Fatigue Severity Score Research Articles

Residual fatigue in Guillain-Barré syndrome is related to axonal loss

To determine the occurrence of residual loss of peripheral nerve axons by motor unit number estimation (MUNE) and conventional nerve conduction studies (NCS) in patients with and without severe fatigue. Thirty-nine patients at a median of 8 years (range 1-23 years) after diagnosis of Guillain-Barré syndrome were neurologically examined and divided in 2 subgroups based on the presence of severe fatigue (defined as a fatigue severity score ≥5). All patients were investigated with standard NCS and MUNE. Normal values for MUNE were collected in 14 healthy controls. MUNE of the thenar muscles was lower in the 15 patients with severe fatigue (median 125, interquartile range 65-141) compared with the 24 patients without severe fatigue (median 258, interquartile range 120-345) (p = 0.002). In the healthy controls, MUNE was 358 (245-416). Severe fatigue was also related to lower sensory nerve action potential amplitude of the median (p = 0.01) and ulnar nerve (p = 0.03). The 2 subgroups did not differ regarding neurologic deficits, disability, and the remaining conventional motor NCS. This study demonstrates that severe fatigue after Guillain-Barré syndrome is related to more pronounced axonal loss, represented by lower MUNEs and lower sensory nerve action potentials.

Fatigue as Prognostic Risk Marker of Mental Sickness Absence in White Collar Employees

To investigate fatigue as prognostic risk marker for identifying working employees at risk of long-term sickness absence (SA). At baseline, fatigue was measured in 633 white collar employees with the checklist individual strength (CIS) including scales for fatigue severity, reduced concentration, reduced motivation, and reduced physical activity. SA was medically certified by an occupational physician in the 3rd or 4th SA week with diagnostic codes according to the 10th version of the International Classification of Diseases. Medically certified SA was retrieved at the individual level from an occupational health register after 1-year follow-up. CIS scores were investigated as prognostic risk markers predicting medically certified SA and particularly SA certified as mental SA. 614 employees (N = 378 men and N = 236 women) had complete data and were eligible for analysis; 63 (10 %) had medically certified SA of whom 39 (6 %) had mental SA. Fatigue severity and total CIS scores were associated with medically certified SA in men, but poorly discriminated between men with and without medically certified SA. Fatigue severity, reduced concentration, reduced motivation, and total CIS scores were also associated with mental SA in men. CIS and its reduced concentration scale were valid prognostic risk markers of mental SA. CONCLUSION Fatigue was a prognostic risk marker of mental SA in white collar men. The CIS should be further validated as a screening tool for the risk of mental SA in white collar working populations.

AB1095 Study on factors associated with chronic fatigue syndrome (fibromyalgia) in patients with systemic lupus erythematosus

ObjectivesTo examine the relation between chronic fatigue syndrome (fibromyalgia), disease activity, and quality of life measures in patients with systemic lupus erythematosus (SLE).MethodsConsecutive 40 patients attending king fahad hospital, Jeddah...

THU0208 Fatigue is an important problem in patients with behcet’s syndrome

BackgroundFatigue is an important problem in several inflammatory conditions, affecting quality of life. It is a patient reported outcome measure used in the evaluation of disease activity and in drug...

AB0409 An observational study of vitamin d in systemic lupus erythematosus patients: associations among vitamin d status, fatigue, quality of life and disease activity

BackgroundSystemic lupus erythematosus (SLE) is a multisystem autoimmune disease in which fatigue and impaired quality of life (QoL) commonly manifest. Fatigue has been associated with increased disease activity in SLE1-3...

