Scholars@Duke
Kai Sun

Kai Sun

Associate Professor of Medicine
Medicine, Rheumatology and Immunology
kai.sun@duke.edu
DUMC 2978, Durham, NC 27710

Selected Publications

Racial differences in medication beliefs and adherence barriers among patients with systemic lupus erythematosus.

Journal Article Lupus · January 2026 IntroductionBlack patients with systemic lupus erythematosus (SLE) have lower medication adherence than White patients, contributing to worse health outcomes. However, racial differences in reasons for nonadherence and beliefs about medications are not wel ... Full text Open Access Link to item Cite

Relationship between hydroxychloroquine blood levels and lupus activity through the lens of the type 1 and type 2 lupus model: a cross-sectional study.

Journal Article Lupus Sci Med · June 30, 2025 INTRODUCTION: In the type 1 and 2 SLE model, inflammation mediates type 1 manifestations, but its role in type 2 manifestations (eg, fatigue, myalgias, mood disturbance, cognitive dysfunction) is less clear. Therapeutic hydroxychloroquine (HCQ) levels redu ... Full text Link to item Cite

THE ASSOCIATION BETWEEN TRAUMA AND QUALITY OF LIFE IN SLE.

Conference JOURNAL OF RHEUMATOLOGY · 2025 Cite

SOCIAL DRIVERS OF HEALTH IN A LARGE ACADEMIC LUPUS CLINIC

Conference JOURNAL OF RHEUMATOLOGY · 2025 Cite

Perspectives of Rheumatologists on the Type 1 and 2 Systemic Lupus Erythematosus Model.

Journal Article ACR Open Rheumatol · December 2024 OBJECTIVE: The Type 1 and 2 systemic lupus erythematosus (SLE) Model was developed to encapsulate all signs and symptoms that patients with SLE experience. Our previous qualitative work demonstrated the model accurately reflects the lived experience of peo ... Full text Open Access Link to item Cite

Using linked electronic medical record-pharmacy data to examine lupus medication adherence: A retrospective cohort study.

Journal Article Lupus · October 2024 INTRODUCTION: Medication nonadherence is common in systemic lupus erythematosus (SLE) and associated with morbidity and mortality. We explored the reliability of pharmacy data within the electronic medical record (EMR) to examine factors associated with no ... Full text Link to item Cite

ChatGPT4's proficiency in addressing patients' questions on systemic lupus erythematosus: a blinded comparative study with specialists.

Journal Article Rheumatology (Oxford) · September 1, 2024 OBJECTIVES: The efficacy of artificial intelligence (AI)-driven chatbots like ChatGPT4 in specialized medical consultations, particularly in rheumatology, remains underexplored. This study compares the proficiency of ChatGPT4' responses with practicing rhe ... Full text Link to item Cite

Implementation of a Clinician-led Medication Adherence Intervention Among Patients With Systemic Lupus Erythematosus.

Journal Article J Rheumatol · September 1, 2024 OBJECTIVE: Medication nonadherence in systemic lupus erythematosus (SLE) leads to poor clinical outcomes. We developed a clinician-led adherence intervention that involves reviewing real-time pharmacy refill data and using effective communication to addres ... Full text Open Access Link to item Cite

Patient and Physician Perspectives of Systemic Lupus Erythematosus Flare: A Qualitative Study.

Journal Article J Rheumatol · May 1, 2024 OBJECTIVE: Systemic lupus erythematosus (SLE) flares are associated with increased damage and decreased health-related quality of life. We hypothesized that there is discordance between physicians' and patients' views of SLE flare. In this study, we aimed ... Full text Link to item Cite

Interpreting hydroxychloroquine blood levels for medication non-adherence: a pharmacokinetic study.

Journal Article Lupus Sci Med · April 30, 2024 OBJECTIVE: Characterise the relationship between hydroxychloroquine (HCQ) blood levels and the number of missed doses, accounting for dosage, dose timing and the large variability in pharmacokinetics (PK) between patients. METHODS: We externally validated ... Full text Link to item Cite

Evaluation of Type 2 SLE symptoms in patients with a range of lupus nephritis activity.

Journal Article Clin Rheumatol · April 2024 BACKGROUND: Type 2 systemic lupus erythematosus (SLE) symptoms, including fatigue, fibromyalgia, and brain fog, contribute to poor health-related quality of life (HRQoL) in patients with lupus. To test the hypothesis that Type 1 (classical inflammatory lup ... Full text Link to item Cite

The Type 1 & 2 systemic lupus erythematosus model: Perspectives of people living with systemic lupus erythematosus.

