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. 2024 May;44(5):765-778.
doi: 10.1007/s00296-024-05548-x. Epub 2024 Mar 7.

Efficacy of lifestyle interventions in the management of systemic lupus erythematosus: a systematic review of the literature

Alexander Tsoi #  1   2 , Alvaro Gomez #  1   2 , Carina Boström  3   4 , Denise Pezzella  1   2 , Jun Weng Chow  1   2 , Charlotte Girard-Guyonvarc'h  5 , Tanja Stamm  6   7 , Laurent Arnaud  8 , Ioannis Parodis  9   10   11
Affiliations

Efficacy of lifestyle interventions in the management of systemic lupus erythematosus: a systematic review of the literature

Alexander Tsoi et al. Rheumatol Int. 2024 May.

Abstract

We performed a systematic review to explore existing evidence regarding the efficacy of lifestyle interventions for the management of systemic lupus erythematosus (SLE). The search was conducted on the 22nd of June 2021 for publications between 1st of January 2000 and the date of search. Additional articles within the aforementioned timeframe and until December 2023 were added by hand searching. Databases utilized were Medline, Embase, Web of Science, and Cinahl. Lifestyle interventions were defined as any intervention encompassing one or more of the following: physical exercise, diet and nutrition, mental health, harmful exposures, sleep, and social relations. The Joanna Briggs Institute critical appraisal tools were used for risk of bias assessment. The search yielded 11,274 unique records, we assessed the full text of 199 records, and finally included 102 studies. Overall, the quality of the evidence is limited, and there were multiple sources of heterogeneity. The two domains most extensively researched were mental health (40 records) and physical exercise (39 records). Psychological interventions had a positive effect on depressive symptoms, anxiety, and health-related quality of life (HRQoL), whereas physical exercise improved fatigue, depressive symptoms, aerobic capacity, and physical functioning. Studies on diet and nutrition (15 records) support that low fat intake and Mediterranean diet may be beneficial for reducing cardiovascular risk, but large interventional studies are lacking. Studies on harmful exposures (7 records) support photoprotection and use of sunscreen. While studies imply benefits regarding disease burden and drug efficacy in non-smokers and regarding HRQoL in normal-weight patients, more survey is needed on tobacco smoking and alcohol consumption, as well as weight control strategies. Studies on social relations (1 record) and sleep (no records) were sparse or non-existent. In conclusion, psychosocial interventions are viable for managing depressive symptoms, and exercise appears essential for reducing fatigue and improving aerobic capacity and physical function. Photoprotection should be recommended to all patients. Lifestyle interventions should be considered a complement, not a substitute, to pharmacotherapy.

Keywords: Diet therapy; Exercise; Healthy lifestyle; Mental health; Systematic review; Systemic lupus erythematosus.

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Conflict of interest statement

IP has received research funding and/or honoraria from Amgen, AstraZeneca, Aurinia, Bristol-Myers Squibb, Elli Lilly, Gilead, GlaxoSmithKline, Janssen, Novartis, Otsuka, and Roche. All other authors declare that they have no conflicts of interest. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Fig. 1
Fig. 1
Flowchart of study selection
See this image and copyright information in PMC

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