Changes in disease activity, lung function and quality of life in patients with refractory sarcoidosis after anti-TNF treatment

Objectives: The effect of infliximab therapy in rheumatoid arthritis and Crohn's disease has been well documented. However, literature on infliximab therapy in the rare disease sarcoidosis is scarce. The aim of our study is to evaluate change in disease activity and quality of life upon infliximab treatment in patients with refractory sarcoidosis.Research design and methods: Retrospective cohort study of 48 patients who received infliximab treatment at a national referral center for sarcoidosis. The clinical effect of infliximab treatment was analyzed in terms of change in disease activity (18F-FDG PET, serum angiotensin-converting-enzyme [ACE], serum-soluble interleukin-2 receptor [sIL-2R]), lung function (predicted VC, FEV1 and DLCOc), fatigue severity (CIS) and physical functioning (SF-36). Study parameters were assessed before the first dose (week 0) and after the last dose (week 18).Results: We found significant decreases in the serum markers ACE and sIL-2R and in SUVmax on 18F-FDG PET. Furthermore, a significant improvement in fatigue severity and physical functioning scores was observed. In patients with a pulmonary treatment indication, we found significant improvements in percentages of predicted VC (7.6%), FEV1 (7.9%) and DLCOc (3.5%).Conclusions: Infliximab improves PET-scan, serum markers, lung function and quality of life in patients with refractory sarcoidosis.

Fatigue in multiple sclerosis: relationship with disease duration, physical disability, disease pattern, age and sex

To evaluate the relationship between disease duration, disability, disease pattern, age and sex with fatigue in MS patients. One hundred and seventy-three clinically definite MS patients and 87 age-matched healthy controls enrolled in this cross sectional study. Demographic data (sex, age), duration of the disease and disease pattern extracted from patient's files and Kurtzke Expanded Disability Status Scale (EDSS) were recorded for each patient by an expert neurologist. Participants were asked to answer the validated and reliable Persian version of beck depression inventory (BDI) and FSS (fatigue severity score) questionnaires. Mean FSS and BDI scores were significantly different between patients and controls (p < 0.001). Patients with longer disease duration, higher EDSS and progressive type of disease had significantly higher FSS and BDI scores. Although men had higher EDSS, FSS and BDI scores were similar in both sex groups. FSS was significantly correlated with age, disease duration, BDI and EDSS. The analysis of covariance revealed that there is no difference in the covariance-adjusted means for fatigue among two disease groups (relapsing remitting and secondary progressive) except for EDSS. MS patients with longer disease duration, higher EDSS and progressive type of disease suffer from fatigue more than cases with lower EDSS, duration of disease and relapsing type of the disease.

The Effect of Intraoperative Infusion of Dexmedetomidine on the Quality of Recovery After Major Spinal Surgery

Surgery induces a variety of metabolic, endocrine, and immune changes collectively known as the "stress response," which may often lead to prolonged postoperative convalescence. Anesthetic management may modulate this physiological response, thus affecting the postoperative course. We hypothesized that the intraoperative administration of dexmedetomidine (DEX), a sympatholytic agent, would reduce the stress response and improve the quality of recovery in patients undergoing major surgery. We conducted a prospective randomized double-blinded study of 54 patients undergoing multilevel spinal fusion. Anesthesia was maintained using either propofol/fentanyl/dexmedetomidine (PFD) or propofol/fentanyl/placebo-saline (PFS). The quality of recovery (a primary endpoint) was assessed using a 40-item quality of recovery questionnaire and a 9-question Fatigue Severity Scores. The tests were carried out preoperatively on postoperative days (POD) 1, 2, 3, and 30. Blood samples were collected at baseline, in the postanesthesia care unit, and at POD 1 and were analyzed for levels of cortisol, C-reactive proteins (CRP), and cytokines interleukin (IL)-1α, IL-1β, IL-1ra, IL-2, IL-6, IL-8, IL-10, and tumor necrosis factor-α. Data were analyzed using SPSS software (version 18) using a multivariate and mixed model approach to test for the effect of surgery and drug group. Pairwise comparisons were assessed by means of the t test or rank tests after correcting for multiple comparisons. The global 40-item quality of recovery questionnaire scores showed a significant effect of time (F(4,114)=22.63, P<0.001) and drug (F(1,51)=4.368, P=0.042), with average scores decreasing to lower values on POD 1 (163.63±2.47) and POD 2 (170.94±2.38) compared with baseline (180.56±1.588, mean±SE, 2-tailed t tests, P<0.001). By POD 3, scores were significantly lower (-13.74 point difference, P=0.005) in the PFS group (169.3±3.87) than in the PFD group (183.04±2.76). All patients reported significantly higher levels of fatigue postoperatively, but intergroup difference in Fatigue Severity Scores was detected on POD 3 only, with scores in the PFS group higher than in the PFD group (50.0±4.0 vs. 36.3±4.9, P=0.035). In both groups, plasma cortisol levels were highest in the postanesthesia care unit, whereas CRP levels were elevated on POD 1. DEX significantly reduced the levels of cortisol, but not those of CRP. Levels of cytokines IL-6, IL-8, and IL-10 were significantly higher immediately after surgery and at POD 1. Plasma levels of other cytokines were not affected by surgery. DEX delayed postoperative rise in IL-10 but not in IL-6 or IL-8. DEX infusion during multilevel spinal fusions moderately improved the quality of recovery and possibly reduced fatigue in the early postoperative period. Moreover, it reduced plasma levels of cortisol and IL-10 in comparison with the control group. Our sample size was not sufficient to detect differences either in the incidence of complications or in clinically relevant outcomes.

