Background/Purpose: Childhood-onset systemic lupus erythematosus (cSLE) is associated with fatigue, pain, and depressive symptoms that adversely impact health-related quality of life. The Treatment and Education Approach for Childhood-Onset Lupus (TEACH), a 6-week cognitive behavioral intervention, has been shown to reduce fatigue and depressive symptoms in pilot testing. Therefore, we worked with a patient/caregiver co-investigative team to adapt TEACH into a remote intervention. This ongoing multisite trial examines whether the remotely delivered TEACH program is feasible, and explores the effect of TEACH on fatigue, depressive symptoms, and pain compared to standard medical treatment after eight and twenty weeks. The present study examines interim results from participants who have completed the TEACH program.

Methods: We conducted a randomized controlled trial of TEACH. Youth ages 12-22 years meeting the ACR classification criteria for cSLE were referred to the study from 7 rheumatology sites across the U.S. and Canada, with 60 patients anticipated to complete the study. Referred patients were screened and were eligible for the study if they had clinical elevations in ≥1 domain using validated measures for fatigue (PROMIS Fatigue T-Score ≥ 60), average pain intensity (visual analog scale ≥ 3/10), and depressive symptoms (Childrens/Beck Depression Inventory T-Score ≥ 60, 90). Eligible participants were randomized to either 1) TEACH, delivered by a live provider over six weekly, one-hour zoom sessions and standard medical care; or 2) standard medical care alone over a period of six weeks. TEACH recruitment and retention rates were used to assess preliminary feasibility. Paired samples t-tests examined changes in symptoms for TEACH completers at post assessment 8 weeks and 20 weeks from baseline, respectively.

Results: Of the 188 patients referred and approached, 85 (45%) completed screening measures, with 63 (74%) qualifying and enrolling for the study. Retention of enrolled participants from baseline to post assessment was high (92%). At the 8-week post assessment, those who completed TEACH (current n = 26) showed significant reductions in fatigue (t(25) = 5.680, p 0.001, M_pre = 62.4 ± 7.4 M_post =53.5 ± 8.2) and improved mood symptoms (t(25) = 5.823, p 0.001, M_pre = 64.6 ± 11.2, M_post = 51.3 ± 9.5), and trending reductions in pain (t(25) = 1.805, p = 0.083, M_pre = 3.2 ± 2.0, M_post = 2.3 ± 1.8) at the post-assessment. At the 20-week follow-up assessment, TEACH completers (current n = 17), maintained significantly improved fatigue (t(16) = 2.757, p = 0.013, M_pre = 62.7 ± 8.2, M_follow-up = 56.4 ± 10.1) and mood (t(16) = 3.402, p = 0.003, M_pre = 61.5 ± 11.4, M_follow-up = 53.3 ± 11.7) symptoms from baseline.

Conclusion: To date, remotely delivered TEACH appears to be feasible as demonstrated by high retention rates. Preliminary analyses suggest TEACH is beneficial regarding symptom reduction which is maintained for 20 weeks for youth with cSLE. Future analyses upon the trials completion will determine whether TEACH is more beneficial than standard medical care alone.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/remotely-delivered-psychological-intervention-may-be-beneficial-to-youth-with-childhood-onset-lupus-a-preliminary-investigation/