RESUMEN
OBJECTIVES: To a) identify threshold values of presenteeism measurement instruments that reflect unacceptable work state in employed r-axSpA patients; b) determine whether those thresholds accurately predict future adverse work outcomes (AWO) (sick leave or short/long-term disability); c) evaluate the performance of traditional health-outcomes for r-axSpA; d) explore whether thresholds are stable across contextual factors. METHODS: Data from the multinational AS-PROSE study was used. Thresholds to determine whether patients consider themselves in an 'unacceptable work state' were calculated at baseline for four instruments assessing presenteeism and two health-outcomes specific for r-axSpA. Different approaches derived from the receiver operating characteristic methodology were used. Validity of the optimal thresholds was tested across contextual factors and for predicting future AWO over 12 months. RESULTS: Of 366 working patients, 15% reported an unacceptable work state; 6% experienced at least one AWO in 12 months. Optimal thresholds were: WPAI-presenteeism ≥40 (AUC 0.85), QQ-method <97 (0.76), WALS ≥0.75 (AUC 0.87), WLQ-25 ≥ 29 (AUC 0.85). BASDAI and BASFI performed similarly to the presenteeism instruments: ≥4.7 (AUC 0.82) and ≥3.5 (AUC 0.79), respectively. Thresholds for WALS and WLQ-25 were stable across contextual factors, while for all other instruments they overestimated unacceptable work state in lower educated persons. Proposed thresholds could also predict future AWO, although with lower performance, especially for QQ-method, BASDAI and BASFI. CONCLUSIONS: Thresholds of measurement instruments for presenteeism and health status to identify unacceptable work state have been established. These thresholds can help in daily clinical practice to provide work related support to r-axSpA patients at risk for AWO.
RESUMEN
Fibromyalgia (FM) in systemic lupus erythematosus (SLE) patients contributes to increased fatigue, anxiety, depression, and mental exhaustion. This study's objective is to systematically review the literature and to determine the frequency of FM in patients with SLE and its associated factors. A literature review was conducted to assess the prevalence of FM in SLE patients and to identify FM-associated factors. This involved searching the PubMed and Cochrane Library databases from 1959 to 2023. Cohorts, case-control, and population-based studies were included, while those not focusing on FM rates in SLE patients were excluded. Data on FM-associated factors and FM frequency in control or connective tissue disease (CTD) groups were obtained if available. Secondary analyses compared FM frequencies in SLE and other groups (healthy controls or CTD groups). Fifty-six studies met the eligibility criteria. Out of the 56 studies, nine included comparative data between SLE patients and healthy controls, while six presented data comparing the frequency of FM in patients with SLE and other CTDs. The combined cohorts included 58,052 SLE patients. Among 5063 SLE patients, FM was detected. The overall random-effects pooled prevalence of FM was 15.8% (95% CI, 13.4-18.5) with high heterogeneity (I2, 97.9%). Our analysis revealed a significantly higher risk of FM in patients with SLE compared to controls (OR, 3.7; 95% CI, 2.74-5.0). There was a higher risk of FM in SLE patients compared to other rheumatic diseases, but the difference was not significant. Our study showed that the prevalence of FM is higher in patients with SLE compared to the general population. FM in SLE may act as a confounding factor when assessing disease activity and treatment response. Research results indicate that concurrent FM is a frequent comorbidity in SLE, emphasizing the importance of recognizing its occurrence in SLE patients.