Iron deficiency and fatigue in adolescent females with heavy menstrual bleeding

Iron deficiency and fatigue are common problems in adolescent females. Heavy menstrual bleeding (HMB) is associated with both iron deficiency and fatigue. The aim of this study was to define baseline ferritin values and fatigue symptoms in a population of young females with excessive menstrual blood loss, as compared to healthy controls. The study population included 11 to 17-year-old menstruating females presenting to an Adolescent Gynaecology Clinic, Menorrhagia Clinic or Sports Medicine clinic. To evaluate the degree and effects of menstrual blood loss, we utilized the Ruta Menorrhagia Severity Score. We investigated the symptoms of fatigue using the Fatigue Severity Scale. We evaluated possible predictors of ferritin level (age, body mass index, fatigue scores and Menorrhagia Severity Score) using generalized linear models. A total of 48 adolescents with HMB and 102 healthy adolescents completed the study. Iron deficiency and elevated fatigue scores were common findings in young women with HMB. Both fatigue severity scores and menorrhagia severity scores were significantly higher in young women with HMB as compared to healthy controls. In adolescents with HMB, 87.5% had ferritin levels ≤40 ng mL(-1), and 29.2% had ferritin levels ≤15 ng mL(-1). Our generalized linear models did not identify any significant univariate relationships between ferritin levels and patient age, body mass index, fatigue score or menorrhagia score. Iron deficiency and symptoms of fatigue are common findings in young women with HMB. Fatigue severity scores are significantly higher in young women with HMB as compared to healthy controls.

Indirect Moxibustion (CV4 and CV8) Ameliorates Chronic Fatigue: A Randomized, Double-Blind, Controlled Study

The antifatigue effect of indirect moxibustion and its antioxidant properties were investigated. A randomized, double-blind, controlled clinical trial was performed with 44 patients who had idiopathic chronic fatigue. The subjects were treated with a placebo or moxibustion (indirect moxibustion on CV4 and CV8 3 times per week for 4 weeks), and their fatigue severity was monitored using a self-rating numeric scale (NRS) and a visual analog scale (VAS). Serum level of reactive oxygen species and malondialdehyde (MDA), total antioxidant capacity, the activity of catalase, superoxide dismutase, glutathione peroxidase, and glutathione reductase and total glutathione content, were determined before initial moxibustion therapy and after the 12th moxibustion treatment. The moxibustion group had a significantly lower fatigue severity score compared to the control for both the NRS (p<0.05) and VAS scores (p<0.01). The level of serum MDA was significantly lower in the moxibustion group than in the placebo group (p<0.05), whereas glutathione reductase activity and total glutathione content increased significantly following moxibustion (p<0.05). The results provide clinical evidence for an antifatigue effect of indirect moxibustion at CV4 and CV8 and suggest that the effect is due to the antioxidant properties of moxibustion.

