In Black Women With SLE, Self-Efficacy Inversely Linked With Fatigue & Pain

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Fatigue and pain are highly prevalent and debilitating symptoms in systemic lupus erythematosus (SLE) that can be mitigated through self-efficacy building interventions,” explains Cristina Drenkard, MD, PhD. “However, individual characteristics may modify the effect of self-efficacy on these outcomes. Moreover, little is known about the impact of self-efficacy on these symptoms among under-represented populations with SLE.

Black women with SLE in particular are more likely to present with more severe disease and poorer outcomes than their White counterparts, Dr. Drenkard notes. “These patients frequently cite pain and fatigue as the most challenging to self-manage,” she says. “Although complex biological and psychosocial factors are implicated in the occurrence and intensity of these symptoms, little is known about the pathways and modifiers of these symptoms in Black women living with SLE. Moreover, patients from minority groups are
often under-represented in SLE research and have fewer opportunities to learn about how to control their symptoms and what individual factors may have a significant impact on the skills needed to self-manage the disease.”

Predicting Patients Who Will Benefit from Self-Efficacy Enhancing Interventions

For a study published in Lupus Science & Medicine, Dr. Drenkard and colleagues sought to address these issues in order to inform self-management interventions, helping to predict who might benefit most. In a cross-sectional analysis of data from 699 Black women with SLE, the researchers used validated, self-reported measures of pain interference, fatigue, depression, symptom self-efficacy, and treatment self-efficacy. The study team conducted linear regression analyses to assess the relationships between each outcome (pain interference and fatigue) and each predictor (treatment self-efficacy and symptom self-efficacy), as well as the interaction of depression and demographics.

The researchers reported a mean disease activity of 15.1 (SD, 8.7), a mean SLE duration of 15.6 (SD, 10.3) years, and mean organ damage of 2.6 (SD, 2.5). Some level of depression was reported in nearly half of
the sample, with 21.6% in the range of moderate/severe. The mean T-scores were 57.8 (SD, 11.0) for fatigue, 58.0 (SD, 9.9) for pain interference, 48.1 (SD, 8.5) for symptom self-efficacy, and 46.1 (SD, 9.2) for treatment
self-efficacy.

Future Research Should Focus on Alleviating Fatigue & Pain Via Intervention

Symptom self-efficacy and treatment self-efficacy were inversely related to fatigue and pain interference in Black women with SLE, and depression disproportionately increased the intensity of these outcomes, according to Dr Drenkard. “For Black women with SLE, higher levels of self-efficacy to manage symptoms and treatments were inversely and independently associated with fatigue and pain interference,” she says. “Yet, these associations were modified by age, educational level attained, and depressive symptoms, and the impact of these interactions on women’s outcomes varied by type and level of self-efficacy.

While older women with low symptom self-efficacy reported disproportionately higher pain interference, those with higher education and mean or high levels of symptom self-efficacy reported lower pain interference. “These results may help predict which patients would benefit most from self-efficacy-enhancing interventions,” Dr. Drenkard says.

The study team agrees that longitudinal studies are needed to ascertain whether self-efficacy-building interventions can alleviate fatigue and pain, improving the QOL of Black women with SLE. “Our data suggest
that improving depression screening and management are crucial to manage these pervasive symptoms and improve the QOL in in patients with SLE,” Dr. Drenkard notes.