Journal Article Lupus · March 2024 OBJECTIVE: In the new Type 1 & 2 model for systemic lupus erythematosus (SLE), Type 1 SLE represents classic inflammatory manifestations, such as arthritis, while Type 2 SLE encompasses symptoms such as pain and fatigue where the relationship to inflammati ... Full text Link to item Cite

A qualitative study of facilitators of medication adherence in systemic lupus erythematosus: Perspectives from rheumatology providers/staff and patients.

Journal Article Lupus · February 2024 OBJECTIVE: Systemic lupus erythematosus (SLE) disproportionately affects patients from racial and ethnic minority groups. Medication adherence is lower among these patient populations, and nonadherence is associated with worse health outcomes. We aimed to ... Full text Open Access Link to item Cite

The Influence of Trauma on Features of Type 2 SLE

Conference ARTHRITIS & RHEUMATOLOGY · 2024 Cite

Using PROMIS-29 to determine symptom burdens in the context of the Type 1 and 2 systemic lupus erythematosus (SLE) model: a cross sectional study.

Journal Article J Patient Rep Outcomes · December 21, 2023 OBJECTIVE: To account for heterogeneity in systemic lupus erythematosus (SLE) and bridge discrepancies between patient- and physician-perceived SLE activity, we developed the Type 1 and 2 SLE model. We examined PROMIS-29 scores, a composite patient-reporte ... Full text Link to item Cite

Development and psychometric evaluation of a physician global assessment for type 2 systemic lupus erythematosus symptoms.

Journal Article Lupus Sci Med · December 17, 2023 OBJECTIVE: Manifestations of SLE can be categorised as type 1 (classic signs and symptoms of SLE) or type 2 (fatigue, widespread pain and brain fog with an unclear relationship to inflammation). While measures of type 1 SLE activity exist, most current phy ... Full text Link to item Cite

The impact of pregnancy planning and medical readiness on reproductive outcomes in women with systemic lupus erythematosus.

Journal Article Lupus · December 2023 Women with systemic lupus erythematosus (SLE) who get pregnant while SLE is active or while on teratogens have higher risk of poor pregnancy outcomes. The American College of Rheumatology (ACR) Reproductive Health Guidelines recommend women conceive when S ... Full text Link to item Cite

Pilot Intervention to Improve Medication Adherence Among Patients With Systemic Lupus Erythematosus Using Pharmacy Refill Data.

Journal Article Arthritis Care Res (Hoboken) · March 2023 OBJECTIVE: Despite high rates of medication nonadherence among patients with systemic lupus erythematosus (SLE), effective interventions to improve adherence in SLE are limited. We aimed to assess the feasibility of a pilot intervention and explore its eff ... Full text Open Access Link to item Cite

Association of Hurried Communication and Low Patient Self-Efficacy With Persistent Nonadherence to Lupus Medications.

Conference Arthritis Care Res (Hoboken) · January 2023 OBJECTIVE: Medication nonadherence is common among patients with systemic lupus erythematosus (SLE), and adherence often fluctuates with time. Underrepresented racial minorities have disproportionately lower rates of medication adherence and more severe SL ... Full text Link to item Cite

Longitudinal Changes in Type 1 & Type 2 SLE Activity

Conference ARTHRITIS & RHEUMATOLOGY · 2023 Cite

Development and Initial Validation of a Systemic Lupus Erythematosus-Specific Measure of the Extent of and Reasons for Medication Nonadherence.

Journal Article J Rheumatol · December 2022 OBJECTIVE: Medication nonadherence is common in patients with systemic lupus erythematosus (SLE) and negatively affects outcomes. To better recognize and address nonadherence in this population, there is a need for an easily implementable tool with interpr ... Full text Link to item Cite

Barriers to Taking Medications for Systemic Lupus Erythematosus: A Qualitative Study of Racial Minority Patients, Lupus Providers, and Clinic Staff.

Journal Article Arthritis Care Res (Hoboken) · September 2022 OBJECTIVE: Underrepresented racial and ethnic minorities are disproportionately affected by systemic lupus erythematosus (SLE). Racial and ethnic minorities also have more severe SLE manifestations that require use of immunosuppressive medications, and oft ... Full text Open Access Link to item Cite

Intermittent and Persistent Type 2 lupus: patient perspectives on two distinct patterns of Type 2 SLE symptoms.

