Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: In recent years, non-pharmacological therapies have been deemed as potentially beneficial for patients with systemic lupus erythematosus (SLE). These include complementary and integrative approaches, physical and psychological interventions. We conducted the systematic review to determine the effects of these therapies to inform practice in SLE patients.
Methods: Literature search was performed using PubMed (MEDLINE), EMBASE, Cochrane, PsychINFO, CINAHL, Web of Science, and Google Scholar until March 2017. We included any randomized controlled trials (RCTs) of non-pharmacologic interventions in SLE patients with sample size > 10 and measuring outcomes including fatigue, depression, disease activity, and quality of life. SLE was defined by 1982 or 1997 ACR criteria in all studies. Articles in both English and Chinese were included. Due to the heterogeneity of interventions and comparisons, a meta-analysis was not performed.
Results: Nine RCT studies totaling 651 participants met the inclusion criteria and were included in this review. SLE disease duration ranged between 2.5 to 12 years, mean age ranged from 13 to 48 years, and 96% were female. Table 1 summarizes the randomized controlled trials evaluating the effects of non-pharmacological treatment in patients with SLE. Of the 9 trials, 4 used exercise interventions, 4 used psychological interventions (1 group psychotherapy, 2 cognitive behavioral therapies, 1 psychoeducation intervention) and 1 used electro-acupuncture. Three of 9 studies utilized control groups consisting of usual medical care. Other studies included control interventions of relaxation, attention placebo, symptom monitoring support, minimal needling, and isotonic and resistance exercise. Compared with the control conditions, non-pharmacological interventions were associated with a significant improvement in fatigue in 3 out of 4 studies (1 exercise, 1 psychological and 1 acupuncture intervention). Four studies reported improvement in overall quality of life as measured by SF-36, compared to control. Two out of six studies also reported improved anxiety and depression, and 3 studies improved pain after interventions. However, one psychotherapy study did not find any clinically important improvement in psychological distress, disease activity, and quality of life compared to usual care. Also, no studies demonstrated a greater improvement in disease activity with 6-20 weeks of non-pharmacological interventions.
Table 1. Non-pharmacological Treatment on Fatigue, Depression, Disease Activity and Quality of Life of SLE
|
Author, Yr Country |
N |
Intervention |
Control |
Outcomes Measure |
Duration (Weeks) |
Results |
|
Tench 2003, UK |
93 |
Home exercise (walking, cycling, swimming), 30-50 min x 3 times/wk, x 12 weeks |
1. Relaxation audiotape, 30 min x 3 times/wk + supervised relaxation session q 2 wk x 12 wks 2. Usual medical care |
– Fatigue (Chalder Fatigue Scale) – Depression, anxiety (HADS) – Disease activity (SLAM) – Quality of Life (SF-36) |
12 |
-Greater improvement in fatigue (P=0.04) for exercise than relaxation or usual medical care – No improvement in depression and anxiety, disease activity, quality of life, between 2 exercise groups |
|
Bogdanovic 2015, Serbia |
60 |
Aerobic exercise, 15 min x 3 times/wk x 6 weeks |
Isotonic exercises, 30 min x 3 times/wk x 6 weeks |
– Fatigue (FSS) – Depression (BDI) – Quality of Life (SF-36) |
6 |
– No significant difference in fatigue – No significant difference in depression between 2 exercise groups – Improvement in Quality of Life (P<0.05) |
|
Abrahão 2016, Brazil |
63 |
Cardiovascular exercise (CT), 50 min x 3 times/wk x 12 weeks |
1. Resistance exercise (RT), 50 min x 3 times/wk x 12 weeks 2. Usual medical care |
– Depression (BDI) – Disease Activity (SLEDAI) – Quality of Life (SF-36) – Aerobic Capacity |
12 |
– No significant different in depression or disease activity between groups – Improvement in Quality of Life in CT and RT groups (P<0.05) – Improvement in aerobic capacity in CT and RT groups (P<0.05) |
|
Prado 2013, Brazil |
19 |
Supervised Aerobic exercise, 30-60 min 2x weekly x 12 weeks |
Usual medical care |
– Disease activity (SLEDAI-2K) – Exercise tolerance |
12 |
– No change in disease activity – Improvement in exercise tolerance (P<0.05) |
