Background/Purpose: In health conditions that cause changes in appearance, especially in areas of the body that are highly visible and socially salient (e.g., face and hands), there can be alterations in body image, self-esteem, and role-evaluation. Given their chronic and progressive nature and disproportionate impact on women, the rheumatic diseases are an important area for the study of body image in chronic illness. Body image has been explored in various rheumatic conditions, such as systemic sclerosis, rheumatoid arthritis, and systemic lupus erythematosus. To date, no systematic review has summarized the literature on body image in multiple rheumatic diseases.

Methods: PubMed/Medline, PsycINFO, and CINAHL databases were searched on May 13, 2016 and updated on December 19, 2017. Results were limited to English-language studies. Additionally, a manual search was undertaken wherein reference lists of selected articles were screened for inclusion. Grey literature (i.e., conference abstracts and dissertations) was excluded. Studies were screened and evaluated for inclusion by two investigators. Full articles were reviewed to determine eligibility based on the following inclusion criteria: 1) study participants comprised of adult patients with rheumatic diseases that can cause visible differences, and 2) at least one validated measure of body image was used. Studies that focused on surgical outcomes were excluded.

Results: Forty-eight articles were eligible for inclusion in the present review. The majority of studies used disease-specific measures of body image. Eligible studies were identified for lupus, rheumatoid arthritis, scleroderma, and ankylosing spondylitis. No single correlate was found to consistently associate with body image. However, younger age, greater depressive symptomatology, presence of active disease flares, and greater functional deficits were most commonly associated with poorer body image scores.

Conclusion: Rheumatic diseases that cause changes in appearance can have significant impacts on body image. The multidimensional nature of the construct of body image and the use of disease-specific measures complicated the synthesis of the findings across groups or comparisons with non-rheumatic disease samples. However, some disease correlates appeared most commonly associated with poorer body image across disease groups and can be useful in guiding intervention efforts.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/body-image-in-rheumatic-diseases-a-systematic-review/