pain, the 28-joint Disease Activity Score-erythrocyte sedimentation rate for disease activity, the Health Assessment Questionnaire-disability index for physical function, the Hospital Anxiety and Depression Scale for anxiety and depression, and the Short Form 36 health survey for quality of life. Laboratory examinations were taken to obtain some biochemical indicators (e.g., rheumatoid factor, anti-cyclic citrullinated peptide antibody). X-ray assessment of hand was performed and hand joint destruction was defined as Sharp score > 0. Independent sample t-test, Mann–Whitney U-test, Chi-square test, and multivariate analysis using backward stepwise logistic regression model were used to analyze these data. Results One hundred and sixty-one RA patients were included in this study. Radiographic findings revealed that almost 47.2% (n = 76) of patients had hand joint destruction. Multivariate analysis found that education ≤ 9 years (p = 0.041), anti-cyclic citrullinated peptide antibody positive (p = 0.021), high disease activity (p = 0.020), and long disease duration (p

Summaries of symptom thresholds required for diagnosis of depression/anxiety. (DOCX 19 kb)

The list of 59 studies included in the meta-analysis. (DOCX 19 kb)

Quality Assessment. (DOCX 19 kb)

Assessment of Publication Bias. (DOCX 56 kb)

Background Systemic lupus erythematosus (SLE) patients are at high risk for depression and anxiety. However, the estimated prevalence of these disorders varies substantially between studies. This systematic review aimed to establish pooled prevalence levels of depression and anxiety among adult SLE patients. Methods We systematically reviewed databases including PubMed, Embase, PsycINFO, and the Cochrane database library from their inception to August 2016. Studies presenting data on depression and/or anxiety in adult SLE patients and having a sample size of at least 60 patients were included. A random-effect meta-analysis was conducted on all eligible data. Results A total of 59 identified studies matched the inclusion criteria, reporting on a total of 10828 adult SLE patients. Thirty five and thirteen methods of defining depression and anxiety were reported, respectively. Meta-analyses revealed that the prevalence of major depression and anxiety were 24% (95% CI, 16%-31%, I2 = 95.2%) and 37% (95% CI, 12%–63%, I2 = 98.3%) according to clinical interviews. Prevalence estimates of depression were 30% (95% CI, 22%–38%, I2 = 91.6%) for the Hospital Anxiety and Depression Scale with thresholds of 8 and 39% (95% CI, 29%–49%, I2 = 88.2%) for the 21-Item Beck Depression Inventory with thresholds of 14, respectively. The main influence on depression prevalence was the publication years of the studies. In addition, the corresponding pooled prevalence was 40% (95% CI, 30%–49%, I2 = 93.0%) for anxiety according to the Hospital Anxiety and Depression Scale with a cutoff of 8 or more. Conclusions The prevalence of depression and anxiety was high in adult SLE patients. It indicated that rheumatologists should screen for depression and anxiety in their patients, and referred them to mental health providers in order to identify effective strategies for preventing and treating depression and anxiety among adult SLE patients. Trial registration Current Meta-analysis PROSPERO Registration Number: CRD 42016044125. Registered 4 August 2016. Electronic supplementary material The online version of this article (doi:10.1186/s12888-017-1234-1) contains supplementary material, which is available to authorized users.

Correlation coefficients between components of SF-36 and PSQI (Spearman rho). (DOC 58Â kb)

