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Depression closely related to fatigue in SLE patients

Presented by
Christina Düsing, Universitätsklinikum Düsseldorf, Germany
ACR 2019
Amongst others, improving the wellbeing of systemic lupus erythematosus (SLE) patients and optimising obesity, hypothyroidism, anaemia, and low vitamin D levels might be useful to improve fatigue, a symptom with a severe impact on quality of life [1].

Fatigue impacts up to 90% of patients with SLE [2]. The cause of fatigue is most likely multifactorial. Disease activity indices and laboratory markers inconsistently correlate with fatigue severity in SLE populations. An incomplete understanding of fatigue mechanisms limits effective treatment.

Therefore, the aim of the study by Christina Düsing (Universitätsklinikum Düsseldorf, Germany) was to identify additional potentially reversible associations with fatigue to generate a target for future interventions. Data came from 234 consecutively recruited SLE (according to the 1997 ACR criteria) outpatients from the university hospital-based lupus reference centre. Clinical and demographic data from routine visits, laboratory variables, as well as sleeping disorders, disease perception, coping, and social activities were analysed with validated questionnaires. The symptom fatigue was assessed using the Fatigue Severity Scale (FSS); 50% of the patients had pathological results (score of ≥4 points). The cohort was almost exclusively Caucasian (99.1%); 87.6% were female with a mean age of 45.3 years and a mean disease duration of 16.2 years.

Factors significantly associated with fatigue were depression (assessed by the German CES-D depression scale): 37.5% of patients with fatigue also showed depression versus 18.2% of patients without fatigue (P<0.001). In addition, patients with sleep disorders, pain, disease activity and damage showed significantly more fatigue (P<0.01). According to a regression analysis, reduced social activities exhibited the highest correlation with fatigue. Of note, in 71.4% of the cohort at least 1 potentially reversible association for fatigue could be identified (see Table). The authors concluded that due to the significant association with depression, psychological wellbeing of SLE patients should be assessed in everyday clinical practice. Additionally, optimising factors like obesity, anaemia, hypothyroidism, and vitamin D deficiency could represent possible targets in order to improve fatigue in SLE patients.

Table: Potentially reversible associations with fatigue in a cohort of 234 SLE patients, absolute numbers and percentages [1]

SLE, systemic lupus erythematosus; FSS, Fatigue Severity Scale; ADS-L, Allgemeine Depressions-Skala-Lang; TSH, thyroid-stimulating hormone

    1. Duesing Ch et al. Abstract 649. ACR 2019, 9-13 November, Atlanta (GA/USA).
    2. Mahieu MA, Ramsey-Goldman R. Curr Rheumatol Rev 2017;13; 103-12.

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