Obesity May Hike Risk of Depression for Women with Lupus

New research suggests obesity places women with lupus at risk of becoming depressed and may increase disease activity, pain, and fatigue.

The new report was presented at annual meeting of the American College of Rheumatology, in San Diego.

Lupus is a chronic (long-term) inflammatory autoimmune disease in which an unknown trigger causes the body’s immune system to attack its own healthy tissues.

The most common type of lupus is systemic lupus erythematosus (SLE), a complex, multiple symptom disease that can cause inflammation, pain, and damage to various parts of the body.

While anyone can develop lupus, it occurs nine to 10 times more often in women than in men and is two to three times more common among women of color.

Obesity is a common comorbidity for people with SLE. While prior research shows that obesity can worsen systemic inflammation in the general population and contributes to worse disease-related outcomes in rheumatoid arthritis, its impact in lupus patients is not well-established.

In the new study, a group of researchers at the University of California, San Francisco, sought to determine whether excess adiposity, or too much body fat, in women with lupus is independently associated with worse patient-reported outcomes (PROs).

“We know from prior research that patients with lupus experience worse health-related quality of life and greater symptom burden compared to the general population, but we do not yet have a complete explanation for these worse experiences,” said Sarah Patterson, M.D.

“For example, neither disease-specific factors such as disease activity nor sociodemographic factors such as poverty fully explain the observed severity of these symptoms.

And because we are interested in understanding how lifestyle factors such as exercise and weight management impact outcomes in lupus, we sought to determine if excess fat associates with worse perceived outcomes in this disease.”

Participants in the sample for the study were drawn from the Arthritis Body Composition and Disability (ABCD) Study. They had to be at least 18 years old, female and have a diagnosis of SLE verified by medical record review.

The researchers evaluated obesity’s association with disease activity, depressive symptoms, pain and fatigue. The study controlled for potential confounders: age, race, education, income, smoking, disease duration, disease damage, and use of glucocorticoid medications such as prednisone.

The patients in the study’s sample of 148 patients were 65 percent white, 14 percent Asian and 13 percent African-American. Their mean age was 48. Of the lupus patients in the sample, 17 percent had a poverty-level income and 86 percent had education beyond high school.

When the researchers measured obesity among the lupus patients in the study, they found that 32 percent met the FMI definition of obesity and 30 percent met the BMI definition.

Using a statistical model, obesity as defined was associated with worse scores for each patient reported outcome: greater disease activity, higher levels of depressive symptoms, more pain, and more fatigue.

The study’s results show that obesity is independently associated with worse outcomes in women with SLE, including increased disease activity, depressive symptoms, pain, and fatigue.

“Our findings have important clinical implications because the PROs we measured, particularly pain and fatigue, are known to have profound effects on quality of life and remain a major area of unmet need for people with lupus,” said Patterson.

“The relationship we observed between excess fat and worse outcomes underscores the need for lifestyle interventions targeting lupus patients who are overweight.

“More research is needed in this area, but it is possible that such interventions will reduce both cardiovascular risk and the severity of debilitating symptoms common in this disease. In the meantime, I hope this work sparks greater interest and motivation among rheumatologists to address weight management with their lupus patients.”

Source: American College of Rheumatology/EurekAlert