Abstract 2388: Is Fatigue Associated With Symptoms Of Post Traumatic Stress Disorder In Subjects Following Stroke?

Introduction: Significant fatigue affecting quality of life is reported by up to 60% of stroke patients in the 6 months post event. We have previously reported an association between post fatigue and anxiety measured by Hospital Anxiety and Depression Score in stroke survivors. Stroke presents frequently as an unexpected potentially life threatening event with features similar to traumatic episodes such as accidents etc. Traumatic events may in turn be associated with development of the anxiety disorder Post Traumatic Stress Disorder (PTSD). We hypothesised that post-stroke fatigue may be related to a PTSD like phenomenon. Method: Independent patients (modified Rankin score &lt;3) who were cognitively intact (AMTS &gt;6) with a history of stroke attending a secondary prevention clinic were approached to participate in the study. All underwent a detailed 1-2 hour interview including assessment of fatigue using 2 tools, the Fatigue Assessment Scale (FAS) and the Fatigue Severity Score (FSS). PTSD severity was assessed using the Clinician Administered PTSD Scale (CAPS). The CAPS is a 30-item structured interview that corresponds to the DSM-IV criteria for PTSD. The CAPS is a standard criterion for the assessment and diagnosis of PTSD. Results: The study was terminated early after 18 patients completed assessments (15 male, median 70 years) due to unexpected distress experienced by some patients in completing the CAPS requiring referral to psychological support services. CAPS correlated strongly with FAS (r=0.72 (95%CI 0.39-0.89) p=0.0007). Seven subjects had a FAS score&gt;20, of these 3 had symptoms of moderate to severe PTSD. No subjects with a FAS &lt;21 had such symptoms (p=0.04, Fishers Exact test). The FSS also correlated with the CAPS but less strongly (r=0.50, p=0.03) Conclusion: Symptoms of PTSD are found in a proportion of patients following stroke. Although subject numbers are small there appears to be a strong correlation between fatigue severity and symptoms of PTSD in patients with stroke.

Abstract 89: Fatigue and Anxiety in Patients Following Stroke and TIA.

Introduction. Up to 60% of patients report fatigue in the 6 months following acute stroke but the cause of this is poorly understood. Previous studies have reported a correlation with depression however the majority of fatigued subjects are not depressed and the majority of depressed subjects are not fatigued. We hypothesised that the association between fatigue and depression may not be direct and that it may be due to the enhanced level of arousal associated with anxiety disorder. Methods: Data was reviewed from four previous studies performed to identify associations of fatigue in stroke patients. All studies were performed in cognitively intact, independent (Modified Rankin Score &lt;3) stroke patients by trained clinicians. Assessments of fatigue (Fatigue Severity Score), Anxiety and Depression (Hospital Anxiety and Depression Scale) were performed on all or subgroups of patients in all 4 studies. The FSS is a 9 item scale predominantly evaluating physical manifestations of fatigue. A score&gt;4 is indicative of severe fatigue. The Hospital Anxiety and Depression Scale is a simple fourteen item questionnaire (seven questions on symptoms of anxiety (HADS-A) and seven depression (HADS-D) based). Each question may be scored between 0 and 3. A score in either subset &lt;8 is considered normal, between 8 and 10 borderline abnormal and &gt;10 definitely abnormal. Results: Data on 94 patients were included in the assessment. 57 (61%) were male and median age was 68 years (range 44-90 years). Mean FSS was 3.6 and 38 subjects (40.4%) had an FSS &gt;4. Mean HADS-A score was 6.4, 14 (14.9%) subjects had a HADS-A &gt;10 and 21 (22.3%) had a score 8-10. Mean HADS-D score was 4.4, 6 (6.4%) subjects had a score &gt;10 and 10 (10.6%) had a HADS-D between 8 and 10. FSS correlated strongly with both HADS-A (r=0.57 (95% ci 0.42-0.69) p&lt;0.0001 and HADS-D (r=0.51 (95% ci 0.34-0.64) p&lt;0.0001). Positive predictive value (PPV) for an FSS&gt;4 for possible anxiety (HADS-A &gt;7) was 0.61. (PPV) for an FSS&gt;5 for possible anxiety was 0.73. Negative predictive value for a FSS&lt;/=4 for HADS-A &lt;8 was 0.79. PPV for an FSS&gt;4 for possible depression (HADS-D &lt;7) was 0.32 and NPV was 0.93. PPV for an FSS of &gt;6 for both HADS-A and HADS-D was 0.87. Conclusion: Post stroke fatigue is strongly correlated with both anxiety and depression in patients with stroke but the prevalence of symptoms of anxiety is higher. It is worthwhile assessing stroke patients complaining of fatigue for evidence of anxiety disorder.

