Beneficial effect of Mediterranean diet on disease activity and cardiovascular risk in systemic lupus erythematosus patients: a cross-sectional study.

OBJECTIVE: To analyse the influence of the Mediterranean diet (Med Diet) on SLE activity, damage accrual and cardiovascular disease risk markers. METHODS: A cross-sectional study was conducted on 280 patients with SLE [46.9 (12.85) years]. Med Diet adherence was assessed through a 14-item questionnaire on food consumption frequency and habits (total score from 0 to 14 points; higher score is greater adherence to the Med Diet). CRP, homocysteine, SLEDAI-2K (SLE disease activity), and SLICC/ACR and SDI (damage accrual) were measured. Obesity, diabetes mellitus, hypertension and blood lipids, among others, were considered cardiovascular disease risk factors. RESULTS: Greater adherence to the Med Diet was significantly associated with better anthropometric profiles, fewer cardiovascular disease risk factors, and lower disease activity and damage accrual scores (P ≤ 0.001 for SLEDAI and SDI). An inverse relationship between the Med Diet score and SLEDAI (P ≥ 0.001; ß = -0.380), SDI (P ≤ 0.001; ß = -0.740) and hsCRP (P = 0.039; ß = -0.055) was observed. The odds ratio for having active SLE (SLEDAI ≥5) or the presence of damage (SDI ≥1) was lower among patients whose Med Diet score was higher (P ≤ 0.001). Finally, greater consumption of Med Diet foods (olive oil, fruits, vegetables, fish, etc.) and abstaining from red meat and meat products, sugars and pastries was associated with less SLE clinical activity and damage. CONCLUSION: Greater adherence to the Med Diet seems to exert a beneficial effect on disease activity and cardiovascular risk in SLE patients. To confirm these findings, further longitudinal studies would be of interest.

Personality disorders and emotional variables in patients with lupus / Trastornos de personalidad y variables emocionales en pacientes con lupus

Summary Introduction: Systemic lupus erythematosus (SLE), a prototype of the autoimmune diseases, is a multi-systemic disease characterized by an alteration in the immunological response, where the production of antibodies is directed against nuclear antigens, thus affecting many organs and systems. The course of this disease includes a wide range of clinical manifestations, different anatomo-pathological findings, and a series of immunological abnormalities. It is characterized by outbreaks and remissions. SLE can be manifested by general malaise, fever, fatigue, weight loss, skin rashes or joint inflammation, anemia, inflammation of the lymphatic glands, lowering of the defenses against infection, and cardiac, kidney, pulmonary and neurological alterations. In chronic dermatological lupus, only the skin is affected; this condition can present rash erythemas, etc. The recent introduction of new immunological diagnostic methods (antinuclear antibodies, anti-DNA antibodies, complementary fraction, etc.) has made it possible to recognize less severe forms of the disease, as well as its outbreaks and therapeutic guidelines. Different psychological variables have been associated with the exacerbation of the disease; one of the most notable is stress, and many patients with lupus also suffer diverse psychiatric and personality disorders associated with the disease, with a prevalence oscillating between 20% and 60%. Furthermore, these alterations have been associated with a lower quality of life, poorer evolution and psychiatric antecedents. In the specific case of personality alterations, previous research has found the existence of a "triad of personality" characteristics in patients with lupus. Depression, hysteria and hypochondria are the factors making up this triad. However, it has not been shown whether these personality disorders are just another symptom of the disease or a consequence of the emotional disorders produced by it. The purpose of this study was to test the possible existence of personality disorders and their relationship with other affective disorders in SLE. Methods: In order to do this, we studied 30 patients with lupus and evaluated their possible personality disorders with the MMPI and their levels of depression and anxiety with the BDI and STAI, respectively. Then, after analyzing the results obtained on the tests administered, three groups were established: patients with lupus who had no emotional disorders, patients with lupus who presented clinical anxiety, and patients with lupus who presented clinical depression. These categories were represented graphically. In order to test the effects of anxiety and depression in the psychopathological personality profile, 10 between-group univariate variance analyses (ANOVA) were carried out, one for each subscale of the MMPI. The variable "presence or non-presence of emotional disorders" was the two-level factor. Results: In the graphic representation of the personality patterns of the three groups, it can be seen that patients with lupus who did not present emotional disorders (neither depression or anxiety) did not show any alterations in their personality patterns. However, this pattern was altered in those who presented depression or anxiety. Later, the results found show statistically significant differences on the subscales of Hypochondria [F=9.795, df=1, 29, ±0.004)], Psychasthenia [F=15.266, df=1, 29, p±0.001], and Schizophrenia [F=4.97, df=1, 29, p±0.001)] among those patients who presented emotional disorders and those who did not present any emotional disorder, with the latter receiving higher scores. Conclusion: We can state that the development of personality disorders in patients with lupus is associated with emotional alterations, which probably relate more to processes of adaptation to the disease than to the disease itself.

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