University Medical Center Utrecht, the Netherlands, department of Rheumatology and Clinical Immunology, Heidelberglaan 100, 3584CX Utrecht, the Netherlands.
Autoimmun Rev. 2024 Oct;23(10):103609. doi: 10.1016/j.autrev.2024.103609. Epub 2024 Aug 27.
Systemic Lupus Erythematosus (SLE) is an autoimmune disease affecting multiple organs, characterized by flares and remission. Treatment aims to reduce flare severity and prevent long-term damage, but remission is often elusive, and patients may still experience flares and a reduced quality of life (QoL). This had led to a growing interest in non-pharmacological therapies to improve patient wellbeing.
We aimed to assess and summarize the efficacy of lifestyle interventions in SLE patients on disease activity and QoL.
A systematic search on lifestyle interventions, SLE, disease activity, and QoL was conducted in PubMed/Medline, Embase and Clinicaltrials.gov in August 2024. Included studies were randomized controlled trials on lifestyle interventions in adult SLE patients. Each trial was appraised using Scottish Intercollegiate Guidelines Network (SIGN) criteria, with participant numbers, study duration, intervention type and outcome measures detailed in separate tables.
A total of 3564 articles were screened, resulting in the inclusion of 25 randomized controlled trials with 1521 patients. Study quality varied from high (11 studies) to low (6 studies) with considerable intervention heterogeneity. The interventions fell into five categories: physical activity, psychotherapy, lifestyle coaching, supplements and dietary interventions. Physical activity (2 studies, 116 patients), psychotherapy (5 studies, 507 patients) and coaching (1 study with 30 patients) had no significant effect on disease activity, while fish oil supplementation showed a slight benefit in two studies with a total of 102 patients. Quality of life generally improved with physical activity (4 studies with in total 253 patients) and psychotherapy (9 studies with in total 623 patients), with significant mental health benefits, but coaching (3 studies with in total 186 patients) showed no effect.
Various lifestyle interventions influence quality of life in SLE patients. Consistent with recent guidelines, both exercise and psychotherapy may positively impact the health-related quality of life in these patients. However, some studies were biased due to self-reported outcomes and the Hawthorne effect, where participants' behavior changed from receiving extra attention. Further research with larger patient cohorts is necessary to reduce the influence of heterogeneity across different studies and to better understand the potential of these promising therapies.
系统性红斑狼疮（SLE）是一种影响多个器官的自身免疫性疾病，其特征是发作和缓解。治疗旨在减轻发作的严重程度并预防长期损害，但缓解通常难以实现，患者仍可能经历发作和生活质量（QoL）下降。这导致人们对改善患者健康的非药物治疗方法越来越感兴趣。
我们旨在评估和总结生活方式干预对 SLE 患者疾病活动度和 QoL 的疗效。
我们在 2024 年 8 月在 PubMed/Medline、Embase 和 Clinicaltrials.gov 上进行了关于生活方式干预、SLE、疾病活动度和 QoL 的系统搜索。纳入的研究是关于成人 SLE 患者生活方式干预的随机对照试验。使用苏格兰校际指南网络（SIGN）标准评估每个试验，详细列出参与者人数、研究持续时间、干预类型和结果测量。
共筛选了 3564 篇文章，最终纳入了 25 项随机对照试验，共 1521 名患者。研究质量从高（11 项研究）到低（6 项研究）不等，干预措施的异质性较大。这些干预措施分为五类：体育活动、心理治疗、生活方式指导、补充剂和饮食干预。体育活动（2 项研究，116 名患者）、心理治疗（5 项研究，507 名患者）和指导（1 项研究，30 名患者）对疾病活动度没有显著影响，而鱼油补充剂在两项共 102 名患者的研究中显示出轻微益处。体育活动（4 项研究，共 253 名患者）和心理治疗（9 项研究，共 623 名患者）通常会改善生活质量，并显著改善心理健康，但指导（3 项研究，共 186 名患者）没有效果。
各种生活方式干预措施影响 SLE 患者的生活质量。与最近的指南一致，运动和心理治疗都可能对这些患者的健康相关生活质量产生积极影响。然而，由于自我报告的结果和霍桑效应，一些研究存在偏倚，即参与者的行为因受到额外关注而发生变化。需要有更大患者群体的进一步研究来减少不同研究之间的异质性影响，并更好地了解这些有前途的治疗方法的潜力。
