Towards a Practical Management of Fatigue in Systemic Lupus Erythematosus

Overview

Journal Lupus Sci Med

Specialties Allergy & Immunology
Rheumatology

Date 2020 Nov 20

PMID 33214160

Citations 13

Authors

Philippe Mertz

Aurelien Schlencker

Matthias Schneider

Pierre-Edouard Gavand

Thierry Martin

Laurent Arnaud

Affiliations

Soon will be listed here.

Abstract

Significant fatigue is reported by two-thirds of patients with SLE and severe fatigue by one-third. The assessment and treatment of fatigue remains a major challenge in SLE, especially in patients with no disease activity. Here, we suggest a practical algorithm for the management of fatigue in SLE. First, common but non-SLE-related causes of fatigue should be ruled out based on medical history, clinical and laboratory examinations. Then, presence of SLE-related disease activity or organ damage should be assessed. In patients with active disease, remission is the most appropriate therapeutic target while symptomatic support is needed in case of damage. Both anxiety and depression are major independent predictors of fatigue in SLE and require dedicated assessment and care with psychological counselling and pharmacological intervention if needed. This practical algorithm will help in improving the management of one the most common and complex patient complaints in SLE.

Citing Articles

Cross-sectional survey to determine fatigue in patients with systemic lupus erythematosus.

Lu J, Yu M, Xu R Front Psychol. 2024; 15:1376257.

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COVID-19 Vaccination-Related Delayed Adverse Events among Patients with Systemic Lupus Erythematosus.

Dey M, Doskaliuk B, Lindblom J, Nikiphorou E, Wincup C, Fathima M J Clin Med. 2023; 12(24.

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A Comprehensive Literature Review on Managing Systemic Lupus Erythematosus: Addressing Cardiovascular Disease Risk in Females and Its Autoimmune Disease Associations.

Dar S, Koirala S, Khan A, Bellary M, Patel A, Mathew B Cureus. 2023; 15(8):e43725.

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Systemic Lupus Erythematous and Obstructive Sleep Apnea: A Possible Association.

Meidan R, Elalouf O, Tauman R, Furer V, Polachek A, Wollman J Life (Basel). 2023; 13(3).

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Effects of illness perception on negative emotions and fatigue in chronic rheumatic diseases: Rumination as a possible mediator.

Lu Y, Jin X, Feng L, Tang C, Neo M, Ho R World J Clin Cases. 2022; 10(34):12515-12531.

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References

Ruiz-Irastorza G, Egurbide M, Olivares N, Martinez-Berriotxoa A, Aguirre C . Vitamin D deficiency in systemic lupus erythematosus: prevalence, predictors and clinical consequences. Rheumatology (Oxford). 2008; 47(6):920-3. DOI: 10.1093/rheumatology/ken121. View

Choi S, Kang J, Park I, Lee Y, Song J, Park Y . Subscale analysis of quality of life in patients with systemic lupus erythematosus: association with depression, fatigue, disease activity and damage. Clin Exp Rheumatol. 2012; 30(5):665-72. View

Moldovan I, Cooray D, Carr F, Katsaros E, Torralba K, Shinada S . Pain and depression predict self-reported fatigue/energy in lupus. Lupus. 2013; 22(7):684-9. DOI: 10.1177/0961203313486948. View

Yuen H, Cunningham M . Optimal management of fatigue in patients with systemic lupus erythematosus: a systematic review. Ther Clin Risk Manag. 2014; 10:775-86. PMC: 4199565. DOI: 10.2147/TCRM.S56063. View

Baker K, Pope J . Employment and work disability in systemic lupus erythematosus: a systematic review. Rheumatology (Oxford). 2009; 48(3):281-4. DOI: 10.1093/rheumatology/ken477. View

Costedoat-Chalumeau N, Amoura Z, Hulot J, Aymard G, Leroux G, Marra D . Very low blood hydroxychloroquine concentration as an objective marker of poor adherence to treatment of systemic lupus erythematosus. Ann Rheum Dis. 2007; 66(6):821-4. PMC: 1954674. DOI: 10.1136/ard.2006.067835. View