Journal Article Lupus Sci Med · August 2022 OBJECTIVE: We have developed a new conceptual model to characterise the signs and symptoms of SLE: the Type 1 and 2 SLE Model. Within the original model, Type 1 SLE consists of inflammatory manifestations like arthritis, nephritis and rashes; Type 2 SLE in ... Full text Link to item Cite

Association of Health Literacy and Numeracy With Lupus Knowledge and the Creation of the Lupus Knowledge Assessment Test.

Journal Article J Rheumatol · June 2022 OBJECTIVE: Limited health literacy and numeracy are associated with worse patient-reported outcomes and higher disease activity in systemic lupus erythematosus (SLE), but which factors may mediate this association is unknown. We sought to determine the ass ... Full text Link to item Cite

The use of patient-reported outcome measures to classify type 1 and 2 systemic lupus erythematosus activity.

Journal Article Lupus · May 2022 OBJECTIVE: We developed a model that categorizes systemic lupus erythematosus (SLE) activity into two dimensions: Type 1 SLE consists of inflammatory activity, including arthritis, nephritis, and rashes; Type 2 SLE includes fatigue, myalgia, mood disturban ... Full text Link to item Cite

Implementability of a SLE Medication Adherence Intervention

Conference ARTHRITIS & RHEUMATOLOGY · 2022 Cite

Racial Differences in Patient-provider Communication, Patient Self-efficacy, and Their Associations With Systemic Lupus Erythematosus-related Damage: A Cross-sectional Survey.

Journal Article J Rheumatol · July 2021 OBJECTIVE: Despite significant racial disparities in systemic lupus erythematosus (SLE) outcomes, few studies have examined how disparities may be perpetuated in clinical encounters. We aimed to explore associations between areas of clinical encounters - p ... Full text Open Access Link to item Cite

Implementation of a Health Literacy Intervention Improves Medication Adherence in Rheumatology Clinics

Journal Article SN Comprehensive Clinical Medicine · July 1, 2021 Health literacy is the degree to which individuals have the capacity to obtain, process, communicate, and understand basic health information and services needed to make health decisions effectively. Adequate health literacy is essential for the optimal ma ... Full text Cite

Using Clinical Characteristics and Patient-Reported Outcome Measures to Categorize Systemic Lupus Erythematosus Subtypes.

Journal Article Arthritis Care Res (Hoboken) · March 2021 OBJECTIVE: The type 1 and type 2 systemic lupus erythematosus (SLE) categorization system was recently proposed to validate the patients' perspective of disease and to capture a more comprehensive spectrum of symptoms. The objective of this study was to ch ... Full text Link to item Cite

Association of HCQ Blood Levels with Type 1 and 2 SLE Activity

Conference ARTHRITIS & RHEUMATOLOGY · 2021 Cite

Intervention to Improve SLE Medication Adherence

Conference ARTHRITIS & RHEUMATOLOGY · 2021 Cite

COVID-19 Vaccine Hesitancy in Rheumatology Patients

Conference ARTHRITIS & RHEUMATOLOGY · 2021 Cite

Racial Differences in Medication Beliefs Among SLE Patients

Conference ARTHRITIS & RHEUMATOLOGY · 2021 Cite

Association of Traditional Chinese Medicine Use With Adherence to Prescribed Western Rheumatic Medications Among Chinese American Patients: A Cross-Sectional Survey.

Journal Article Arthritis Care Res (Hoboken) · October 2020 OBJECTIVE: Chinese Americans are a fast-growing immigrant group with worse rheumatic disease outcomes compared to white populations and frequently use traditional Chinese medicine (TCM). Whether TCM use is associated with lower adherence to Western rheumat ... Full text Link to item Cite

Racial Disparities in Medication Adherence between African American and Caucasian Patients With Systemic Lupus Erythematosus and Their Associated Factors.

Journal Article ACR Open Rheumatol · July 2020 OBJECTIVE: Medication nonadherence is more common in African Americans compared with Caucasians. We examined the racial adherence gaps among patients with systemic lupus erythematosus (SLE) and explored factors associated with nonadherence. METHODS: Cross- ... Full text Open Access Link to item Cite

Is Traditional Chinese Medicine Use Associated with Worse Patient-reported Outcomes among Chinese American Rheumatology Patients?

