Applied Evidence
Beyond chronic pain: How best to treat psychological comorbidities
When chronic pain is accompanied by disturbances in sleep, a psychiatric disorder, or substance misuse, a single agent with multiple symptom...
The authors of the review noted that consensus opinion holds that oral corticosteroids and NSAIDs reduce SLE-associated joint pain, but they found no studies that objectively evaluated either of these interventions.1
Fish oil also helps arthritis
Two RCTs on the effects of 3 g/d of omega-3 polyunsaturated fatty acids (fish oil) for 24 weeks in SLE patients with mild disease found a reduction in Systemic Lupus Activity Measure-Revised (SLAM-R) scores.2,3 SLAM-R is a validated measure of SLE disease activity, rated on a scale from 0 to 81, including 23 clinical and 7 laboratory manifestations of disease.
In the first study (52 subjects), disease activity decreased from an average SLAM-R score of 6.1 at baseline to 4.7 (P<.05). The second study (60 subjects) found a similar reduction in mean SLAM-R scores from 9.4 to 6.3 (P<.001) and joint pain scores from 1.27 to 0.83 (P=.047).
Drug treatments don’t significantly relieve fatigue
An industry-sponsored RCT that compared abatacept with placebo found improvements in fatigue that weren’t clinically meaningful in posthoc analysis (-9.45 points difference on a self-reported 0-to-100 visual analog scale; 95% confidence interval, -17.65 to -1.25, with a 10-point reduction considered to be clinically meaningful). Abatacept also had a high rate of serious adverse events, including facial edema, polyneuropathy, and serious infections (24/121 with abatacept vs 4/59 placebo; NNH=8).4
Another RCT found no effect of dehydroepiandrosterone on fatigue in women with inactive SLE.5