Adolescent chronic fatigue syndrome; a follow-up study displays concurrent improvement of circulatory abnormalities and clinical symptoms

BackgroundThe pathophysiology of chronic fatigue syndrome (CFS) in adolescents is unknown, and the clinical course and prognosis is still questioned. Recent research indicates that abnormalities of autonomic cardiovascular control may play an important role. The aim of this research project was to perform a follow-up study of adolescents with chronic fatigue syndrome, focusing on clinical symptoms and autonomic cardiovascular control.Methods47 adolescents (12-18 years old) with CFS were recruited from the outpatient clinic at the Department of Pediatrics, Oslo University Hospital. In a primary visit and a follow-up visit (3-17 months later), we evaluated: a) a wide range of complaints and symptoms and b) cardiovascular variables at baseline and during a 20° head-up tilt-test (HUT).ResultsAt the second visit, patients reported significant improvement regarding functional impairments, fatigue severity, muscular pain, concentration problems, post-exertional malaise and the problem of non-relieving rest. Also, at the second visit, baseline heart rate (HR), blood pressure, total peripheral resistance index (TPRI) and LF/HF (low-frequency:high-frequency heart rate variability ratio, an index of sinus node sympathovagal balance derived from spectral analyses of heart rate) were significant lower, and the increases in HR, mean blood pressure (MBP), diastolic blood pressure (DBP) and TPRI during tilt were significantly less pronounced as compared to the first visit. There was a significant correlation between changes in autonomic symptom score, fatigue severity score and functional impairment score from the first to the second visit.ConclusionsThe majority of adolescents with CFS experienced an improvement over time in functional impairment, self-reported fatigue and additional symptoms, and a concurrent improvement of autonomic cardiovascular control. A possible connection between clinical symptoms and abnormal autonomic control in CFS might represent a focus for further research.

