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Obesity and tobacco smoking are independently associated with poor patient-reported outcomes in SLE: a cross-sectional study
Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology, Dermatology, and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology, Dermatology, and Rheumatology, Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0002-4875-5395
Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection/Rheumatology, Linköping University, Linköping, Sweden.
2024 (English)In: Rheumatology International, ISSN 0172-8172, E-ISSN 1437-160X, Vol. 44, no 5, p. 851-861Article in journal (Refereed) Published
Abstract [en]

We investigated associations of obesity and tobacco smoking with health-related quality of life (HRQoL), pain, fatigue, and functional impairment in systemic lupus erythematosus (SLE). Furthermore, we explored whether there was an effect modification between these two factors. We included adult SLE patients from the Linköping University Hospital (n = 325) in the present cross-sectional analysis. We further included population-based controls and performed cardinality matching to balance age and sex distributions with cases (n = 224). HRQoL was assessed with the EQ-5D index score; pain, fatigue, and overall SLE-related health state with visual analogue scales (VAS; 0 [best] to 100 [worst]); and functional impairment with the HAQ-DI. Unacceptable outcomes were defined as VAS scores corresponding to the 90th percentile derived from the matched controls. SLE patients reported worse scores than controls in all measures, and approximately 30% experienced unacceptable outcomes. When compared with normal-weight, obese SLE patients reported lower HRQoL, and greater functional impairment and risk of unacceptable pain (OR: 3.2; 95% CI 1.6-6.7) and fatigue (OR: 2.1; 95% CI 1.0-4.3). Similarly, the current smokers reported higher levels of functional impairment and a greater risk of unacceptable pain (OR: 3.8; 95% CI 1.8-8.2) and fatigue (OR: 2.8; 95% CI 1.3-5.9) than never smokers. The associations were independent of age, sex, disease duration, disease activity, and organ damage. There was no evidence of a synergistic effect between increased BMI and smoking on any outcome. In summary, obesity and smoking are risk factors for unacceptable patient-reported outcomes in SLE, regardless of clinical activity.

Place, publisher, year, edition, pages
Springer, 2024. Vol. 44, no 5, p. 851-861
Keywords [en]
Fatigue, Obesity, Pain, Patient reported outcome measure, Smoking, Systemic lupus erythematosus
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:oru:diva-112418DOI: 10.1007/s00296-024-05546-zISI: 001176590500002PubMedID: 38451301Scopus ID: 2-s2.0-85186882298OAI: oai:DiVA.org:oru-112418DiVA, id: diva2:1845716
Funder
Karolinska InstituteSwedish Rheumatism Association, R-941095; R-939149Stiftelsen Konung Gustaf V:s 80-årsfond, FAI-2020–0741; FAI-2020–0663Swedish Society of Medicine, SLS-974449Nyckelfonden, OLL-974804Region Östergötland, RÖ-932055Region Stockholm, FoUI-955483
Note

Open access funding provided by Karolinska Institute. This work was supported by grants from the Swedish Rheumatism Association (R-941095 to IP and R-939149 to CS); King Gustaf V’s 80-year Foundation (FAI-2020–0741 to IP and FAI-2020–0663 to CS); Professor Nanna Svartz Foundation (2020–00368 to IP); Swedish Society of Medicine (SLS-974449 to IP); Nyckelfonden (OLL-974804 to IP); Ulla and Roland Gustafsson Foundation (2021–26 to CS); Region Östergötland (ALF Grants; RÖ-932055 to CS); Region Stockholm (FoUI-955483 to IP); and Karolinska Institutet (to IP).

Available from: 2024-03-20 Created: 2024-03-20 Last updated: 2024-04-11Bibliographically approved

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