Determinants of health status in fibromyalgia: a comparative study with systemic lupus erythematosus.
OBJECTIVE
To compare perceived health status in women with fibromyalgia (FM) and systemic lupus erythematosus (SLE) using the Medical Outcomes Study (MOS) Short Form Health Survey (SF-36); and to identify determinants of physical and mental health in each patient group.


METHODS
A cross sectional study of 46 women with FM (mean age 48.13 yrs, SD 9.40) and 59 women with SLE (mean age 42.36 yrs, SD 11.31). Patients with FM were recruited from a rheumatology clinic and a rheumatology practice, while patients with SLE were recruited from 4 rheumatology clinics. Clinical examination determined disease activity (by Systemic Lupus Activity Measure) in SLE and a tender point count was used for FM. Patients completed questionnaires assessing health status (SF-36), stress (Hassles), social support (Social Support Questionnaire 6), and coping (Coping Inventory for Stressful Situations).


RESULTS
Patients with FM reported more impairment on the following SF-36 subscales: physical function (p < 0.001), role physical (p < 0.001), bodily pain (p < 0.001), and vitality (p < 0.001). Physical component summary scores were also significantly lower (p < 0.001) for the FM group. Four hierarchical regression analyses were computed to determine factors related to physical and mental health in each patient group, with the following variables in the equation: age, income, disease activity (Step 1), hassles (Step 2), emotional and task coping, and social support (Step 3). Better physical health in FM was related to higher income (R2 = 0.17, p < 0.05). In the SLE group, better physical health was associated with younger age, less disease activity, and lower hassles (R2 = 0.37, p < 0.0001). Worse mental health among women with FM was associated with more hassles, more emotional coping, and less satisfaction with social support (R2 = 0.64, p < 0.0001), while lower income, higher hassles, and more emotional coping were linked to worse mental health in SLE (R2 = 0.46, p < 0.0001).


CONCLUSIONS
Health related quality of life (HRQL) is impaired among women with FM and SLE, with FM patients reporting greater impairment along several dimensions. Enhancing the HRQL of patients with FM and SLE requires targeting specific modifiable psychosocial factors.
Da Costa
D
D
Division of Clinical Epidemiology, The Montreal General Hospital, Quebec, Canada. mbh1@musica.mcgill.ca
Dobkin
P L
PL
Fitzcharles
M A
MA
Fortin
P R
PR
Beaulieu
A
A
Zummer
M
M
Senécal
J L
JL
Goulet
J R
JR
Rich
E
E
Choquette
D
D
Clarke
A E
AE
D000328:Adult; D005260:Female; D005356:Fibromyalgia / Q000503:physiopathology* / Q000523:psychology*; D006304:Health Status; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000503:physiopathology* / Q000523:psychology*; D008875:Middle Aged