|
Karlson 2004, USA |
122 |
Psychoeducational intervention 1 time, followed by a phone call once a month x 5 months |
Attention Placebo + Video presentation about lupus, 45 min once |
– Fatigue – Disease activity (SLAQ, SLAM) – Quality of Life (SF-36) – Self efficacy |
20 |
– Reduction in fatigue score in experimental group (P<0.05) – No improvement in disease activity – Improvement in quality of life (P=0.03), global mental health status (P=0.03), and self-efficacy (P=0.004) |
|
Dobkin 2002, Canada |
133 |
Group psychotherapy, 90 mins x weekly x 3 months + booster session, 1 time/month x 3 months |
Usual medical care |
– Psychological symptoms (SCL-90-R) – Disease activity (SLAM-R) – Quality of life (SF-36) |
12 |
– No significant group differences in psychological symptoms, disease activity, and quality of life |
|
Greco 2004, USA |
92 |
Biofeedback-assisted/Cognitive-behavioral therapy + relaxation techniques (BF/CBT), 6 sessions x 3 months |
1. Symptom monitoring support intervention (SMS) 2. Usual medical care |
– Psychological Functioning (CES-D, STRESS, ASES) – Disease Activity (SLEDAI, SLAM-R) – Quality of life: Physical function (SF-36-PF) -Pain (AIMS2-pain) |
12 |
– Greater improvement for BF/CBT in long-term psychological function (P=0.02) – No improvement in disease activity in all groups (P>0.05) – Greater improvement for BF/CBT in physical function (SF-36-PF) (P<0.05) and pain reduction (P=0.04) |
|
Navarrete 2010, Spain |
45 |
Cognitive-behavioral therapy + relaxation techniques + social skill training, 120 min/wk x 10 weeks |
Usual medical care |
– Psychological parameters (SVI, BDI, Anxiety Spielberger’s STAI) – Disease activity (SLEDAI) – Quality of Life (SF-36) |
10 |
– Improvement in stress (P<0.04), depression (P<0.002) and anxiety (P<0.001) – No improvement in disease activity – Improvement in SF-36 scales (P<0.05) including physical role (P<0.05), pain (P<0.013), social function (P<0.04), mental health (P<0.02), general health (P<0.05) |
|
Greco 2008, USA |
24 |
Electrical Acupuncture 10 sessions x 5 wks 30 min/session |
1. Minimal needling, 10 sessions x 2 times over 5 wks 2. Usual medical care |
– Fatigue (FSS) – Disease activity (SLAM-R) – Pain (AIMS2-pain, MPI, SF-36 body pain) |
5 |
– Both acupuncture and needling improvement in fatigue compared to usual care – No improvement in disease activity – Both acupuncture and needling improvement in pain compared to usual care |
|
CFS = Chalder Fatigue Scale; HADS = Hospital Anxiety and Depression Scale; SLAM = Systemic Lupus Activity Measure; SF-36 = Short-Form Health Survey; FSS = Fatigue Severity Score; BDI = Beck Depression Inventory; SLEDAI = The Systemic Lupus Erythematosus Disease Activity Index; SLEDAI-2K = Systemic Lupus Erythematosus Disease Activity Index 2000; SLAQ = Systemic lupus activity questionnaire for population studies; SCL-90-R = The Symptom Checklist 90-Revised; SLAM-R = The Systemic Lupus Activity Measure-Revised (SLAM-R); CES-D = The Center for Epidemiological Studies Depression scale (CES-D); STRESS = Cohen’s Perceived Stress Scale; ASES = Arthritis Self-Efficacy Scale; AIMS2-pain = The Revised Arthritis Impact Measurement Scales; SVI = Stress Vulnerability Inventory; STAI = Spielberger’s State-Trait Anxiety Inventory; MPI = Multidimensional Pain Inventory |
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Conclusion: The review showed promising results for physical exercise and psychological interventions as an adjunct to traditional medical therapy for improvement in fatigue and quality of life. However, many studies had small sample sizes and short intervention durations. Further high-quality RCTs with longer follow-up periods are warranted.
To cite this abstract in AMA style:
Fangtham M, Nash JL, Hyon S, Bannuru RR, Wang C. Non-Pharmacological Treatment on Fatigue, Depression, Disease Activity, and Quality of Life of Systemic Lupus Erythematosus: A Systematic Review [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/non-pharmacological-treatment-on-fatigue-depression-disease-activity-and-quality-of-life-of-systemic-lupus-erythematosus-a-systematic-review/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/non-pharmacological-treatment-on-fatigue-depression-disease-activity-and-quality-of-life-of-systemic-lupus-erythematosus-a-systematic-review/