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Predictors of fatigue and severe fatigue in a large international cohort of patients with systemic lupus erythematosus and a systematic review of the literature

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Arnaud L1, Gavand PE1,2, Voll R3, Schwarting A4, Maurier F5, Blaison G6, Magy-Bertrand N7, Pennaforte JL8, Peter HH9, Kieffer P10, Bonnotte B11, Poindron V1,2, Fiehn C12, Lorenz H13, Amoura Z14, Sibilia J1,15, Martin T1,2. Rheumatology (Oxford). 2018 Dec 27. doi: 10.1093/rheumatology/key398. [Epub ahead of print]

Abstract

Author information 1 Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, France. 2 Service d'immunologie clinique Nouvel hôpital civil, Strasbourg, France. 3 Klinik für Rheumatologie und Klinische Immunologie & Center of Chronic Immunodeficiency (CCI) Universitätsklinikum, Freiburg, Germany. 4 I.st Department of Internal Medicine, Universitätsmedizin, Mainz, Germany. 5 Internal Medicine Unit, Hôpitaux Privés de Metz, Metz, France. 6 Service de médecine interne - Centre de compétence en maladies auto-immunes et systémiques rares, Hôpitaux Civils de COLMAR, Colmar, France. 7 Service de médecine interne, CHRU de Besançon, Besançon, France. 8 Service de médecine interne, CHU de Reims - Hôpital Robert Debré, Reims, France. 9 Freiburg University Hospital, Uniklinikum Medizinische Klinik Abt, Rheumatologie and Klinische Immunologie, Freiburg, Germany. 10 Centre de compétence des maladies autoimmunes et systemiques rares, Service de médecine interne et soins continus du, centre hospitalier de Mulhouse, Mulhouse, France. 11 CHU Dijon Bourgogne, Service de médecine interne et immunologie clinique, France. 12 ACURA Centre for Rheumatic Diseases, Baden-Baden, Germany. 13 Department of Medicine V, University Hospital Heidelberg, Center for Rheumatic Diseases Baden-Baden, Heidelberg, Germany. 14 Service de Médecine Interne 2, Institut E3M, Assistance Publique-Hôpitaux de Paris (APHP), Groupement Hospitalier Pitié-Salpêtrière, Paris, France. 15 Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, Strasbourg, France.

Abstract OBJECTIVE: Fatigue is reported in up to 90% of patients with SLE. This study was conducted to identify the determinants associated with fatigue in a large cohort of patients with SLE, as well as to provide a systematic review of the literature.

METHODS: Patients from the Lupus BioBank of the upper Rhein, a large German-French cohort of SLE patients, were included in the FATILUP study if they fulfilled the 1997 ACR criteria for SLE and had Fatigue Scale for Motor and Cognitive Functions scores collected. Multivariate logistic regression analyses were performed to assess the determinants of fatigue and severe fatigue.

RESULTS: A total of 570 patients were included (89.1% female). The median age was 42 years (interquartile range 25-75: 34-52). The median value of the SAfety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI was 2 (0-4). Fatigue was reported by 386 patients (67.7%) and severe fatigue by 209 (36.7%). In multivariate analyses, fatigue was associated with depression [odds ratio (OR): 4.72 (95% CI: 1.39-16.05), P = 0.01], anxiety [OR: 4.49 (95% CI: 2.60-7.77), P < 0.0001], glucocorticoid treatment [OR: 1.59 (95% CI 1.05-2.41), P = 0.04], SELENA-SLEDAI scores [OR: 1.05 (95% CI: 1.00-1.12) per 1 point increase, P = 0.043] and age at sampling [OR: 1.01 (95% CI: 1.00-1.03) per 1 year increase, P = 0.03]. Severe fatigue was independently associated with anxiety (P < 0.0001), depression (P < 0.0001), glucocorticoid treatment (P = 0.047) and age at sampling (P = 0.03).

CONCLUSION: Both fatigue and severe fatigue are common symptoms in SLE, and are strongly associated with depression and anxiety. Disease activity and the use of glucocorticoids were also independently associated with fatigue, although more weakly.