Duke Health Referring Physicians


Patients With SLE, Depression, and Fibromyalgia are More Symptomatic, Have Higher Perceived Disease Activity

New information on the association of these factors can help clinicians individualize management approaches

Depression is a common comorbidity in individuals with systemic lupus erythematosus (SLE), but the exact relationship between these two conditions has yet to be clarified. Previous research revealed conflicting findings about the association of SLE disease activity and depression. A new study, however, has found that individuals with SLE and depression are more symptomatic and self-report higher levels of SLE disease activity than individuals without depression. Moreover, the study also revealed strong associations between depression, fibromyalgia, and SLE-related symptoms that may have important implications for patient care.

Amanda M. Eudy, PhD, of Duke University School of Medicine in Durham, NC, presented results of this study at the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals Annual Meeting held October 20 to 24 in Chicago, IL.

The study enrolled 208 individuals diagnosed with SLE, 91% of whom were female, with a mean age of 45 years. Participants completed several questionnaires at each clinic visit, including the Patient Health Questionnaire (PHQ-9) used to monitor depression, the Systemic Lupus Activity Questionnaire (SLAQ), and the ACR Fibromyalgia Diagnostic Criteria 2011.

Overall, 30% of participants met the PHQ-9 criteria for depression (score ≥ 10) and 47% met the SLAQ criteria for mild, moderate, or severe depression, confirming high levels of depression in individuals with SLE. Of note, using the SLAQ criteria, 17% had moderate or severe depression.

Fibromyalgia was strongly associated with depression in individuals with SLE. Researchers found that participants with diagnosed comorbid fibromyalgia and SLE (22% of enrollees) had more than 3 times the rate of depression than participants without fibromyalgia (PHQ-9 criteria). Approximately 65% of participants with SLE and fibromyalgia met criteria for depression on the PHQ-9, versus approximately 18% of participants without fibromyalgia. Using SLAQ criteria, 33% of participants with fibromyalgia reported mild depression and 31% reported moderate to severe depression. In contrast, 20% of those without fibromyalgia reported mild depression and 13% reported moderate or severe depression.

Participants with depression defined by either the PHQ-9 or the SLAQ criteria also reported more fatigue, muscle weakness and/or pain, swollen and/or stiff joints, anxiety, and forgetfulness. Participants with depression (PHQ-9 criteria) also had higher measures of disease activity determined by the SLE Disease Activity Index (SLEDAI) as well as physician global assessment (PGA).

Depression was also associated with higher overall SLAQ scores, symptom severity scores, widespread pain scores, and patient-reported disease activity. For example, patient-reported disease activity in those with no/mild depression was 3.8 (standard deviation [SD] 2.8) on a scale of 1 to 10 versus a score of 6 (SD 2.6) for those with moderate to severe depression (P < .0001). Interestingly, however, there was no statistically significant difference in SLEDAI scores between participants with no/mild depression and moderate/severe depression.

The authors concluded that up to 47% of individuals with SLE experience depression and that comorbid fibromyalgia may predict depression. Those with SLE and depression are more likely to experience disease-related symptoms, cognitive dysfunction, and mood disorders. Moreover, individuals with SLE and depression self-report increased SLE disease activity, as well as increased disease activity determined by a rheumatologist. Clinician awareness of the association of SLE, depression, and fibromyalgia is important in choosing individualized therapies for patients with these comorbid conditions.

Source: Eudy AM, Rogers JL, Criscione-Schreiber LG, et al. Self-reported depression among patients with systemic lupus erythematosus. Presented at: 2018 ACR/ARHP Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 747.