Jump Rebecca L, Robinson Michael E, Armstrong Ashley E, Barnes Elena V, Kilbourn Kristin M, Richards Hanno B
Department of Medicine, University of Florida, Gainesville 32610-0221, USA.
J Rheumatol. 2005 Sep;32(9):1699-705.
Pain and psychological distress are associated with fatigue, and social support may play a buffering role in the adjustment to a chronic disease. Investigations of the relationship between fatigue and disease activity in chronic diseases have provided inconclusive findings. The influence of medications on perceived fatigue remains unclear. We investigated the relationship between pain, depression, fatigue, and disease activity in patients with systemic lupus erythematosus (SLE).
Participants (n = 127) completed a psychosocial questionnaire during routine clinic visits. Hierarchical multiple regression analysis was conducted to predict the contribution of disease activity, pain, depression (Beck Depression Inventory), and perceived social support to fatigue.
Disease activity as measured by SLE Disease Activity Index (SLEDAI) did not significantly predict self-reported levels of fatigue. Medication usage did not predict fatigue levels. Pain and depression were both unique positive predictors of fatigue. Controlling for pain and depression, perceived social support contributed negatively to the variance in fatigue scores, suggesting a buffering effect. This model reliably explained 42% of the variance in fatigue scores.
Our results emphasize the importance of depression, pain, and perceived social support in predicting reported fatigue levels in patients with SLE. In contrast, disease activity measured by SLEDAI does not appear to account for fatigue in SLE. Understanding the effect of psychosocial factors on fatigue in SLE may improve patient outcomes through psychosocial interventions aimed at reducing pain and increasing coping skills and social support.
疼痛和心理困扰与疲劳相关，社会支持可能在慢性病适应过程中起缓冲作用。关于慢性病中疲劳与疾病活动度之间关系的研究结果尚无定论。药物对感知到的疲劳的影响仍不明确。我们研究了系统性红斑狼疮（SLE）患者疼痛、抑郁、疲劳与疾病活动度之间的关系。
参与者（n = 127）在常规门诊就诊时完成一份社会心理问卷。进行分层多元回归分析，以预测疾病活动度、疼痛、抑郁（贝克抑郁量表）和感知到的社会支持对疲劳的影响。
用SLE疾病活动指数（SLEDAI）衡量的疾病活动度并不能显著预测自我报告的疲劳水平。药物使用情况也不能预测疲劳水平。疼痛和抑郁都是疲劳的独特正向预测因素。在控制疼痛和抑郁后，感知到的社会支持对疲劳得分的方差有负向贡献，表明存在缓冲效应。该模型可靠地解释了疲劳得分方差的42%。
我们的结果强调了抑郁、疼痛和感知到的社会支持在预测SLE患者报告的疲劳水平方面的重要性。相比之下，用SLEDAI衡量的疾病活动度似乎并不能解释SLE患者的疲劳情况。了解社会心理因素对SLE患者疲劳的影响，可能通过旨在减轻疼痛、提高应对技能和增加社会支持的社会心理干预来改善患者的预后。