Iron Deficiency and Fatigue in Adolescent Females with Heavy Menstrual Bleeding,

Abstract 4215 IntroductionAdolescent females are one of two pediatric populations at greatest risk for iron deficiency. An important risk factor for iron deficiency in adolescent females is excessive menstrual blood loss. Due in part to changes in circadian rhythms and poor sleep hygiene, fatigue is also a pervasive problem in adolescence, and may be exacerbated by iron deficiency secondary to menorrhagia. Clinical trials have shown that non-anemic adult women with low serum ferritin (≤15„30 ng/ml) and unexplained fatigue demonstrate improvement in fatigue with iron supplementation. Similar studies have not been performed in women <18 years of age. Our primary objective was to define baseline ferritin values and fatigue symptoms in a population of young females with a history of heavy menstrual bleeding. MethodsThe study population included 11,Ÿ17 year old females presenting to an Adolescent Gynecology Clinic or Menorrhagia Clinic for initial evaluation or follow-up of heavy menstrual bleeding. To mirror our clinical practice, the study population included patients who did and did not take iron supplements, as well as those who did and did not use hormonal contraception. To evaluate the degree and effects of menstrual blood loss, we utilized the Ruta Menorraghia Scale (RMS), a subjective measurement of menstrual blood loss and health-related quality of life. Possible responses to each multiple choice question were assigned ordinal scores to produce a total menorrhagia severity score (MSS). We investigated symptoms of fatigue using the Fatigue Severity Scale (FSS), a Likert scale measurement of fatigue’s effects, symptoms, and severity (possible responses range from 1 to 7). Hemoglobin and ferritin levels were obtained by venipuncture after the completion of survey instruments. A control population of 12,Ÿ17 year old menstruating females was recruited from a Sports Medicine clinic. These patients completed the RMS and FSS instruments but did not undergo venipuncture. We compared FSS and MSS between the two populations using the Kruskal Wallis test. We evaluated possible predictors of ferritin level (age, body mass index, fatigue scores, and MSS) using generalized linear models. ResultsA total of 31 adolescents diagnosed with heavy menstrual bleeding and 37 healthy adolescents completed the study. Mean MSS was 39.3 (±17.4) in those with a history of heavy menstrual bleeding, compared to 17.9 (±10.0) in controls (p<.0001). When completing the menorrhagia scale, over two-thirds (71%) of adolescents with heavy menstrual bleeding reported that menses mildly to moderately affected their ability to participate in physical education class or sports, compared to 27% of controls. Thirteen (41.9%) of those with heavy bleeding reported missing at least one day of school with each menses, compared to 8.1% of controls. Mean fatigue score was 4.2 (±1.5) in patients with heavy menstrual bleeding, similar to values reported in adults with sleep-wake disorders. In contrast, the mean fatigue score was 2.98 (±1.1, p=.001) in the control population, similar to values reported in normal healthy adults. Twenty-five of 31 (80.6%) adolescents with heavy menstrual bleeding had ferritin levels ≤30 ng/ml, and ten (32.2%) had ferritin levels ≤15 ng/ml. Our generalized linear models did not identify any significant univariate relationships between ferritin levels and patient age, body mass index, fatigue score, or menorrhagia score. This finding may be due to our small sample size, or the narrow range of ferritin levels in our study population (87% had a ferritin level <40 ng/ml). DiscussionIron deficiency and symptoms of fatigue were common findings in a small population of young women with heavy menstrual bleeding. Fatigue severity scores were significantly higher in our study population as compared to healthy controls. Larger studies are needed to delineate the relationship between menstrual blood loss, fatigue, and ferritin values in adolescents, in order to plan for future intervention trials of iron supplementation. We also identified a high frequency of physical activity limitations and school absence in young women with heavy menstrual bleeding, highlighting the importance of including these types of patient-reported outcomes in the design of clinical trials for this patient population. Disclosures:No relevant conflicts of interest to declare.

Validity and reliability of the Taiwanese version of the Pittsburgh Sleep Quality Index in cancer patients

Background Sleep disturbance remains a common symptom among cancer patients. Assessment of sleep disturbance in cancer patients is hindered by infrequent use of standardized tools for sleep management. Objectives The purposes of this study were to validate the Taiwanese version of the Pittsburgh Sleep Quality Index (PSQI-T) and to determine detection cut-off points in cancer patients. Design A cross-sectional and descriptive correlational design. Participants A sample of 205 Taiwanese patients with various cancer diagnoses. Methods The survey included the Pittsburgh Sleep Quality Index-Taiwanese version, the MD Anderson Symptom Inventory-Taiwanese version, the Brief Fatigue Inventory-Taiwanese version, the seven-day sleep log, and Manual of Mental Disorders, Fourth Edition. Results The internal consistency Cronbach's alpha for the PSQI was 0.79. Test–retest reliability was 0.91 for the global score over a 20- to 28-day interval in a sample of 16 patients. Construct validity was established by a significant relationship of the PSQI-T global score to the total symptom severity score and the fatigue severity score. Convergent validity was examined by correlating the PSQI-T scores and scores of the DSM-IV and scores on the seven-day sleep log. Known-group validity was established by comparing PSQI-T scores for patients having low fatigue levels and those having high fatigue levels. Receiver-operating characteristic (ROC) curves were used to determine the detection cut-off points. Conclusions We found that a PSQI-T global score of 8 generates the best sensitivity and specificity for measuring sleep disturbance in cancer patients. The PSQI-T is a reliable, valid, and sensitive instrument for measuring sleep quality among Taiwanese cancer patients.