Introduction Reported adherence to urate-lowering therapy (ULT) in gout varies widely (17%–83.5%). Variability may partly be due to different adherence measurement methods. This review aimed to quantify ULT adherence in adult patients with gout. Methods This analysis examined studies in PubMed, Web of Science, CNKI Scholar and WanFang databases from inception to January 2017. Papers were selected by inclusion and exclusion criteria in the context. Random-effect meta-analysis estimated adherence. Results 22 studies were found by the inclusion criteria, which involved 1 37 699 patients with gout. Four ways to define adherence were reported. Meta-analysis revealed that the overall adherence rate was 47% (95% CI 42% to 52%, I 2 =99.7%). Adherence rate to ULT was 42% (95% CI 37% to 47%, I 2 =99.8%) for prescription claims, 71% (95% CI 63% to 79%) for pill count, 66% (95% CI 50% to 81%, I 2 =86.3%) for self-report and 63% (95% CI 42% to 83%, I 2 =82.9%) for interview, respectively. The influential factor on adherence rate was country of origin. Conclusions Among adult patients with gout, overall adherence rate to ULT was as low as 47%, which suggested that clinicians should pay more attention to medication adherence in patients with gout to effectively improve adherence to ULT.

The aim of this meta-analysis was to evaluate the effect of telephone-based interventions on prognostic outcomes and health-related quality of life (HRQoL) in breast cancer patients and survivors. A systematic search of the Cochrane Library, Web of science, Medline, EMBASE, CNKI and CBM database was carried out. Randomised, controlled trials (RCTs) examining the effects of telephone-based intervention versus a control group receiving no telephone intervention, on prognostic outcomes and HRQoL with breast cancer were included. A meta-analysis was conducted to quantify the effects of telephone-based interventions on anxiety, depression, fatigue, self-efficiency, physiological function, social-domestic function and quality of life. In total, 14 studies involving 2002 participants were included. Due to the effect of telephone-based interventions, statistically significant results were found on anxiety (standard mean difference [SMD] = −0.16, 95% confidence intervals [CI] [0.01, 0.30], p = .04), self-efficiency (SMD = 0.22, 95% CI [−0.34, −0.10], p = .0004), social-domestic function (SMD = 0.19, 95% CI [−0.35, −0.03], p = .02) and quality of life (SMD = 0.54, 95% CI [−1.00, −0.08], p = .02). Although the effects on depression, fatigue and physiological function were in the expected direction, these effects were not statistically significant (p > .05) based on the insufficient evidence.

Yunfei Xia,1,* Rulan Yin,1,2,* Ting Fu,1,2 Lijuan Zhang,1,2 Qiuxiang Zhang,1,2 Genkai Guo,1 Liren Li,2 Zhifeng Gu11Department of Rheumatology, Affiliated Hospital of Nantong University, 2School of Nursing, Nantong University, Nantong, People’s Republic of China *These authors contributed equally tothis work Objective: Nonadherence in rheumatoid arthritis (RA) patients using disease-modifying antirheumatic drugs (DMARDs) may lead to joint damage and function loss. The aim of this cross-sectional study was to explore Chinese RA patients’ adherence rates and investigate potential risk factors for nonadherence.Methods: A total of 122 RA patients were recruited from the Affiliated Hospital of Nantong University from January 2014 to April 2015. Patients were asked to complete a set of standardized self-report questionnaires (Compliance Questionnaire on Rheumatology, Health Assessment Questionnaire, Short Form-36 questionnaire, 28-joint Disease Activity Score, Hospital Anxiety and Depression Scale, and Visual Analog Scale). Independent samples t-tests, chi-square analyses, and logistic regression modeling were used to analyze these data.Results: Based on Compliance Questionnaire on Rheumatology, 38% of the patients adhered to DMARDs. Adherence was associated with education, income, depression, and the total number of DMARDs. Other demographic and clinical characteristics were not associated with adherence. Logistic regression models identified income, depression, and the total number of DMARDs as predictors of medication nonadherence.Conclusion: In this study, 62% of patients with RA were not adherent to their DMARD prescription. Education, income, depression, and the total number of DMARDs were associated with medication adherence, and income, depression, and the total number of DMARDs were independent predictors of medication adherence in patients with RA. These findings could help medical personnel develop helpful interventions to improve adherence in RA patients by paying more attention to the patients with theseaccompanyingrisk factors and, finally, improve RA patients’ quality of life.Keywords: rheumatoid arthritis, disease-modifying antirheumatic drugs, adherence