Background/Purpose: Fatigue is a frequently reported disabling symptom for patients with systemic sclerosis (SSc). It has a major impact on overall quality of life including work, family and social life. Our aim is to evaluate the frequency of fatigue among SSc patients compared to healthy and diseased controls and to delineate the factors associated with fatigue. 

Methods: We included SSc and rheumatoid arthritis (RA) patients who visited our outpatient clinic for their routine follow-up and healthy controls recruited from hospital staff. Comprehensive physical examination with nailfold capillaroscopy and assessment of Rodnan skin score (RSS) were performed by a single physician. Health assessment questionnaire disability index (HAQ-DI), multidimensional assessment of fatigue (MAF) scale, fatigue severity scale (FSS), fatigue impact scale (FIS), and Beck depression inventory (BDI) were filed by all participants. Having a score of ≥5 in FSS was tabulated as having fatigue for statistical analysis. Multivariate regression analysis was performed to determine the factors associated with high fatigue scores in SSc. 

Results: Seventy patients with SSc, 52 RA patients and 100 healthy controls were included in this study. MAF scores were significantly higher among RA patients (p<0.0001), followed by SSc patients (p=0.013) compared to healthy controls. Similarly, RA patients had higher FSS scores (p<0.0001), followed by SSc patients (p<0.0001) compared to healthy controls. FIS and BDI scores were highest in SSc patients (p<0.0001), followed by patients with RA (p<0.0001) and these were also significantly higher than healthy controls. The frequency of fatigue, determined by FSS score, was significantly higher with 77% among RA patients (40 out of 52 scored ≥5 in FSS) (χ²=14.758, df:2, p<0.0001), followed by SSc patients of whom 60% (42 out of 70) reported high FSS scores (χ²=9.402, df:1, p=0.002). SSc patients who experienced fatigue had higher frequency of skin pigmentation (72.9% vs. 45.5%, p=0.02), GI involvement (70% vs 35%, p=0.007), and higher HAQ (1.26 vs 0.54) and BDI scores (24.7 vs 12.1, p<0.001). The components of HAQ-DI which were significantly higher among SSc patients with fatigue were VAS-Raynaud (1.53 vs 0.32), VAS-digital ulcer (1.36 vs 0.32), VAS-GI (1.2 vs 0.39), and VAS-general (1.87 vs 0.76). In multivariate analysis, RSS (p=0.016, ß=0.365, 95%CI=0.28-0.45), pulmonary arterial hypertension (p=0.043, ß=0.258, 95%CI=0.009-0.504), VAS-digital ulcer (p=0.036, ß=0.339, 95%CI=0.009-0.271), and VAS-GI (p=0.016, ß=0.169, 95%CI=0.032-0.297) were independent predictors of fatigue. 

Conclusion: Around two-thirds of our SSc patients reported higher levels of fatigue. This increase in fatigue correlated with the extent of skin sclerosis, pulmonary hypertension and patient-reported digital ulcer and gastrointestinal involvement severity. 

 

	Systemic sclerosis (n=70)	Rheumatoid arthritis (n=52)	Healthy controls (n=100)	p value
Mean age, yrs	46.95 ± 11.96	54.07 ± 14.84	45.97 ± 10.39	<0.0001
Female/male ratio	65/5 (13)	40/12 (3.3)	96/4 (16)	0.001
Multidimensional assessment of fatigue scale	24.1 ± 14.08	33.9 ± 14.4	16.8 ± 6.06	<0.0001
Fatigue severity scale	4.61 ± 1.87	5.1 ± 1.8	3.97 ± 1.43	<0.0001
Fatigue impact scale	63.6 ± 39.4	61.69 ± 38.16	35.03 ± 28.67	<0.0001
Beck depression inventory	19.55 ± 12.34	17.15 ± 13.89	11.32 ± 9.55	<0.0001

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fatigue-in-systemic-sclerosis/