Body image in lupus: Is it disease activity, physical function, depression, pain, fatigue, sleep, fibromyalgia or stress?

Patients with systemic lupus erythematosus (SLE) frequently experience poor body image (BI), an important issue, though not well researched or understood thus far. BI is perception of one’s own body. The effects of disease activity, damage, sleep, stress, pain, fatigue, function, medications, depression and fibromyalgia (FM) on BI in SLE are not known. Objective: We aimed to evaluate the relative role of the specific variables listed above on BI in SLE patients. Methods: SLE patients receiving rheumatology care at two academic medical centers were recruited. Each patient completed questionnaire assessments evaluating target variables and BI. Disease activity was evaluated using SELENA-SLEDAI. Multivariate regression analyses including stepwise modeling were conducted with BI as the dependent variable for all patients and for patients with and without FM. Results: 115 SLE patients participated. Mean (SD) age was 40.1 (13.8) years. For all patients and patients without FM, depression (β -1.7, p 0.02), stress (β -1.8, p 0.05), ACR malar rash (β -13.5, p 0.03), and steroid dose (β -0.4, p 0.04) were found to be independent predictors of BI, and explained 54% of BI variance. On stepwise regression modelling, scores for depression (β -2.2, p <0.001), stress (β -1.6, p 0.05), and disease activity (β -1.5, p 0.005) were found to be predictive of poor BI in the whole group, and similar results were noted among those without fibromyalgia. Malar rash presence as defined in the ACR classification criteria for SLE (β -10.3, p 0.04) was most predictive of poor BI among patients without fibromyalgia. Of the modifiable variables among those without FM, depression and stress had similar contributions to BI, followed by disease activity. In patients with fibromyalgia, depression (β -3.6, p 0.002) alone was associated with BI. Conclusions: Depression, stress, and disease activity are important predictors of BI in SLE patients. Malar rash is a risk for poor BI among those without FM. Attention to depression and stress concurrently with control of disease is suggested among SLE patients with poor BI.