Background/Purpose:  Fatigue is a major patient complaint in SLE, often severely impacting quality of life and activities including work. In this study, we analyze neuropsychiatric (NP) symptoms in relation to fatigue in SLE together with measures of disease activity, organ damage and potential contributing factors such as pain, psychiatric co-morbidities and sleep quality.

Methods: Measurements of fatigue were performed using the Fatigue Severity Scale (FSS) and the Visual Analogue Scale (100mm) (VAS). NP manifestations were defined according to NPACR case definitions. Disease activity, organ damage, health related quality of life and co-morbid conditions were recorded. Pain was recorded using the VAS (100mm). Depression and anxiety were evaluated with the Hospital Anxiety and Depression scale (HAD). Sleep disturbances were assessed using the Karolinska Sleep Questionnaire (KSQ). Cerebrospinal fluid was obtained in 33 patients who consented to lumbar puncture. Linear regression analyses were performed with VAS fatigue and FSS as outcome variables.

Results: 72 SLE patients and 26 matched healthy controls were included in this cross-sectional study. VAS fatigue and FSS were closely correlated (r=0.63, p<0.001). An increased VAS fatigue in the SLE group was associated with the following NP manifestations; cerebrovascular disease (p=0.047), headache (p<0.01), cognitive dysfunction (p=0.008) and depression (p=0.006). Furthermore, higher VAS fatigue scores correlated with increased HAD anxiety and HAD depression scores (p<0.001), lower EQ5D scores (p<0.001) and higher pain scores (p<0.001). However, there were no correlations between VAS fatigue score and age, disease duration, organ damage, co-morbidity or disease activity. Detection of CSF oligoclonal bands did not correlate with fatigue scores. Although most correlations were similar when using the FSS as outcome we found small differences compared to VAS fatigue; presence of autonomic neuropathy correlated with increased FSS (p=0.049) and there was no significant correlation between FSS and headache (p=0.163). In addition, a reduced overall sleep quality was seen comparing SLE patients and healthy controls using the KSQ (p<0.001). An increased FSS and VAS fatigue score in the SLE group correlated with scores in 3 sub-indices of the KSQ; insomnia (p<0.001), repeated awakenings (p<0.001) and daytime sleepiness (p<0.001). Finally, lower EQ5D scores was associated with increased both FSS and VAS fatigue scores (p<0.001 for both).

Conclusion:  NP involvement in SLE may contribute to fatigue development in these patients, hypothetically mediated in part by a reduced sleep quality. Other factors, such as pain and concomitant psychiatric disease are also implicated, while disease activity may be of less importance.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fatigue-in-sle-is-associated-with-neuropsychiatric-involvement-pain-impaired-sleep-and-a-reduced-quality-of-life/