Geenen R, Overman C, Christensen R, Asenlof P, Capela S, Huisinga K . EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018; 77(6):797-807. DOI: 10.1136/annrheumdis-2017-212662. View

Burgos P, Alarcon G, McGwin Jr G, Crews K, Reveille J, Vila L . Disease activity and damage are not associated with increased levels of fatigue in systemic lupus erythematosus patients from a multiethnic cohort: LXVII. Arthritis Rheum. 2009; 61(9):1179-86. PMC: 2748186. DOI: 10.1002/art.24649. View

Ruiz-Irastorza G, Gordo S, Olivares N, Egurbide M, Aguirre C . Changes in vitamin D levels in patients with systemic lupus erythematosus: Effects on fatigue, disease activity, and damage. Arthritis Care Res (Hoboken). 2010; 62(8):1160-5. DOI: 10.1002/acr.20186. View

10.

Balsamo S, Santos-Neto L . Fatigue in systemic lupus erythematosus: an association with reduced physical fitness. Autoimmun Rev. 2011; 10(9):514-8. DOI: 10.1016/j.autrev.2011.03.005. View

11.

Arnaud L, Mertz P, Amoura Z, Voll R, Schwarting A, Maurier F . Patterns of fatigue and association with disease activity and clinical manifestations in systemic lupus erythematosus. Rheumatology (Oxford). 2020; 60(6):2672-2677. DOI: 10.1093/rheumatology/keaa671. View

12.

Zard E, Arnaud L, Mathian A, Chakhtoura Z, Hie M, Touraine P . Increased risk of high grade cervical squamous intraepithelial lesions in systemic lupus erythematosus: A meta-analysis of the literature. Autoimmun Rev. 2014; 13(7):730-5. DOI: 10.1016/j.autrev.2014.03.001. View

13.

Conceicao C, Meinao I, Bombana J, Sato E . Psychoanalytic psychotherapy improves quality of life, depression, anxiety and coping in patients with systemic lupus erythematosus: a controlled randomized clinical trial. Adv Rheumatol. 2019; 59(1):4. DOI: 10.1186/s42358-019-0047-y. View

14.

Adiga A, Nugent K . Lupus Hepatitis and Autoimmune Hepatitis (Lupoid Hepatitis). Am J Med Sci. 2017; 353(4):329-335. DOI: 10.1016/j.amjms.2016.10.014. View

15.

Carsons S, Vivino F, Parke A, Carteron N, Sankar V, Brasington R . Treatment Guidelines for Rheumatologic Manifestations of Sjögren's Syndrome: Use of Biologic Agents, Management of Fatigue, and Inflammatory Musculoskeletal Pain. Arthritis Care Res (Hoboken). 2016; 69(4):517-527. DOI: 10.1002/acr.22968. View

16.

Wincup C, Parnell C, Cleanthous S, Tejera Segura B, Nguyen M, Bryant K . Red cell distribution width correlates with fatigue levels in a diverse group of patients with systemic lupus erythematosus irrespective of anaemia status. Clin Exp Rheumatol. 2019; 37(5):852-854. View

17.

Hanly J, Su L, Urowitz M, Romero-Diaz J, Gordon C, Bae S . Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis Rheumatol. 2015; 67(7):1837-47. PMC: 4485527. DOI: 10.1002/art.39111. View

18.

Parisis D, Bernier C, Chasset F, Arnaud L . Impact of tobacco smoking upon disease risk, activity and therapeutic response in systemic lupus erythematosus: A systematic review and meta-analysis. Autoimmun Rev. 2019; 18(11):102393. DOI: 10.1016/j.autrev.2019.102393. View

19.

Devilliers H, Amoura Z, Besancenot J, Bonnotte B, Pasquali J, Wahl D . Responsiveness of the 36-item Short Form Health Survey and the Lupus Quality of Life questionnaire in SLE. Rheumatology (Oxford). 2014; 54(5):940-9. DOI: 10.1093/rheumatology/keu410. View

20.

Iaboni A, Ibanez D, Gladman D, Urowitz M, Moldofsky H . Fatigue in systemic lupus erythematosus: contributions of disordered sleep, sleepiness, and depression. J Rheumatol. 2006; 33(12):2453-7. View