Perceived Stress and Fatigue in Systemic Lupus Erythematosus

Patricia P. Katz¹, Desiree R Azizoddin² and Meenakshi Jolly³, ¹Medicine/Rheumatology, University of California, San Francisco, San Francisco, CA, ²Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, ³Rheumatology, Rush University Medical Center, Chicago, IL

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: depression, Fatigue, patient-reported outcome measures, stress and systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 6, 2017

Title: Patient Outcomes, Preferences, and Attitudes Poster II

Session Type: ACR Poster Session B

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

Background/Purpose: Fatigue is a common and often severe symptom among individuals with systemic lupus erythematosus (SLE). Yet, there is an incomplete understanding of the causes of fatigue. We examined perceived stress and depressive symptoms as potential predictors of fatigue in a large cohort of individuals with SLE.

Methods: Data from two years of the Lupus Outcomes Study (n = 650), obtained through annual structured telephone interviews, were used. All participants had physician-confirmed SLE. Fatigue was measured with the SF-36 Vitality scale (reversed); scores ranged from 0 – 100, with higher scores indicating greater fatigue. The following additional measures were also administered: 4-item Cohen Perceived Stress scale (PS), Centers for Epidemiological Studies Depression scale (CESD); Systemic Lupus Activity Questionnaire (SLAQ, self-reported disease activity), and Brief Index of Lupus Damage (BILD; self-reported lupus damage). Cross-sectional multivariate linear regression analyses examined the association of CESD and PS on fatigue. Longitudinal analyses were then conducted to identify predictors of increases in fatigue. Three longitudinal regression models were constructed. The first examined the association of CESD at time 1 (T1) with fatigue at time 2 (T2), controlling for T1 fatigue, age, sex, disease duration, SLAQ, BILD, comorbid conditions, self-report of fibromyalgia, obesity, and pain (SF-36 Pain subscale). The second model then added PS at T1, and the third added decrease in PS from T1 to T2.

Results: Sample characteristics are shown in Table 1. In cross-sectional analyses, both CESD and PS were significantly associated with fatigue (Table 2). In longitudinal analyses, T1 CESD was a significant independent predictor of T2 fatigue (Table 2, Model 1). When T1 PS was added (Model 2), PS was a significant predictor of T2 fatigue but CESD was no longer significant. The further addition of T1-T2 decrease in PS increased the predictive power of the mode (Model 3), and decline in PS was associated with a significant decrease in fatigue.

Conclusion: Both depressive symptoms and perceived stress were associated with concurrent fatigue. While depressive symptoms initially predicted subsequent increases fatigue, the effects were mediated by perceived stress. Furthermore, a decrease in perceived stress was associated with a decrease in fatigue. These results suggest that perceived stress plays an important role in SLE fatigue and may be an important focus of interventions to reduce fatigue.

Table 1. Characteristics of sample, n = 650
	Mean ± SD	% (n)
Age	52.7 ± 12.4
Female		92 (598)
T1 SLE activity (0 – 10)	4.1 ± 2.7
T1 BILD (0 – 12)	2.2 ± 2.0
T1 Pain (0 – 100)*	41.9 ± 11.2
T1 CES-D score	13.7 ± 12.1
T1 Fatigue (0 – 100)	54.8 ± 23.9
T1 Perceived stress score (0 – 16)	5.2 ± 3.5
T1-T2 decline in stress (≥ 2 points)		26.6 (173)
* Lower scores reflect higher pain

Table 2. Multivariate analysis results
	Cross-sectional analysis	Longitudinal analysis
	Cross-sectional analysis		Model 1	Model 2	Model 3
CESD	0.66 (<.0001)	T1 CESD	0.14 (0.04)	-0.03 (0.77)	-0.08 (.38)
Perceived stress	0.75 (.005)	T1 perceived stress	—	0.8 (.002)	1.57 (<.0001)
		T1-T2 decrease in perceived stress	—	—	-10.78 (<.0001)
Model R²	0.64	Model R²	0.58	0.58	0.62
• Tabled values are beta (p-value) from multivariate linear regression analysis • Cross-sectional analyses controlled for T1 age, sex, disease duration, self-reported disease activity and damage, pain, comorbid conditions, self-report of fibromyalgia, and obesity. • Longitudinal analyses controlled for the above plus T1 fatigue.

Disclosure: P. P. Katz, Bristol-Myers Squibb, 2; D. R. Azizoddin, None; M. Jolly, Pfizer Inc, 2,Medimmune, celgene, boehringer ingelheim, aurinia,, 7.

To cite this abstract in AMA style:

Katz PP, Azizoddin DR, Jolly M. Perceived Stress and Fatigue in Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/perceived-stress-and-fatigue-in-systemic-lupus-erythematosus/. Accessed .

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