Background/Purpose: Little is known about the self-esteem and body image impact in young people with rheumatic and musculoskeletal diseases (RMD). Studies in chronic illness suggest that chronic health conditions can develop changes in appearance, or social activities disruption, consequentially body image and self-esteem can be altered mainly in young people. The purpose of this study was to synthesize existing research related to self-esteem and body image in young people with RMD.

Methods: Databases (MEDLINE, Embase, PsycINFO, and CINAHL) were searched until April 2023. Results were limited to English-language studies. Studies were screened and evaluated for inclusion by two investigators. The systematic review included: a) All original articles reporting self-esteem or body image of young people with RMDs ; b) Qualitative studies (data obtained through individual interview and/or focus groups), quantitative studies (information obtained through questionnaires) or c) mixed designs (articles including qualitative and quantitative methods) Case studies, letters to the editor and commentaries were excluded. Additionally, a manual search was undertaken wherein reference lists of selected articles were screened for inclusion.

Results: Twelve articles were eligible for inclusion in the present review. Eligible studies were identified for juvenile idiopathic arthritis (6), lupus (3), scleroderma (2), and vasculitis (1). As main results we highlight the following: Glucocorticoids use was found to consistently associate with poor body image, in all conditions (due to visible side-effects of medication). Greater body image concerns were associated with facial lesions, and the resulting perceived stigma (this appearance concern was also related to depression). Females showed lower self-esteem than males. Anxiety and apprehension about their physical and sexual attractiveness was associated with lower self-esteem. Feeling of restrictions in their experimentation with drinking and sexual relations also impacted their self-esteem. A lower self-esteem was associated with poor QoL, and regarding DMARDs treatments, use of IL-6 treatment improved self-esteem.

Conclusion: The use of disease-specific measures and the heterogeneous group of studies complicated the synthesis of the findings. However, some factors appeared most associated with poorer self-esteem and body image across disease groups. Young people with RMD, who already face additional medical and psychosocial burden, might benefit from monitoring tools and interventions designed to improve their body image and bolster self-esteem in the ongoing context of self-care and adherence. Moreover, understanding these issues can help in treatment planning, and clinical decision-making for this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/self-esteem-and-body-image-of-young-people-with-rheumatic-diseases-a-systematic-review/