Benign multiple sclerosis: a new definition of this entity is needed

Background: To study a cohort of benign multiple sclerosis (BMS) patients beyond physical disability, including the evaluation of cognitive and social function, as well as fatigue, pain and MRI studies. Methods: A cohort of 342 patients was prospectively followed for 10.9 ± 0.71 years. Forty-three patients (12.5%) met the BMS diagnosis criteria [Expanded Disability Status Scale (EDSS) < 3 after at least 10 years’ disease duration], undergoing full neurological examination every 6 months. Neuropsychological status, pain, fatigue, social functioning and work-related disability, as well as brain MRIs, were assessed yearly. Results: By the end of follow-up, 20 of 43 BMS patients (47%) had suffered cognitive impairment and 23 (53.3%) referred depression. Furthermore, 21 (48.8%) reported significant changes in pain intensity, with fatigue and environmental severity scores significantly increasing over time in 33–35% of patients. Finally, 32 BMS patients (74%) showed significant increase in the number of new or enlarging T2 lesions, gadolinium-enhanced lesions, and persistent black holes, without changes in EDSS. Thirty-five of 43 patients (81%) fulfilling the BMS diagnostic criteria showed significant worsening of cognitive function, fatigue, pain or depression during the 10-year follow-up. Conclusions: Currently accepted criteria for BMS diagnosis may cause overestimation of true prevalence, underscoring the need for routine monitoring of non-motor symptoms and imaging studies, to help physicians improve diagnostic accuracy as well as therapeutic decision-making in this subgroup of MS patients.

Fatigue Perceived by Multiple Sclerosis Patients Is Associated With Muscle Fatigue

Background. Fatigue is a debilitating symptom in multiple sclerosis (MS). Previous studies showed no association between fatigue as perceived by the patient and physiological measures of fatigability. Objective. The authors investigated associations between perceived fatigue and measures of fatigability after correction for differences in maximal voluntary contraction (MVC). Methods. A total of 20 people with relapsing-remitting MS with an Extended Disability Severity Score less than 5.5 and 20 healthy controls filled out the Fatigue Severity Score questionnaire of perceived fatigue. The authors obtained the MVC from the first dorsal interosseus muscle, voluntary muscle activation, and force decline during a sustained MVC (124 s, muscle fatigue). Results. Patients perceived increased levels of fatigue compared with controls (P < .001). Although patients and controls developed similar amounts of muscle fatigue during the sustained contraction, a linear regression model that included both muscle fatigue and MVC was positively associated with perceived fatigue in patients only (R2 = 0.45; P = .01). Voluntary activation during the sustained contraction was negatively associated with perceived fatigue (R2 = 0.25; P = .02). Conclusion. The data indicate that fatigue perceived by MS patients is associated with measures of fatigability. This observation helps in the understanding of mechanisms underlying the increased levels of fatigue perceived by MS patients. These data also emphasize that for comparison of fatigue-related parameters between groups, correction for individual maximal force is essential.

Immunological/Virological Peripheral Blood Biomarkers and Distinct Patterns of Sleeping Quality in Chronic Hepatitis C Patients

The rational of this study we intended to investigate whether the peripheral blood immunological/virological biomarkers were associated with distinct patterns of sleeping quality in patients with chronic hepatitis C-(HCV). Distinct well-established indexes/scores were used to categorize the sleeping quality of HCV patients, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale and Fatigue Severity Scores. Our findings demonstrated that HCV patients classified as 'good sleeper' displayed an enhanced frequency of circulating CD8(+) T cells, lower frequency of activated (CD69(+)) neutrophils and eosinophils but enhanced frequency of activated lymphocytes besides lower seric levels of IL-4/IL-8/IL-10 but higher levels of IL-12, besides lower HCV virus load and lower anti-HCV IgG levels. In contrast, HCV patients classified as 'poor sleeper' displayed enhanced levels of activated neutrophils and eosinophils but lower frequency of activated lymphocytes, higher seric levels of IL-6/TNF-α/IL-10 but lower levels of IL-12 besides higher HCV virus load and increased anti-HCV IgG levels. Positive correlation was further confirmed by the relationship between the leucocyte activation status, the cytokine levels, the HCV viral load and the anti-HCV IgG reactivity with the PSQI indexes. Analysis of cytokine signature curves demonstrated that lower frequency of IL-10 was observed in HCV patients classified as 'good sleepers', whereas enhanced frequency of IL-6 was found HCV patients classified as 'poor sleepers'. In conclusion, our data suggest that immunological biomarkers (leucocytes activation status and seric cytokines levels) are likely to be associated with sleeping quality patterns in HCV patients, suggesting their putative use for clinical monitoring purposes.

