As systemic lupus erythematosus (SLE) is a chronic condition with a significant impact on physical and mental health, all potential interventions to improve quality of life are relevant for SLE patients.

Among the possible non-pharmacological interventions, exercise and diet have a pivotal role.^{1 2} For SLE patients aerobic exercise programs are safe and effective on improving aerobic and functional capacity, in addition to tolerance to exercise. Physical activity enhances cardiovascular well-being in SLE patients by reducing their body weight and waist circumference, while improving their maximum oxygen consumption, endothelial function and insulin sensitivity. Moreover, several studies also suggest a reduction in fatigue and a beneficial effect of exercise on depression, anxiety, pain, poor-quality sleep and, more generally, on health-related quality of life (HRQoL).

Diet can have a role in reducing modifiable cardiovascular risk factors; a benefit on SLE activity and HRQoL is also reported. The most robust evidence is available for polyunsaturated fatty acids enriched diets; however, we cannot draw definitive conclusions on whether there is any kind of diet that is better than another for SLE patients. Patients with SLE who smoke have an increased risk of disease flare, particularly skin manifestations, a poorer HRQoL and a reduced response to antimalarial drugs. The more intense and the longer tobacco consumption is the higher the risk of poor control of disease activity. Therefore, these facts can provide additional motivation for patients to stop smoking.

Alongside clinical advantages, evidence-based activities promoting healthy lifestyles could contribute both to patient empowerment in disease self-management and to the sustainability of public health services.

Learning Objectives

• Describe the link between lifestyles, disease activity and long-term outcomes in SLE

• Discuss the current state of studies on non-pharmacological interventions in SLE

References

1. Fangtham M, Kasturi S, Bannuru RR, et al. Non-pharmacologic therapies for systemic lupus erythematosus. Lupus 2019;28(6):703–12.

2. Rodríguez Huerta MD, Trujillo-Martín MM, Rúa-Figueroa Í, et al. Healthy lifestyle habits for patients with systemic lupus erythematosus: A systemic review. Semin Arthritis Rheum 2016;45(4):463–70.