Physical activity and patient education are important nonpharmacological management strategies for systemic sclerosis (SSc) and systemic lupus erythematosus (SLE), according to a study published in RMD Open. 

SLE and SSc are both rheumatic connective tissue diseases that are associated with a substantial disease burden and a poor health-related quality of life. Despite therapeutic advancements, patients with either disorder have a shorter life expectancy compared with their healthy peers. 

Clinicians are increasingly turning their attention toward nonpharmacological means to manage these disorders. Studies indicate that healthy habits such as physical exercise can reduce fatigue and improve disease symptoms. Some clinicians advocate for the delivery of healthcare and education via e-health settings, something that was necessary during the COVID-19 pandemic. 

The authors conducted a systematic literature review to assess the merits of various nonpharmacological means to manage SLE/SSc, with the view of submitting these recommendations to the European Alliance of Associations for Rheumatology (EULAR). 

Read more about SSc etiology 

In this study, a task force of 25 experts across various healthcare and research sectors was set up. The literature review was guided by 9 questions agreed by the task force—these included topic areas such as type and efficacy of interventions, outcomes, patient expectations and education needs, and barriers for the nonpharmacological management of SLE/SSc. The task force looked for studies using academic search engines for content published between January 2000 and June 2021. 

One hundred eighteen articles were ultimately selected for analysis. The research team then conducted a robust assessment of the findings and analysis reported in these studies. The research team reported that physical exercise was the most studied nonpharmacological management strategy for SLE/SSc and yielded significant health benefits, such as reduction in fatigue in SLE and improvement in hand function in SSc. In addition, there was some evidence indicating that education and self-management likewise improved clinical outcomes. Other notable nonpharmacological management strategies included psychological intervention in SLE and laser treatment in SSc. 

“In conclusion, non-pharmacological management of SLE and SSc encompasses a wide range of interventions, which can be combined and provided either with or without adjunct pharmacological treatment,” the authors concluded. 


Parodis I, Gomez A, Tsoi A, et al. Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosisRMD Open. Published online August 2, 2023. doi:10.1136/rmdopen-2023-003297