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.
Highlights
Chrong-Reen WangFatigue is a universal symptom experienced by nearly everyone in the general population
A recent study from our group described 3 main clusters of fatigue in Systemic Lupus Erythematosus (SLE) patients: (1) the most frequent profile (67.5% of the patients) was represented by patients with moderate fatigue, low disease activity and low anxiety and depression; (2) a quarter of the patients had very high fatigue, high depression and anxiety but low disease activity; and (3) less than 10% of the patients had high levels of fatigue, with high disease activity, low anxiety and no depression [11]. This suggests that the mental health status is an important predictor of fatigue in SLE, that disease activity plays a weaker role in SLE fatigue, and that, most of the time, other factors contribute to fatigue in SLE
Disease activity seems to have a complex contribution to fatigue, and its role remains controversial
Summary
Fatigue is a universal symptom experienced by nearly everyone in the general population. Fatigue impairs quality of life, and may lead to irritability, inability to concentrate, and poor motivation [1,2] In chronic conditions such as Systemic Lupus Erythematosus (SLE), and in other autoimmune diseases such as Sjögren’s syndrome or systemic sclerosis, the experience of fatigue seems to differ from ‘everyday tiredness’, as being more frequent, unpredictable and typically unresolved by rest [3]. This symptom remains a complex, multidimensional and poorly understood concept, often neglected by clinicians who prefer to focus on objective manifestations.
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