Determinants of Work Disability in Patients with Systemic Sclerosis: A Longitudinal Study of the GENISOS Cohort

To determine the prevalence, correlates, and predictors of work disability (WD) in the Genetics versus ENvironment In Scleroderma Outcome Study (GENISOS). We hypothesized that WD in systemic sclerosis (SSc) is a function of demographic, clinical, and psychosocial factors. Patients enrolled in the GENISOS cohort were subdivided in 3 groups: work disabled, working, and retired or homemakers. The latter group (n = 29) was excluded from further analysis. We used logistic regression analysis with a forward hierarchical variable selection strategy to investigate the independent correlates of WD at enrollment. Cox regression proportional Hazard's model with a similar variable selection strategy was utilized to determine the predictors of WD in those working at enrollment. Overall, 284 patients with a mean age of 48.7 years and disease duration of 2.5 (±1.6) years were enrolled into the GENISOS cohort, consisting of 83.5% female, 46.8% white, 28.9% Hispanic, and 20.4% African American. Patients were longitudinally followed in 1438 study visits. At enrollment, 124 patients (43.7%) were work disabled, whereas 131 (46.1%) were working. Lower level of education (P < 0.001), higher Medsger Lung Severity Index (P = 0.012), higher Fatigue Severity Score (P = 0.008), and less social support (P < 0.001) correlated independently with WD. Of those working at baseline, 35 (26.7%) eventually developed WD. Non-white ethnicity (P = 0.038), lower DLCO % predicted value (P = 0.038), and higher Fatigue Severity Score (P = 0.009) at enrollment independently predicted WD on follow-up visits. WD is a major problem among SSc patients and its prevalence is substantially higher than other rheumatic conditions. Demographic, clinical, and psychosocial factors correlate with WD cross-sectionally and predict WD longitudinally in these patients.

Clinical Characteristics of Patients with Medically Unexplained Chronic Widespread Pain: A Primary Care Center Study

BackgroundChronic widespread pain (CWP) is known as a common symptom of several organic and psychological disorders. Although medically unexplained CWP (MUE) has lots of clinical distress symptoms, there were no distinct symptoms or signs. Therefore, we conducted this study to investigate clinical distress symptoms of MUE distinct from those of medically explained CWP (ME).MethodsOne hundred nine patients with CWP were enrolled in the study. We classified the study subjects into three groups depending on their medical problems associated with CWP: organic group (ORG), psychological group (PSY), and MUE. All subjects were asked to fill out self-report questionnaires consisting of clinical distress scales including the Korean version of the Fibromyalgia Impact Questionnaire (FIQ-K), fatigue scale, depression scale, and stress scale. And physicians examined 18 tender points over their entire body of the subjects.ResultsMUE patients had higher FIQ-K and fatigue severity scores than ORG patients (all P < 0.05). The average number of tender points were 11.33 in MUE patients, 6.48 in ORG patients and 5.02 in PSY patients and statistically significant (P < 0.0001). There were no statistically different factors between MUE and PSY patients with exception for the number of tender points. Depressive symptom was the highest in PSY patients but not statistically different from MUE patients.ConclusionMUE patients had higher physical impairments, fatigue severity and more number of tender points than ORG patients, but had no different clinical characteristics from PSY patients except for the number of tender points.