Right Insular Cortex-Thalamic Functional Connectivity as a Potential Marker for Fatigue in Systemic Lupus Erythematosus and Primary Sjögren's Syndrome

Yuichiro fujieda¹, Kodai Sakiyama¹, Nobuya Abe¹, Ryo Hisada¹, Michihito Kono¹, Masaru Kato¹, Olga Amengual², Khin Khin Tha³, Hisashi Shirakawa⁴ and Tatsuya Atsuma⁵, ¹Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan, ²Hokkaido University, Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan, ³Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University Hospital, Sapporo, Japan, ⁴Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto, Japan, ⁵Hokkaido University, Department of Rheumatology, Endocrinology and Nephrology, Sapporo, Japan

Meeting: ACR Convergence 2023

Keywords: Fatigue, Imaging, Neuropsychiatry, Sjögren's syndrome, Systemic lupus erythematosus (SLE)

Session Information

Date: Tuesday, November 14, 2023

Title: (2257–2325) SLE – Diagnosis, Manifestations, & Outcomes Poster III

Session Type: Poster Session C

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

Background/Purpose: Fatigue is a common symptom in patients with systemic lupus erythematosus (SLE) and primary Sjögren’s syndrome (pSS). Resting-state functional magnetic resonance imaging (rs-fMRI) has emerged as a powerful tool for mapping large-scale networks in the human brain. Several studies have investigated the functional connectivity (FC) between brain regions of interests (ROIs) of fatigue using rs-fMRI. However, the evidence concerning patients with SLE and pSS remains unclear.The objective of this study is to identify the specific FC of fatigue in patients with SLE and pSS.

Methods: rs-fMRI data were acquired from SLE, pSS, and healthy controls. Demographic, clinical, and laboratory data were extracted from patients’ electronic medical records. Disease activity was assessed by SLE Disease Activity Index score with the Safety of Estrogens in SLE National Assessment modification (SELENA-SLEDAI), and EULAR Sjögren’s syndrome disease activity index (ESSDAI). In addition, the Chalder fatigue scale (CFS) and fatigue assessment questionnaire were collected. FCs were analyzed and compared among SLE, pSS, and HCs by ANCOVA, adjusted for age and sex. The association among SELENA-SLEDAI, ESSDAI, questionnaire scores, and FCs was evaluated by correlation analysis.

Results: A total of 9 SLE patients (90% female; median age: 44 years, IQR: 33-61), 5 SS patients (100% female; median age: 48 years, IQR: 44-49) and 16 HCs (63% female; median age: 41 years, IQR: 34-46) were enrolled. The median SELENA-SLEDAI was 4 (IQR: 0-10) and the median prednisolone dose was 4 mg/day (IQR: 0-10), the median ESSDAI was 3 (IQR: 2-4). In SLE and pSS patients with fatigue, higher FC was observed between the right insular cortex (IC) and right thalamus compared to HCs (p=0.049). There was a significant correlation between FC of the right IC and right thalamus and CFS, a fatigue evaluation index, in patients with SLE/pSS (r²=0.4, p=0.0125). CFS did not correlate with SELENA-SLEDAI and ESSDAI either.

Conclusion: We identified a specific FC between right IC and right thalamus which may be associated with fatigue in SLE and pSS patients.

The specific functional connectivity (FC) between the right insular cortex (IC) and right thalamus in patients with systemic lupus erythematosus (SLE) and primary sjögren’s syndrome (pSS). (A) FC value between right IC and right thalamus in healthy controls (HCs) and SLE/pSS. *p<0.05, ANCOVA, adjusted for age and sex. (B) Correlation analysis between the FC and Chalder fatigue scale in SLE/pSS.

Disclosures: Y. fujieda: None; K. Sakiyama: None; N. Abe: None; R. Hisada: None; M. Kono: None; M. Kato: None; O. Amengual: None; K. Tha: None; H. Shirakawa: None; T. Atsuma: AbbVie, 5, 6, Alexion, 5, 6, Astellas, 5, 6, Boehringer-Ingelheim, 2, Bristol-Myers Squibb, 6, Chugai, 5, 6, Daiichi Sankyo, 5, 6, Eisai, 5, 6, Eli Lilly, 5, 6, Gilead, 5, 6, GSK, 2, 5, Merck Sharp & Dohme, 2, 6, Mitsubishi Tanabe Pharma, 5, 6, Otsuka, 5, 6, Pfizer, 5, 6, Sanofi/Genzyme, 2, 6, Takeda, 5, 6, UCB, 5, 6.

To cite this abstract in AMA style:

fujieda Y, Sakiyama K, Abe N, Hisada R, Kono M, Kato M, Amengual O, Tha K, Shirakawa H, Atsuma T. Right Insular Cortex-Thalamic Functional Connectivity as a Potential Marker for Fatigue in Systemic Lupus Erythematosus and Primary Sjögren’s Syndrome [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/right-insular-cortex-thalamic-functional-connectivity-as-a-potential-marker-for-fatigue-in-systemic-lupus-erythematosus-and-primary-sjogrens-syndrome/. Accessed .

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