Assignable Causes for Fatigue in Primary Sjögren's Syndrome: Data from the UK Primary Sjögren's Syndrome Registry

Rebecca L Lambson¹, Ben Hargreaves², Dennis W Lendrem², Victoria Hindmarsh³, Claire Humphrey³, Sheryl Mitchell³, Bridget Griffiths⁴, Simon Bowman⁵, UKPSS Registry⁶ and Wan-Fai Ng⁷, ¹Newcastle University, Medical School, Newcastle upon Tyne, United Kingdom, ²Institute of Cellular Medicine (Musculoskeletal Research Group), NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals Foundation Trust and Newcastle University, Newcastle upon Tyne, United Kingdom, ³Freeman Hospital, Newcastle upon Tyne, United Kingdom, ⁴Rheumatology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom, ⁵Rheumatology Dept, University Hospital Birmingham, Birmingham, United Kingdom, ⁶Newcastle University, Newcastle upon Tyne, United Kingdom, ⁷NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Sjogren's syndrome and fatigue

Session Information

Date: Sunday, November 8, 2015

Title: Sjögren's Syndrome Poster I: Clinical Insights into Sjögren's Syndrome

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Fatigue is frequently reported as an important symptom in need of management by patients with Primary Sjögren’s Syndrome (SS) [1-3]. It can be severe, having a major effect on quality of life, but many patients report that their fatigue is not always well managed [3, 4]. Furthermore, PSS patients often present with complex multiple co-morbidities, but, until now no analysis of assignable causes of fatigue has been attempted in this patient group. This study attempts to identify the aetiology of fatigue in a large cohort of PSS patients.

Methods:

We studied fatigue in 795 PSS patients from the UK Primary Sjögren’s Syndrome Registry. All patients met the American-European Consensus Group criteria [5] for PSS. The objective of the study was to identify assignable causes of fatigue in PSS patients. The following conditions were considered potentially treatable conditions that can cause fatigue independent of PSS: thyroid disease, diabetes mellitus, celiac disease, significant anaemia (Hb<10), and depression. Medications that can cause drowsiness (e.g. antipsychotics) were also included in the analysis.

Results:

43% (n=340) of patients had assignable cause(s) other than PSS for their fatigue. Of these, 50% (n=172) had hypothyroidism or abnormal TSH, 8% (n=28) had depression, 6% (n=20) had celiac disease, 6% (n=20) had non-insulin-dependent-diabetes, 2% (n=7) had insulin-dependent-diabetes, and 2% (n=7) had significant anaemia. Concurrent medications ranged from 0-26 with 50% (n=169) of the cohort with an assignable cause for their fatigue taking medications that can cause drowsiness. 78% (n=266) of these patients had 1 assignable cause for their fatigue apart from SS, 19% (n=64) had 2 assignable causes and 3% (n=10) had 3.

Having said this, the fatigue in the majority of patients in this study cohort was unassignable (57%, n=455). There were few other tangible differences between those with an assignable cause for their fatigue to those without. The number of pSS medications prescribed ranged from 0-8, with 56% (n=444) of the total cohort taking at least 1 medication. 601 patients from the entire cohort (n=795) were classed as having “abnormal fatigue” (score of >2 on the profile of fatigue score), of those with an assignable cause for their fatigue 82% (n=279) had “abnormal fatigue” compared to 71% (n=322) patients whose cause of fatigue is unknown. Physical fatigue was ranked as the first or second most important symptom in need of improvement by 71% (n=243) patients with an assignable cause for their fatigue and 69% (n=316) in those without an assignable cause for their fatigue.

Conclusion:

Overall, 70% of PSS patients rate their fatigue as one of the most important symptoms needing improvement demonstrating the need for fatigue management. A significant proportion (43%) of PSS patients have assignable causes for fatigue other than PSS. Fatigue management is critical to patients with PSS, therefore, screening for and appropriate management of any other assignable causes of patients’ fatigue is important. However, the majority of PSS patients with fatigue have no obvious assignable causes, further investigation into the biological basis of fatigue in PSS is necessary.

Disclosure: R. L. Lambson, None; B. Hargreaves, None; D. W. Lendrem, None; V. Hindmarsh, None; C. Humphrey, None; S. Mitchell, None; B. Griffiths, None; S. Bowman, Cellgene, 5,Glenmark, 5,GlaxoSmithKline, 5,Eli Lilly and Company, 5,Novartis Pharmaceutical Corporation, 5,Roche Pharmaceuticals, 5,Takeda, 5,UCB, 5; U. Registry, None; W. F. Ng, None.

To cite this abstract in AMA style:

Lambson RL, Hargreaves B, Lendrem DW, Hindmarsh V, Humphrey C, Mitchell S, Griffiths B, Bowman S, Registry U, Ng WF. Assignable Causes for Fatigue in Primary Sjögren’s Syndrome: Data from the UK Primary Sjögren’s Syndrome Registry [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/assignable-causes-for-fatigue-in-primary-sjgrens-syndrome-data-from-the-uk-primary-sjgrens-syndrome-registry/. Accessed .

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