Abstract
Fatigue is a common constitutional feature of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). While the two diseases share a common mechanism of autoimmunity, they differ in their clinical manifestations and treatment. Fatigue is one of the most commonly reported symptoms in both groups, associated with pain, depression and anxiety, and affecting function, work and quality of life. Fatigue is not easy to assess or conceptualise. It can be linked to disease activity, although it is not always, and is challenging to treat. Several measures have been trialled in RA and SLE; however, none have been adopted into mainstream practice. Despite being a common symptom, fatigue remains poorly managed in both RA and SLE—more so in the latter, where there have been relatively fewer studies. Additionally, comorbidities contribute to fatigue, further complicating its management. Pain, depression and anxiety also need to be addressed, not as separate entities, but together with fatigue in a holistic manner. Here, we describe the similarities and differences between fatigue in patients with RA and SLE, discuss concepts and practices applicable to both conditions and identify areas for further research. Through this review, we aim to highlight the importance of the holistic management of fatigue in SLE.
Highlights
Fatigue is a subjective symptom of malaise and aversion to activity, comprising both physical and mental aspects [1]
Significant fatigue is reported by two-thirds of patients with systemic lupus erythematosus (SLE), and severe fatigue is reported by one-third of these patients, as defined by the Fatigue Scale for Motor and Cognitive Functions scale (FSMC)—a self-administered questionnaire initially developed for patients with multiple sclerosis [5,6,7,8]
While the two diseases share a common mechanism of autoimmunity, they differ in their underlying immunopathology, treatment and resulting clinical manifestations, such as organ involvement
Summary
Fatigue is a subjective symptom of malaise and aversion to activity, comprising both physical and mental aspects [1] It is often poorly defined in clinical practice and may be reported by patients as “fatigue”, “tiredness”, “lethargy” or “exhaustion”, as well as other descriptors for a lack of energy [1]. While the two diseases share a common mechanism of autoimmunity, they differ in their underlying immunopathology, treatment and resulting clinical manifestations, such as organ involvement Despite these differences, fatigue is one of the most commonly reported symptoms in both patient groups, and is associated with symptoms of pain, depression and anxiety, while impacting function, work and overall quality of life [7,10,11]. We wish to highlight the importance of the holistic management of fatigue in SLE, addressing all possible causes, as a symptom that is intertwined with the other aspects of the disease
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