Impact of fatigue on health-related quality of life and illness perception in a monocentric cohort of patients with systemic lupus erythematosus

Abstract

BackgroundFatigue is a very common and debilitating symptom in patients with systemic lupus erythematosus (SLE), even among those with a mild or inactive disease. The objective of this study is to define fatigue determinants and describe the impact of fatigue on health-related quality of life (HRQoL) and illness perception in a monocentric cohort of patients with SLE.MethodsThis is a cross-sectional study. Adult patients with SLE were included. For each patient, demographics, medications, comorbidities, organ damage (Systemic Lupus International Collaborating Clinics Damage Index), active disease manifestations and Systemic Lupus Disease Activity Index scores were collected. It was evaluated if each patient met the definitions of remission and low disease activity. At enrolment, each patient completed the Short Form-36 (SF-36), Functional Assessment Chronic Illness Therapy-Fatigue (FACIT-F), Lupus Impact Tracker (LIT), Systemic Lupus Activity Questionnaire (SLAQ) and Brief Index of Lupus Damage (BILD). The FACIT-F questionnaire was also administered to a group of healthy controls.Results223 patients were included (mean age 44.9±13.2 years, median disease duration 13 years). 18.2% had an active disease, 43.5% met the definition of remission on treatment, and 11.8% had a concomitant fibromyalgia. The median FACIT-F score of our cohort was significantly lower compared with that of healthy controls (40 vs 47; p<0.001). FACIT-F scores were irrespective of age, disease duration, disease activity and damage. FACIT-F score was significantly lower in patients with fibromyalgia (p<0.01). FACIT-F scores demonstrated a significant correlation with all other patient-reported outcomes: SF-36 (r=0.53–0.77), LIT (r=−0.78), SLAQ (r=−0.72) and BILD (r=−0.28).ConclusionsFatigue in patients with SLE has a strong negative impact on HRQoL and patient perception of the disease burden. Fatigue seems irrespective of disease activity but significantly influenced by the presence of fibromyalgia.

Age at diagnosis and health-related quality of life are associated with fatigue in systemic lupus erythematosus patients: Data from the Almenara Lupus Cohort

“…found that FACIT-F scores were unrelated to damage. 43 The same was reported in the LUMINA study in which damage was not associated with increased levels of fatigue. 41…”

Systemic Lupus Erythematosus (SLE) Therapy: The Old and the New

“…Fatigue is the most common complaint of patients with SLE, reported by 80–100% of patients. It is the result of a multifactorial etiology and leads to a strong reduction of the HRQoL [ 89 ] and work productivity [ 90 ]. The relationship between several psychosocial factors, mainly pain, mood and sleep disorders, and comorbidities, such as fibromyalgia, anemia and vitamin D deficiency, is well established and can explain why fatigue is detectable even in patients in remission or with low disease activity.…”

Systematic review of digital and non-digital non-pharmacological interventions that target quality of life and psychological outcomes in adults with systemic lupus erythematosus

“…2 Limitations in physical functioning most commonly emerge as limited or impaired mobility (e.g., in the lower limb area), fatigue, and pain. 3–5 As a result, patients with SLE experience broader impacts in their day-to-day activities relevant to work (i.e., productivity, 6 ability to maintain employment 2,7 ), daily functioning (i.e., social and household activities), 8 and standard of living (i.e., mood, sleep). 4,7,9–11 These limitations can have serious impacts on patients’ psychological well-being and quality of life (QOL).…”