Cited by 44Systemic Sclerosis and Related DiseasesSystemic Lupus Erythematosus ResearchRheumatoid Arthritis Research and Therapies

Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis

Open access
Parodis, Ioannis, Gomez, Alvaro, Tsoi, Alexander, Chow, Jun Weng, Pezzella, Denise, Girard, Charlotte, Stamm, Tanja A, Boström, Carina·2023·RMD Open

Abstract

Through this systematic literature review, we assembled evidence to inform the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). We screened articles published between January 2000 and June 2021. Studies selected for data extraction (118 for SLE and 92 for SSc) were thematically categorised by the character of their intervention. Of 208 articles included, 51 were classified as robust in critical appraisal. Physical activity was the most studied management strategy and was found to be efficacious in both diseases. Patient education and self-management also constituted widely studied topics. Many studies on SLE found psychological interventions to improve quality of life. Studies on SSc found phototherapy and laser treatment to improve cutaneous disease manifestations. In summary, non-pharmacological management of SLE and SSc encompasses a wide range of interventions, which can be combined and provided either with or without adjunct pharmacological treatment but should not aim to substitute the latter when this is deemed required. While some management strategies i.e., physical exercise and patient education, are already established in current clinical practice in several centres, others e.g., phototherapy and laser treatment, show both feasibility and efficacy, yet require testing in more rigorous trials than those hitherto conducted.

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Crossref · 10.1136/rmdopen-2023-003297

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  • Expert consensus (EULAR) recommends a multidisciplinary approach for SLE and systemic sclerosis, including patient education, psychosocial support, and physical therapy.

    “Expert consensus, including EULAR recommendations, emphasizes a multidisciplinary approach for systemic lupus erythematosus and systemic sclerosis, highlighting the importance of patient education, psychosocial support, and physical therapy in routine care [97].”

    From Chronic Stress and Autoimmunity: The Role of HPA Axis and Cortisol Dysregulation (2025) · cites this paper as [97]

    The Discussion (page not provided) identifies physical exercise and patient education as established strategies for SLE and SSc, and describes psychological interventions for depressive symptoms in SLE. The Results (page not provided) report physical therapy and a multidisciplinary programme in SSc. This paper is a review informing EULAR recommendations; it does not itself state that EULAR recommends the specified multidisciplinary package for both diseases in routine care. (LLM, conf=0.86)

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9 of the 248 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [45]Patterson SL, Trupin L, Yazdany J, et al. Physical inactivity independently predicts incident depression in a multi-racial/ethnic systemic lupus cohort. Arthritis Care Res 2021; 9: 09. PMC9829076 33421358
  2. [218]Sandqvist G, Eklund M. Hand mobility in scleroderma (HAMIS) test: the reliability of a novel hand function test. Arthritis Care Res 2000; 13: 369– 74. 14635312

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Authors
Parodis, I., Gomez, A., Tsoi, A., Chow, J. W., Pezzella, D., Girard, C., Stamm, T. A., & Boström, C.
Affiliations
  • Karolinska University Hospital (SE)
  • Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
  • University of Geneva (CH)
  • Ludwig Boltzmann Gesellschaft (AT)
  • Karolinska Institutet (SE)
Corresponding author
Parodis, Ioannis
Venue
RMD Open
Publisher
BMJ
Published
2023-08
Volume
9
Issue
3
Pages
e003297
ISSN
2056-5933 (ISSN-L)
OpenAlex
W4385480990
Cited by
44
References
248
Citations by year
2026: 12 · 2025: 12 · 2024: 17 · 2023: 3
FWCI
2.00
Type
journal article
Language
en
Open access
Locations
  • RMD Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
European Alliance of Associations for Rheumatology
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Systemic Sclerosis and Related Diseases
  • Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
  • Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
Keywords
systemic lupus erythematosus, systemic sclerosis, non-pharmacological treatment, physical activity, patient education, self-management, psychological intervention, quality of life, phototherapy, laser therapy, cutaneous manifestations, EULAR recommendations
MeSH terms
Humans, Lupus Erythematosus, Systemic, Quality of Life, Scleroderma, Systemic

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