Fatigue in Systemic Lupus Erythematosus: An Update on Its Impact, Determinants and Therapeutic Management

Abstract

Fatigue is a complex and multifactorial phenomenon which is often neglected by clinicians. The aim of this review was to analyze the impact, determinants and management of fatigue in patients with Systemic Lupus Erythematosus (SLE). Fatigue is one of the most prevalent symptoms in SLE, reported by 67% to 90% of patients. It is also described as the most bothersome symptom, considering that it may impair key aspects of health-related quality of life, while also leading to employment disability. It is a multifactorial phenomenon involving psychological factors, pain, lifestyle factors such as reduced physical activity, whereas the contribution of disease activity remains controversial. The management of fatigue in patients with SLE should rely upon a person-centered approach, with targeted interventions. Some pharmacological treatments used to control disease activity have demonstrated beneficial effects upon fatigue and non-pharmacological therapies such as psychological interventions, pain reduction and lifestyle changes, and each of these should be incorporated into fatigue management in SLE.

The association of psychosocial stressors and psychiatric disorders with fatigue in systemic lupus erythematosus patients

“…This result further supports the fact that fatigue in SLE is influenced by combinations of several factors rather than a single factor. 3,6 In this study, psychosocial stressors, such as histories of major personal illness and changes in eating habits, were significantly associated with fatigue in LLDAS patients. Therefore, although the patient is already in low disease activity, identification of major personal illness and change in eating habits is still recommended in terms of identification of risk factors and prevention of fatigue in SLE patients.…”

“…This is consistent with the study of Kawka et al which stated that even though disease activity has a complex contribution to fatigue, psychosocial factors seemed to provide the most important contribution. 3 Based on the MINI examination, most of the participants had a generalized anxiety disorder (30.1%), depression (16.4%), and dysthymia (12.3%). These were in line with several studies which found mood disorders such as depression and anxiety disorders to be very common in SLE patients.…”

“…4 Many factors contribute to fatigue in SLE, such as disease activity, and other modifiable factors include physical activity, psychosocial stressors, and depression. [3][4][5][6] Consequently, fatigue in SLE is influenced by a combination of several factors rather than disease activity alone.…”

“…2 A prior study reported 67%–90% of SLE patients with fatigue which was described as the most bothersome symptom experienced; hence, it is the most common and aggravating symptom of this disease. 3 Despite advances in treatment for SLE, there are no effective guidelines for evaluating and treating fatigue. 4 Many factors contribute to fatigue in SLE, such as disease activity, and other modifiable factors include physical activity, psychosocial stressors, and depression.…”

Effect of Self- Care management on Health Outcomes and Symptoms for Females with Systemic Lupus Erythematosus

“…Fatigue is a general and continued feeling of tiredness or difficulty performing physical and mental activities for days to weeks, which is not resolved by rest (5) . Fatigue is the most common and disabling symptom in SLE that may impair female patients' physical and mental health and reduce quality of life by impacting upon their emotions, work, and daily life activities (6) . Non-pharmacological interventions and lifestyle arrangements are very important in disease management, these include female education, protection from sunlight, rest and the reduction of fatigue, use of medication, infection control, vaccination, a diet low in salt, fat and cholesterol, avoidance of stress, pregnancy and contraception and reduction of psychosocial effects (7) .…”