Stress ‘primary driver’ for fatigue in patients with SLE
Although depression and stress are both predictors of fatigue among patients with systemic lupus erythematosus at 1 year, stress is the “primary driver,” and reductions in stress are associated with a clinically meaningful decrease in fatigue, according to findings published in Arthritis Care & Research.
“Understanding predictors and correlates of fatigue in SLE is key to guiding the development of and providing effective and efficacious treatment,” Desiree R. Azizoddin, PsyD, of the Dana Farber Cancer Institute and Harvard University Medical School, and colleagues wrote. “However, current literature is greatly limited by cross-sectional methodology, that does not permit for causal inferences or longitudinal understanding regarding the etiology of fatigue in SLE.”
To analyze stress and depressive symptoms as predictors of fatigue in patients with SLE, Azizoddin and colleagues examined 2 years of data from the Lupus Outcomes Study at the University of California, San Francisco. According to the researchers, participants in the study were recruited form both clinical and community sources, and fulfilled the American College of Rheumatology’s classification criteria for SLE.
Data were primarily obtained through annual structured telephone interviews. Fatigue was measured using the 36-question short-form health survey (SF-36) vitality scale. Depression, disease and stress were assessed through various self-reported measures.
Azizoddin and colleagues analyzed data from 650 participants. The researchers used multivariate linear regression models to analyze predictors of changes in fatigue. Specifically, model one tested the association of time-one (T1) depression with time two (T2) fatigue. Model two added T1 perceived stress to model two, and final models added T1T2 decrease in stress. The researchers controlled for T1 fatigue, age, sex, self-report of fibromyalgia, pain and SLE duration, activity, and damage.
According to the researchers, the mean SF-36 score was 55. T1 depression significantly predicted T2 fatigue, the researchers wrote. However, when T1 stress was added, stress (beta = 1.7; P <.0001) significantly predicted T2 fatigue and depression was no longer a significant predictor. In addition, an analysis of T1-T2 decrease in stress was associated with a clinically meaningful decline in fatigue (beta = –11.8; P < .0001).
“Depression and stress are primary factors that explain the development of fatigue overtime in patients with SLE, irrespective of their concurrent [fibromyalgia] diagnosis, disease activity, and damage,” Azizoddin and colleagues wrote. “Stress is the primary driver for fatigue and should be targeted through comprehensive evaluation and management. If clinicians are to succeed in helping patients improve fatigue across the disease spectrum, they must include evaluation of stress and pursue evidence-based interventions targeting stress that mobilize patients’ engagement in self-management, concurrent with ongoing management of their lupus.” – by Jason LadayDisclosure: The researchers report funding from the NIH.