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Fatigue and its correlates in Indian patients with systemic lupus erythematosus

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Fatigue is a disabling yet poorly understood symptom in patients with systemic lupus erythematosus (SLE). Many variables influence fatigue including physical function, pain, fibromyalgia and psychiatric comorbidity. Literature is conflicted on its association with disease activity. To assess fatigue and its correlates among patients with SLE. Existent data from validation of Hindi LupusPRO study were utilized for this study. SLE patients were enrolled and underwent assessments of disease activity and damage (SELENA-SLEDAI and SLICC/ACR Damage Index (SDI)). Depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), fatigue (Fatigue Severity Scale (FSS)) and fibromyalgia were evaluated. Physical function and bodily pain were assessed using Short Form 36 (SF-36). Statistical analysis was done using the STATA version 14. A total of 140 females and 4 males with SLE with a mean age of 32.48 (SD 7.26) years were recruited. Median duration of illness was 3 years (IQR-4). Fatigue (FSS ≥ 4) was present in 74 (51.39%) participants. Prevalence of depression (PHQ-9 ≥ 10) and anxiety (GAD-7 ≥ 10) were 25% and 22.9%, respectively. Concomitant fibromyalgia was present in 8 participants (5.56%). Higher fatigue scores correlated with greater disease activity, shorter disease duration, worse physical function, bodily pain, depression and anxiety. On stepwise regression, disease duration, disease activity, bodily pain, depression and anxiety were independent predictors of fatigue (R2 = 0.35, p < 0.001). Fatigue is seen in over half of Indian patients with SLE and is independently associated with disease activity, disease duration, pain and psychiatric comorbidity. Multidisciplinary approach is indicated to address fatigue in SLE.

Key Points

Fatigue is common in patients in Indian patients with SLE

Higher disease activity, shorter duration of disease, pain and psychiatric comorbidity were associated with fatigue

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Correspondence to Benzeeta Pinto.

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Approval was obtained from the ethics committee of Post Graduate Institute of Medical Education and Research, Chandigarh, India. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.



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All participants were informed of the study details and written informed consents were taken.

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Pinto, B., Dhooria, A., Grover, S. et al. Fatigue and its correlates in Indian patients with systemic lupus erythematosus. Clin Rheumatol 40, 905–911 (2021).

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