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Fatigue in systemic lupus erythematosus

Association with disease activity, quality of life and psychosocial factors

Fatigue bei systemischem Lupus erythematodes

Assoziation mit Krankheitsaktivität, Lebensqualität und psychologischen Faktoren

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Abstract

Objective

The aim of the study was to determine which disease-related factors and non-disease features can explain the presence of systemic lupus erythematosus (SLE)-related fatigue in Turkish patients.

Methods

This cross-sectional study was carried out with 99 SLE patients and 71 healthy controls. To assess fatigue and health-related quality of life (HRQoL) the participants were asked to complete two questionnaires: the short form-36 health survey (SF-36) and the multidimensional assessment of fatigue (MAF) scale. Anxiety and depression of participants were assessed by the hospital anxiety and depression scale (HADS).

Results

A total of 99 patients (female/male 95/4) and 71 controls (female/male 40/31) were studied. The mean age and standard deviation (±SD) of patients and controls were 43.3 ± 12.2 years and 43.2 ± 12.1 years, respectively. The mean (SD) disease duration was 7.8 ± 5.3 years and median SLE disease activity index (SLEDAI) score was 0 (range = 0–16). The level of fatigue was higher in patients compared to controls with mean MAF scores of 24.7 ± 12.2 and 12.8 ± 9.9 (p < 0.001), respectively. The HADS-D and HADS-A scores were also significantly higher in SLE patients (6.6 ± 4.3 vs. 3.6 ± 2.9, p < 0.001 and 7.2 ± 4 vs. 4.9 ± 4, p = 0.007, respectively). There were no significant associations between the MAF and SLEDAI scores (r = 0.05, p = 0.63) but MAF scores positively correlated with age, HADS-A and HADS-D scores and negatively correlated with physical component summary (PCS), mental component summary (MCS) and each domain of SF-36 except role emotional in SLE patients.

Conclusion

Fatigue is an important factor influencing patient daily life independent from disease activity in our study. The SLE patients with severe fatigue should also be assessed for other possible underlying causes such as anxiety, depression and poor quality of life.

Zusammenfassung

Ziel

Ziel der Studie war es zu bestimmen, durch welche krankheitsbedingten Faktoren und nicht krankheitsbedingten Merkmale das Vorliegen einer durch Lupus erythematodes (SLE) hervorgerufenen Fatigue bei türkischen Patienten erklärt werden kann.

Methoden

Diese Querschnittsstudie wurde mit 99 SLE-Patienten und 71 gesunden Kontrollpersonen durchgeführt. Um Fatigue und gesundheitsbedingte Lebensqualität (HRQoL) zu untersuchen, wurden die Teilnehmer gebeten, 2 Fragebögen auszufüllen: den Short-Form(SF)-36 Fragebogen zum Gesundheitszustand und die Multidimensional Assessment of Fatigue (MAF) Scale. Angst und Depression der Teilnehmer wurden mittels der Hospital Anxiety and Depression Scale (HADS) untersucht.

Ergebnisse

Insgesamt wurden 99 Patienten (95 weiblich, 4 männlich) und 71 Kontrollpersonen (40 weiblich, 31 männlich) untersucht. Das mittlere Alter (± Standardabweichung [SD]) der Patienten und Kontrollpersonen betrug 43,3 ± 12,2 bzw. 43,2 ± 12,1 Jahre. Die mittlere (± SD) Krankheitsdauer lag bei 7,8 ± 5,3 Jahren und der mediane Score des SLE-Krankheitsaktivitätsindex („SLE disease activity index“, SLEDAI) betrug 0 (Range: 0–16). Der Fatigue-Wert war bei den Patienten höher als bei der Kontrollgruppe mit einem mittleren MAF-Score von 24,7 ± 12,2 bzw. 12,8 ± 9,9 (p < 0,001). Die HADS-D- und HADS-A-Scores waren ebenfalls signifikant höher bei SLE-Patienten (6,6 ± 4,3 vs. 3,6 ± 2,9 [p < 0,001] bzw. 7,2 ± 4 vs. 4,9 ± 4, [p = 0,007]). Es gab keine signifikante Assoziation zwischen den MAF- und SLEDAI-Scores (r = 0,05; p = 0,63), jedoch korrelierten die MAF-Scores positiv mit dem Alter, den HADS-A- und HADS-D-Scores sowie negativ mit der Physical Component Summary (PCS), der Mental Component Summary (MCS) und jeder Domäne des SF-36-Fragebogens mit Ausnahme der emotionalen Rollenfunktion.

Schlussfolgerung

Fatigue ist ein wichtiger Faktor, der das Alltagsleben der Patienten in unserer Studie unabhängig von der Krankheitsaktivität beeinflusst. SLE-Patienten mit schwerer Fatigue sollten auch auf andere möglicherweise zugrunde liegenden Ursachen wie Angst, Depression oder schlechte Lebensqualität untersucht werden.

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Authors and Affiliations

  1. School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey

    S. Yilmaz-Oner MD, M. Can MD, F. Alibaz-Oner MD, G. Ozen MD &  H. Direskeneli MD

  2. School of Medicine, Marmara University, Istanbul, Turkey

    B. Ilhan MD & O. Polat-Korkmaz MD

  3. Faculty of Health Sciences, Department of Health Management, Marmara University, Istanbul, Turkey

    G. Mumcu

  4. College of Medicine, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    H. M. Kremers MD MSc

  5. School of Medicine, Department of Nephrology, Marmara University, Istanbul, Turkey

    S. Tuglular MD

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  1. S. Yilmaz-Oner MD
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Correspondence to S. Yilmaz-Oner MD.

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Conflict of interests

S. Yilmaz-Oner, B. Ilhan, M. Can, F. Alibaz-Oner, O. Polat-Korkmaz, G. Ozen, G. Mumcu, H.M. Kremers, S. Tuglular and H. Direskeneli state that they have no competing interest.

All studies on humans described in this manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current revised form). Informed consent was obtained from all patients included in the study.

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Redaktion

U. Müller-Ladner, Bad Nauheim

U. Lange, Bad Nauheim

S. Yilmaz-Oner and B. Ilhan contributed equally to the study

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Yilmaz-Oner, S., Ilhan, B., Can, M. et al. Fatigue in systemic lupus erythematosus. Z Rheumatol 76, 913–919 (2017). https://doi.org/10.1007/s00393-016-0185-0

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