Exploring the influence of social support, disease activity, and fibromyalgia on the emotional well-being of women with systemic lupus erythematosus.

Abstract

Background: Systemic Lupus erythematosus (SLE) is an autoimmune disorder in which females are affected more commonly than males. In addition to the physical burden of the disease, patients with SLE are at higher risk of psychological disorders. In Jordan, there is a paucity of studies assessing the emotional well-being and psychosocial burden of SLE. This study aims to explore fibromyalgia, mental health-related problems and their association with SLE disease activity and its various manifestations.

Methods: This cross-sectional study enrolled all sequential female patients diagnosed with SLE who attended a single-provider rheumatology clinic at the Jordan University Hospital (JUH), in Amman, Jordan. Data was collected between September 2023 and March 2024. A structured questionnaire was utilized to collect demographic data as well as SLE disease features. Comorbid psychiatric disorders were assessed using PHQ-9 and GAD-7 for depression and anxiety, respectively, fibromyalgia by FiRST, disease activity by SLEDAI score, quality of life by SF-12 and perceived social support were evaluated using MSPSS.

Results: We analyzed the data of 63 female patients diagnosed with SLE. The mean age was 40.3 ± 15.3 years with a mean age of 28.3 ± 12.1 years at diagnosis. The most common manifestations were mucocutaneous and hematological manifestations each affecting 84.1% of patients. Regarding treatments, 79.4% of patients were using hydroxychloroquine and 73.0% of patients were using glucocorticoids. According to PHQ-9, 34.9% of patients had depression and 7.9% of patients had severe depression. positive FiRST screening suggestive of fibromyalgia was found in 31.7%. The mean PCS-12 scores were 41.9 ± 9.8 and the mean MCS-12 was 51.9 ± 3.4 indicating a moderate level of physical and mental health, respectively. Using multivariate logistic regression, vascular involvement (OR = 14.9, 95% CI: 1.1-202.4) were associated with depression while patients with high PCS-12 scores (OR = 0.889, 95% CI: 0.79-0.96) had lower odds of positive FiRST screening.

Conclusion: Our study showed that patients with SLE are at an increased risk of comorbid psychiatric disorders, which adds to the complexity of the disease. The management of SLE should adopt a multidisciplinary approach to address both the physical and psychosocial burdens.