Journal Article J Rheumatol · December 2019 OBJECTIVE: Chinese Americans are a fast-growing immigrant group with more severe rheumatic disease manifestations than whites and often a strong cultural preference for traditional Chinese medicine (TCM). We aimed to examine TCM use patterns and associatio ... Full text Link to item Cite

Biologic Differences Between Type 1 and 2 Lupus

Conference ARTHRITIS & RHEUMATOLOGY · October 1, 2019 Link to item Cite

Longitudinal Changes in Manifestations of SLE

Conference ARTHRITIS & RHEUMATOLOGY · October 1, 2019 Link to item Cite

The PROMIS-29 as a Measure of Type 1 and 2 SLE Activity

Conference ARTHRITIS & RHEUMATOLOGY · October 1, 2019 Link to item Cite

Racial Disparities in Lupus Medication Adherence

Conference ARTHRITIS & RHEUMATOLOGY · October 1, 2019 Link to item Cite

Disability Among Subtypes of SLE

Conference ARTHRITIS & RHEUMATOLOGY · October 1, 2019 Link to item Cite

Pharmacotherapies Targeting Type 2 SLE Symptoms

Conference ARTHRITIS & RHEUMATOLOGY · October 1, 2019 Link to item Cite

Association of serum uric acid and risk of hypertension in adults: a prospective study of Kailuan Corporation cohort.

Journal Article Clin Rheumatol · May 2017 Whether hyperuricemia is an independent risk factor for hypertension in adults is still under debate. To determine the association between serum uric acid and risk of hypertension in the Chinese population, we conducted a prospective study using the "Kailu ... Full text Link to item Cite

Relationship of meeting physical activity guidelines with quality-adjusted life-years.

Journal Article Semin Arthritis Rheum · December 2014 OBJECTIVE: The quality-adjusted life-year (QALY) is a standard outcome measure used in cost-effectiveness analyses. This study investigates whether attainment of federal physical activity guidelines is associated with higher QALY estimates among adults wit ... Full text Link to item Cite

Relationship of meeting physical activity guidelines with health-related utility.

Journal Article Arthritis Care Res (Hoboken) · July 2014 OBJECTIVE: Health-related utility measures overall health status and quality of life and is commonly incorporated into cost-effectiveness analyses. This study investigates whether attainment of federal physical activity guidelines translates into better he ... Full text Link to item Cite

Factors associated with survival among adults with HIV-associated TB in Guangxi, China: A retrospective cohort study

Journal Article Future Virology · September 1, 2012 Aim: Although China has the second highest burden of TB in the world and faces a burgeoning HIV epidemic, the epidemiology and 12-month clinical outcomes of HIV-infected TB patients have not previously been reported. Methods: We reviewed records of all HIV ... Full text Cite

Association between missed early visits and mortality among patients of china national free antiretroviral treatment cohort.

Journal Article J Acquir Immune Defic Syndr · May 1, 2012 BACKGROUND: China's National Free Antiretroviral Treatment program has scaled-up rapidly since 2002, leading to a significant reduction of mortality among its participants. However, few studies have evaluated indicators for patient access to medical care a ... Full text Link to item Cite

Diagnosis of pulmonary tuberculosis among asymptomatic HIV+ patients in Guangxi, China.

Journal Article Chin Med J (Engl) · December 2010 BACKGROUND: Pulmonary tuberculosis (PTB) among asymptomatic Chinese patients with HIV infection has not been investigated despite high tuberculosis burden in China. This study was aimed to evaluate the prevalence, risk factors and clinical outcomes of PTB ... Link to item Cite

Recent key advances in human immunodeficiency virus medicine and implications for China.

Journal Article AIDS Res Ther · May 26, 2010 In this article we summarize several recent major developments in human immunodeficiency virus treatment, prevention, outcome, and social policy change. Updated international guidelines endorse more aggressive treatment strategies and safer antiretroviral ... Full text Link to item Cite

Calibrated finger rub auditory screening test (CALFRAST).

Journal Article Neurology · May 5, 2009 BACKGROUND: Determination of auditory function is a fundamental part of a complete neurologic examination. Disability from permanent hearing loss is common in the general population. Current bedside auditory tests are unreliable and cumbersome. We evaluate ... Full text Link to item Cite