Fatigue in Systemic Lupus Erythematosus and Other Autoimmune Skin Diseases

M. Tarazi; R.G. Gaffney; D. Pearson; C.J. Kushner; V.P. Werth

Disclosures

The British Journal of Dermatology. 2019;180(6):1468-1472. 

In This Article

Abstract and Introduction

Abstract

Background: Fatigue is a well-established symptom in systemic lupus erythematosus (SLE), but has not been well characterized in other skin-limited autoimmune diseases such as cutaneous lupus erythematosus (CLE), amyopathic dermatomyositis (ADM) or autoimmune blistering diseases (AIBD).

Objectives: In this retrospective study, we compared fatigue in controls (n = 84) with that in patients enrolled in prospective longitudinal databases with SLE (n = 165), CLE (n = 226), ADM (n = 136) and AIBD (n = 79).

Methods: We used the 36-Item Short Form Survey (SF-36) vitality scale to analyse median scores and the percentages of patients with clinically significant fatigue (defined as a score ≤ 35) between experimental groups and controls.

Results: Median and interquartile range (IQR) vitality scores demonstrated greater fatigue in the experimental groups (SLE 35, IQR 20–55; CLE 50, IQR 30–70; ADM 50, IQR 30–65; AIBD 55, IQR 35–70) than in controls (73, IQR 65–85) (P < 0·05 for each experimental group vs. control). The SLE group had worse fatigue than all of the other groups (P < 0·05 SLE vs. each group), but there was no difference between the CLE, ADM or AIBD groups (all P > 0·05). In addition, the experimental groups had more clinically significant fatigue (score ≤ 35) (SLE 44·2%, CLE 25·2%, ADM 31·6%, AIBD 24·1%) than controls (2%) (P < 0·01 for each experimental group vs. control). The SLE group had more clinically significant fatigue than the CLE group (P < 0·01); however, there was no difference in clinically significant fatigue between SLE and either ADM (P = 0·17) or AIBD (P = 0·055).

Conclusions: These findings demonstrate that patients with skin-limited autoimmune disease experience more fatigue than controls. Fatigue is an important symptom that negatively affects quality of life for patients. It should be addressed by clinicians and measured in future clinical trials.

Introduction

Fatigue is a well-established symptom in systemic lupus erythematosus (SLE) that significantly impacts patients' quality of life and contributes to disease morbidity. It has been described as an abnormal or extreme whole-body tiredness that is disproportionate to activity or exertion.[1] Overall, 53–80% of patients with SLE identified fatigue as one of their primary symptoms, and its aetiology is thought to be multifactorial.[1] Studies aimed at finding a relationship between fatigue and immunological, inflammatory or other disease characteristics have shown inconsistent results. Fatigue strongly correlates with psychosocial factors such as mood disorders, anxiety, poor sleep quality and chronic pain syndromes.[2]

Although patients with skin-limited autoimmune diseases anecdotally report significant fatigue, there are limited data in patients with conditions such as cutaneous lupus erythematosus (CLE), amyopathic dermatomyositis (ADM) and autoimmune blistering diseases (AIBDs). The aim of this study was to compare fatigue severity between patients with these skin-limited autoimmune conditions and those with SLE, as well as with a healthy control group.

Given what is known about fatigue's influence on quality of life in multiple different inflammatory conditions, it is important to gain a better understanding of the prevalence of fatigue in patients with skin-limited autoimmune diseases. In this retrospective study we use median 36-Item Short Form Survey (SF-36) vitality scores to compare fatigue in historical controls with patients enrolled in prospective longitudinal databases with SLE, CLE, ADM and AIBD. We also examined the percentage of patients in each group who experienced 'clinically significant' fatigue.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....