Fatigue in chronic inflammatory demyelinating polyneuropathy

Abstract

Introduction: In this study we aimed to better understand fatigue in chronic inflammatory demyelinating polyneuropathy (CIDP) as it relates to disease activity status. Methods: Patients with probable or definite CIDP were stratified into active CIDP or CIDP in remission. Assessments of fatigue, physical impairment, disability, sleepiness, sleep quality, and depression were collected. Results: Of the 85 patients included in the study, 46 (54%) had active disease, whereas 39 (46%) were in remission. Fatigue was substantial in both groups, but was more severe in the active group. Use of sedating medications was a major contributor to fatigue. Sleep quality was poor in both groups, whereas depression more commonly affected those with active CIDP. Inflammatory Neuropathy Cause and Treatment disability, poor sleep quality, and higher level of depression had the greatest effect on fatigue severity. Discussion: Fatigue is common in CIDP regardless of the disease activity state. Minimizing sedating medications, improving sleep quality, and managing depression may improve CIDP-associated fatigue.

Clinical outcome of CIDP one year after start of treatment: a prospective cohort study

“…A considerable number of patients reported neuropathic pain and nearly all patients reported fatigue interfering with daily activities. Both fatigue and pain are common (long-term) symptoms and can persist despite treatment [40][41][42][43]. The reported median fatigue scores in our study are comparable to other data in the literature and considerably higher than median scores derived from control populations as reported in other studies [41,42].…”

Fatigue in chronic inflammatory demyelinating polyradiculoneuropathy

“…As above, fatigue is a non‐specific symptom and seen in many diseases. Furthermore, fatigue is seen in both active CIDP and CIDP in remission as shown by Gable and colleagues 14 . They concluded that fatigue is likely a residual symptom that does not require immune therapy.…”

“…6,13,14 Thus, one must conclude that fatigue can be improved by treatment of the underlying condition only to a minor degree. 10,14 There are studies that exercise may improve fatigue in most chronic disorders, but prospective, randomized studies are necessary to confirm this in CIDP. 8,11,12 Many other items that are related to and impact fatigue but are not specific to the disease in question are known, including age, gender, obstructive sleep apnea, poor sleep, depression, anxiety, personality type, and life experiences.…”

“…Since fatigue is a non‐specific symptom of multiple chronic diseases, it is not unexpected that correlations of fatigue with objective disease signs and/or laboratory tests are uncommon and when found are weak 6,13,14 . Thus, one must conclude that fatigue can be improved by treatment of the underlying condition only to a minor degree 10,14 . There are studies that exercise may improve fatigue in most chronic disorders, but prospective, randomized studies are necessary to confirm this in CIDP 8,11,12 .…”

“…Some of these factors can be modified and can improve the level of fatigue 8 . Thus, the paper by Gable and coworkers in this issue of Muscle & Nerve not only analyzed previously assessed factors, such as muscle strength and depression, but also sleep quality, daytime sleepiness, pain, and use of different medications 14 . They found significant overlap between fatigue, sleepiness, and depression in patients with active CIDP and in those in whose CIDP was in remission.…”