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Abstract
Background Fatigue is a very common and debilitating symptom in patients with systemic lupus erythematosus (SLE), even among those with a mild or inactive disease. The objective of this study is to define fatigue determinants and describe the impact of fatigue on health-related quality of life (HRQoL) and illness perception in a monocentric cohort of patients with SLE.
Methods This is a cross-sectional study. Adult patients with SLE were included. For each patient, demographics, medications, comorbidities, organ damage (Systemic Lupus International Collaborating Clinics Damage Index), active disease manifestations and Systemic Lupus Disease Activity Index scores were collected. It was evaluated if each patient met the definitions of remission and low disease activity. At enrolment, each patient completed the Short Form-36 (SF-36), Functional Assessment Chronic Illness Therapy-Fatigue (FACIT-F), Lupus Impact Tracker (LIT), Systemic Lupus Activity Questionnaire (SLAQ) and Brief Index of Lupus Damage (BILD). The FACIT-F questionnaire was also administered to a group of healthy controls.
Results 223 patients were included (mean age 44.9±13.2 years, median disease duration 13 years). 18.2% had an active disease, 43.5% met the definition of remission on treatment, and 11.8% had a concomitant fibromyalgia. The median FACIT-F score of our cohort was significantly lower compared with that of healthy controls (40 vs 47; p<0.001). FACIT-F scores were irrespective of age, disease duration, disease activity and damage. FACIT-F score was significantly lower in patients with fibromyalgia (p<0.01). FACIT-F scores demonstrated a significant correlation with all other patient-reported outcomes: SF-36 (r=0.53–0.77), LIT (r=−0.78), SLAQ (r=−0.72) and BILD (r=−0.28).
Conclusions Fatigue in patients with SLE has a strong negative impact on HRQoL and patient perception of the disease burden. Fatigue seems irrespective of disease activity but significantly influenced by the presence of fibromyalgia.
- systemic lupus erythematosus
- patient perspective
- autoimmune diseases
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Footnotes
Contributors EE contributed to the acquisition of data, and to the analysis and interpretation of data, and was in charge of writing the manuscript. CT contributed to the conception and design of the study and to the acquisition of data, was responsible for the analysis and interpretation of data, and contributed to writing the manuscript. CS, FF, AP, LC, VS, DZ, UP, AS and LR actively contributed to the acquisition of data and drafting the manuscript. MM contributed to the conception and design of the study and to the acquisition of data, was responsible for the analysis and interpretation of data, and contributed to writing the manuscript. All authors have read and approved the final version of the article.
Funding EE received financial support from the INTEGRATE project (European Commission, 3rd Health Programme, Proposal ID 769736) and from the University of Pisa (BIHO).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the local ethics committee ('Comitato Etico di Area Vasta Nord Ovest' (CEAVNO), committee’s reference number: 14478). Patients signed informed consent for the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.