{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T16:52:05Z","timestamp":1767372725052,"version":"build-2065373602"},"reference-count":52,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,2,6]],"date-time":"2019-02-06T00:00:00Z","timestamp":1549411200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"The Cornell Brewer Foundation"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether sleep disturbance and symptoms of depression mediate the relationship between pain and cognitive dysfunction (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>) in a sample of 115 patients with systemic lupus erythematosus (<jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 115 patients with <jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content> completed questionnaires regarding pain, perceived stress, depression, sleep, and <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>. Relationships among pain, sleep, depression, and <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> were assessed using bootstrap mediation models, controlling for race\/ethnicity, fibromyalgia diagnosis, current corticosteroid use, disease activity and damage, and perceived stress.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mediation analyses indicated that the effect of pain on <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> was mediated by sleep disturbance (\u03b2 = 0.30) and depression symptoms (\u03b2 = 0.33). These effects were maintained even after controlling for the aforementioned covariates, of which only disease activity (\u03b2 = 0.20) and stress (\u03b2 = 0.22) remained significantly linked to <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> (overall model R<jats:sup>2<\/jats:sup> = 0.53; all <jats:italic>P<\/jats:italic> &lt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>After controlling for disease activity and perceived stress, the relationship between pain and <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> was explained by sleep disturbance and depression symptoms. Although these relationships need validation in longitudinal studies with additional measurement modalities, our findings may indicate promising, nonpharmacologic intervention avenues for <jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content> patients with pain and <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>. Specifically, cognitive behavioral therapies for depression and sleep are known to reduce distress and enhance functioning across various psychosocial domains. Given the symptom burden of <jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content>, interventions that maximize potential benefits without the use of additional pharmacologic treatments may be of particular utility.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23593","type":"journal-article","created":{"date-parts":[[2018,5,4]],"date-time":"2018-05-04T07:22:19Z","timestamp":1525418539000},"page":"406-412","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Sleep Disturbance and Depression Symptoms Mediate Relationship Between Pain and Cognitive Dysfunction in Lupus"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3979-0439","authenticated-orcid":false,"given":"Teresa A.","family":"Lillis","sequence":"first","affiliation":[{"name":"Rush University Medical Center  Chicago Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Tirone","sequence":"additional","affiliation":[{"name":"Rush University Medical Center  Chicago Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nisarg","family":"Gandhi","sequence":"additional","affiliation":[{"name":"John H. 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