Dual trajectories of fatigue and disease activity in an inception cohort of adults with systemic lupus erythematosus over 10 years

Moazzami, Mitra; Strand, Vibeke; Su, Jiandong; Touma, Zahi

doi:10.1177/0961203320983892

Cited by 10 publications

(13 citation statements)

References 31 publications

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“…Disease activity seems to play a role in the genesis of fatigue but it cannot fully explain fatigue by itself. Indeed, a study based on an inception cohort of adult patients with SLE found that fatigue and disease activity followed distinct trajectories over 10 years [20]. Additionally, in our recent FATILUP studies [21], the association between fatigue and disease activity was significant, but weak (OR: 1.05 (95% CI: 1.00-1.12) per 1 point increase in SELENA-SLEDAI score).…”

Section: Lupus-related Determinantsmentioning

confidence: 83%

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Fatigue in Systemic Lupus Erythematosus: An Update on Its Impact, Determinants and Therapeutic Management

Kawka

Schlencker

Mertz

et al. 2021

JCM

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Fatigue is a complex and multifactorial phenomenon which is often neglected by clinicians. The aim of this review was to analyze the impact, determinants and management of fatigue in patients with Systemic Lupus Erythematosus (SLE). Fatigue is one of the most prevalent symptoms in SLE, reported by 67% to 90% of patients. It is also described as the most bothersome symptom, considering that it may impair key aspects of health-related quality of life, while also leading to employment disability. It is a multifactorial phenomenon involving psychological factors, pain, lifestyle factors such as reduced physical activity, whereas the contribution of disease activity remains controversial. The management of fatigue in patients with SLE should rely upon a person-centered approach, with targeted interventions. Some pharmacological treatments used to control disease activity have demonstrated beneficial effects upon fatigue and non-pharmacological therapies such as psychological interventions, pain reduction and lifestyle changes, and each of these should be incorporated into fatigue management in SLE.

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Section: Lupus-related Determinantsmentioning

confidence: 83%

“…Fibromyalgia is a major predictor of fatigue in SLE [14,18,36]. In a study conducted by Touma et al, trajectories with higher fatigue scores were associated with a higher prevalence of fibromyalgia [20]. Fibromyalgia is common in SLE patients (from 6.2% to 30% of patients) but may be underdiagnosed by physicians [21,37].…”

Section: Comorbiditiesmentioning

confidence: 99%

Fatigue in Systemic Lupus Erythematosus: An Update on Its Impact, Determinants and Therapeutic Management

Kawka

Schlencker

Mertz

et al. 2021

JCM

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“…A recent study examining fatigue trajectories in a cohort of SLE patients found no association with disease activity, but identified higher levels of fatigue in those with fibromyalgia. This study also noted an association between higher glucocorticoid use and fatigue, suggesting a role for the side effects of medication, particularly glucocorticoids [36]. Crucially, while many studies have examined the relationship between inflammatory molecules and organ involvement, such as lupus nephritis, very few studies have been performed examining fatigue-in stark contrast to RA.…”

Section: The Role Of Disease Activitymentioning

confidence: 55%

Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Comparison of Mechanisms, Measures and Management

Dey

Parodis

Nikiphorou

2021

JCM

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Fatigue is a common constitutional feature of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). While the two diseases share a common mechanism of autoimmunity, they differ in their clinical manifestations and treatment. Fatigue is one of the most commonly reported symptoms in both groups, associated with pain, depression and anxiety, and affecting function, work and quality of life. Fatigue is not easy to assess or conceptualise. It can be linked to disease activity, although it is not always, and is challenging to treat. Several measures have been trialled in RA and SLE; however, none have been adopted into mainstream practice. Despite being a common symptom, fatigue remains poorly managed in both RA and SLE—more so in the latter, where there have been relatively fewer studies. Additionally, comorbidities contribute to fatigue, further complicating its management. Pain, depression and anxiety also need to be addressed, not as separate entities, but together with fatigue in a holistic manner. Here, we describe the similarities and differences between fatigue in patients with RA and SLE, discuss concepts and practices applicable to both conditions and identify areas for further research. Through this review, we aim to highlight the importance of the holistic management of fatigue in SLE.

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“…Until now, the clinical segregation of SLE patients was heterogeneous between different studies. Before the rst description of type 1/type 2 symptoms by Duke University (10), some studies described SLE patients with active/inactive disease and high/low fatigue (7) and found quite similar proportions as with the type 1/type 2 categorization (19). Interestingly, as in the cohort from Duke University, no signi cant difference was observed between the immunological pro les of the four clinical groups.…”

Section: Ifn Modulesmentioning

confidence: 96%

Categorization of Patients With Systemic Lupus Erythematosus Using Disease Activity, Patient-Reported Outcomes and Transcriptomic Signatures

Arcani

Jouve

Chiche

et al. 2021

Preprint

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Objective Patients with systemic lupus erythematosus (SLE) display symptoms that are not always related to disease activity and may distort clinical trial results. Recently, a clinical categorization based on the presence of type 1 (inflammatory manifestations) and/or type 2 (widespread pain, fatigue, depression) symptoms has been proposed in SLE. Our aim was to develop a type 2 score derived from the Short-Form health survey (SF-36) to categorize SLE patients and to compare immunological and transcriptomic profiles between groups. Methods Seventeen items from the SF-36 were selected to build a type 2 score for 50 SLE patients (100 visits; LUPUCE cohort) and the SLEDAI was used to define type 1 symptoms. Patients were categorized in four groups: minimal (no symptoms), type 1, type 2 and mixed (both type 1 and type 2 symptoms). Clinical, immunological and transcriptomic profiles were compared between the groups. Results Type 2 scores ranged from 0 to 31, with a cut-off value of 14 (75th percentile). The sample categorization was: minimal in 39%, type 1 in 37%, type 2 in 9% and mixed in 15%. Type 2 patients were older than minimal patients and had a longer disease duration than type 1 and mixed patients. Immunological data and modular interferon signatures did not differ between the groups. Conclusion Patients with SLE can be categorized into four clinical groups using the SLEDAI score and our SF-36-derived type 2 score. This categorization is non-redundant with immunological or transcriptomic profiles and could prove useful to stratify patients in clinical trials.

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Dual trajectories of fatigue and disease activity in an inception cohort of adults with systemic lupus erythematosus over 10 years

Cited by 10 publications

References 31 publications

Fatigue in Systemic Lupus Erythematosus: An Update on Its Impact, Determinants and Therapeutic Management

Fatigue in Systemic Lupus Erythematosus: An Update on Its Impact, Determinants and Therapeutic Management

Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Comparison of Mechanisms, Measures and Management

Categorization of Patients With Systemic Lupus Erythematosus Using Disease Activity, Patient-Reported Outcomes and Transcriptomic Signatures

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