The effects of lifestyle interventions on disease activity and quality of life in patients with systemic lupus erythematosus: A systematic review.
Level 1 - systematic review of randomized trials
Systematic review of randomized controlled trials
PubMed 39209012 · doi:10.1016/j.autrev.2024.103609
What was done
A systematic review searching PubMed/Medline, Embase, and Clinicaltrials.gov through August 2024 for randomized controlled trials evaluating lifestyle interventions in adult systemic lupus erythematosus (SLE) patients. Interventions were categorized into physical activity, psychotherapy, lifestyle coaching, supplements, and dietary interventions. Trials were appraised using Scottish Intercollegiate Guidelines Network (SIGN) criteria to assess effects on disease activity and health-related quality of life (QoL).
What was found
A total of 25 RCTs involving 1,521 patients were included (11 high quality, 6 low quality). On disease activity, physical activity (2 studies, n=116), psychotherapy (5 studies, n=507), and coaching (1 study, n=30) showed no significant effect, whereas fish oil showed a slight benefit in 2 studies (n=102). For QoL, physical activity (4 studies, n=253) and psychotherapy (9 studies, n=623; showing significant mental health benefits) led to improvements, while coaching (3 studies, n=186) showed no effect. Numerical effect estimates and confidence intervals were not reported in the abstract.
Why it matters
While lifestyle modifications rarely modify underlying SLE disease activity, structured exercise and psychotherapy provide meaningful non-pharmacological improvements in quality of life and mental well-being for patients.
Limits
Substantial intervention heterogeneity existed across included trials, and several subgroups contained very small sample sizes. Risk of bias was noted from reliance on self-reported outcomes and Hawthorne effects due to non-blinded attention. The abstract reports no pooled quantitative meta-analytic estimates.
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