Association of coping responses with fibromyalgia tender points in patients with systemic lupus erythematosus

Objective. To determine the association between fibromyalgia (FM) tender points (TP) and psychological constructs in patients with systemic lupus erythematosus (SLE). Methods. One hundred seventy-three patients with SLE were examined for FM TP, and asked to complete 2 questionnaires at the same visit, the Health-Related Hardiness Scale (HRHS), and the Mishel Uncertainty in Illness Scale (MUIS). Results. The examination of FM TP showed that 38.2% had no TP, 44.5% had 1-10 TP, and 17.3% had ≥ 11 TP. The mean ± SD score of the HRHS was 155.6 ± 19.7 (range 105.0-198.0; higher scores indicate greater hardiness), and the MUIS was 85.3 ± 18.7 (range 41.0-132.0; higher scores indicate uncertainty). There were significant associations between FM TP and HRHS (no TP 161.2 ± 20.2, 1-10 TP 152.5 ± 19.7, ≥ 11 TP 151.0 ± 15.8; p = 0.0108) and between FM TP and MUIS (no TP 78.2 ± 20.2, 1-10 TP 86.9 ± 17.6, ≥ 11 TP 95.8 ± 14.7; p = 0.0001). Conclusion. This study shows a strong association between FM TP and uncertainty or lack of 'hardiness.' We conclude that SLE patients with FM TP are less likely to be good 'copers.' Prospective studies to determine if 'poor coping' predicts FM in SLE are recommended. If the association between coping and FM is causal, it will justify interventions to improve coping and similar constructs, such as self- efficacy.