Background/Purpose: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that leads to a variety of negative health outcomes. Though treatment continues to advance, fatigue remains one of the most salient, unaddressed patient complaints. Understanding the mechanisms of fatigue can help guide the development of interventions to improve health outcomes. The aim was to evaluate the role of six variables (disease activity, insomnia, depression, stress, pain, and physical functioning) towards fatigue in individuals with SLE.

Methods: 116 ethnically-diverse, primarily female participants (91%) with SLE, receiving care at university medical centers, completed assessments of disease activity, and quality of life outcomes (FACIT-FT, Insomnia Severity Index, Perceived Stress Scale (PSS-4), Pain Inventory, Depression-PHQ-9, and LupusPRO-physical function). All patients met ACR classification criteria for SLE and did not have concurrent diagnosis of fibromyalgia. Multivariate linear and stepwise regression analyses were conducted with fatigue (FACIT-FT) as the dependent variable and above six variables as independent variables.

Results:

Mean(SD) age was 39.80(13.9) years; 50% were African American, 21% Caucasian, 13% Hispanic, 9% Asian, and 8% other. Mean(SD) FACIT-FT was 18.6(11.8). Collectively, these six variables explained 57% variance in fatigue; wherein depression, stress and pain were significant independent predictors of fatigue on the multivariate model, but not disease activity, sleep or physical health. Largest magnitude of effect on fatigue was with stress (β 0.77, 95% CI0.17, 1.38, p=0.01) followed by depression (β 0.66, 95% CI0.21, 1.10, p=0.005). On stepwise regression analysis, stress, depression and pain collectively explained 56% of variance in fatigue in SLE. All three were independent correlates of fatigue, and the largest contribution to fatigue was again from stress (β0.84,95% CI 0.27,1.42, P=0.005), followed by depression (β0.79, 95% CI 0.44,1.14, p=<0.001).

Conclusion:

Stress and depression are the largest and independent contributors to fatigue among patients with SLE without concurrent fibromyalgia. Disease activity, sleep and physical health were not associated with fatigue in patients with SLE without concurrent fibromyalgia. Evaluation of stress and depression needs to be incorporated during assessment of SLE patients, especially in context of fatigue. This stress-depression-fatigue model needs further validation in a longitudinal study

Table 1. Demographics and general characteristics (n=116)

Note. SDI: SLICC/ACR Damage Index. SS: SELENA-SLEDAI. PGA: Physician Global Assessment

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fatigue-in-systemic-lupus-the-role-of-disease-activity-and-its-mediators/