Abstract
Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with heterogeneous clinical manifestations including fatigue. Previous studies aimed at proving the relationship between fatigue and SLE disease activity showed conflicting results. In 2015, Asia Pacific Lupus Collaboration (APLC) developed low disease activity criteria, named Lupus Low Disease Activity State (LLDAS). Patients who spend more time in LLDAS have significantly lower morbidity. This study aimed to evaluate the association between disease activity based on LLDAS and fatigue. 
 Methods: This is a analytical cross-sectional study. Subjects were SLE patients at rheumatology clinic in Dr. Hasan Sadikin Hospital, Bandung during June-January 2018. Subjects were evaluated based on LLDAS criteria and divided into 2 groups: LLDAS and non-LLDAS. Fatigue status of the subjects was assessed with Fatigue Severity Scale (FSS).
 Results: A hundred and thirty-three subjects were included in this study, divided into 63 subjects in LLDAS group and 60 subjects in non-LLDAS group. Nineteen subjects (30.2%) in LLDAS group had fatigue and 39 subjects (65%) in non-LLDAS had fatigue. There was a significant association between LLDAS and fatigue (p< 0.001). Nonetheless, fatigue level in LLDAS group was still high since disease activity was not the only factor related to fatigue. Fatigue may be a distinct clinical manifestation of neuropsychiatric lupus and may be independent of lupus disease activity
 Conclusions: There was a significant association between LLDAS and fatigue showed by lower fatigue level was found in the LLDAS group than in the non-LLDAS group.
 
 Keywords: Systemic lupus erythematosus, disease activity, Lupus Low Disease Activity State, fatigue
Highlights
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by various clinical manifestations.[1,2,3,4] Clinical manifestations are vary among individuals, from minimally symptomatic to life-threatening condition.[4,5,6,7] Fatigue is one of most important manifestations of SLE and affects physical, social, and emotional functioning
Fatigue level in Lupus Low Disease Activity State (LLDAS) group was still high since disease activity was not the only factor related to fatigue
Fatigue may be a distinct clinical manifestation of neuropsychiatric lupus and may be independent of lupus disease activity.Conclusions There was a significant association between LLDAS and fatigue showed by lower fatigue level was found in the LLDAS group than in the nonLLDAS group
Summary
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by various clinical manifestations.[1,2,3,4] Clinical manifestations are vary among individuals, from minimally symptomatic to life-threatening condition.[4,5,6,7] Fatigue is one of most important manifestations of SLE and affects physical, social, and emotional functioning. Most individuals with SLE reported fatigue to be most disabling symptom.[8]. Fatigue can be measured subjectively by using a selfadministered questionnaire. Systemic Lupus Erythematosus (SLE) is an autoimmune disease with heterogeneous clinical manifestations including fatigue. Previous studies aimed at proving the relationship between fatigue and SLE disease activity showed conflicting results. This study aimed to evaluate the association between disease activity based on LLDAS and fatigue
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