Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
Rheumatol Int. 2024 May;44(5):765-778. doi: 10.1007/s00296-024-05548-x. Epub 2024 Mar 7.
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.
我们进行了系统评价，以探索现有关于生活方式干预治疗系统性红斑狼疮 (SLE) 的疗效的证据。检索于 2021 年 6 月 22 日进行，检索时间为 2000 年 1 月 1 日至检索日。在上述时间范围内，直至 2023 年 12 月，通过手动搜索添加了额外的文章。使用的数据库包括 Medline、Embase、Web of Science 和 Cinahl。生活方式干预被定义为包含以下一项或多项干预措施的任何干预措施：体育锻炼、饮食和营养、心理健康、有害暴露、睡眠和社会关系。使用 Joanna Briggs 研究所的批判性评估工具进行偏倚风险评估。搜索产生了 11274 条独特的记录，我们评估了 199 条记录的全文，最终纳入了 102 项研究。总的来说，证据质量有限，存在多种异质性来源。研究最多的两个领域是心理健康（40 项记录）和体育锻炼（39 项记录）。心理干预对抑郁症状、焦虑和健康相关生活质量（HRQoL）有积极影响，而体育锻炼则改善了疲劳、抑郁症状、有氧运动能力和身体功能。关于饮食和营养（15 项记录）的研究支持低脂肪摄入和地中海饮食可能有益于降低心血管风险，但缺乏大型干预性研究。关于有害暴露（7 项记录）的研究支持光保护和防晒霜的使用。虽然研究表明在不吸烟者中，戒烟和控制体重策略对疾病负担和药物疗效以及正常体重患者的 HRQoL 有益，但需要更多关于吸烟和饮酒的调查。关于社会关系（1 项记录）和睡眠（无记录）的研究很少或不存在。总之，心理社会干预对于管理抑郁症状是可行的，运动对于减轻疲劳、提高有氧运动能力和身体功能是必不可少的。应建议所有患者进行光保护。生活方式干预应被视为药物治疗的补充，而不是替代。
