Service de Médecine Interne, Hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France.
Joint Bone Spine. 2011 Mar;78(2):156-60. doi: 10.1016/j.jbspin.2010.05.002. Epub 2010 Jun 19.
Fatigue is a prominent symptom in many rheumatic diseases. Numerous factors contribute to cause fatigue, which can be a source of frustration for the patients and physicians, as the treatment often fails to produce the desired improvement. Diagnostic guidelines direct insufficient attention to the various semiological patterns of fatigue seen in rheumatic diseases. This update describes three main patterns of fatigue, depending on whether the source is physical or mental: muscle weakness in patients with neuromuscular disease; asthenia related to organic disease with excessive energy expenditure, deficient energy production (e.g., endocrine disorders), or inadequate recovery; and weariness due to the impact of stress and depression on quality of life. The prevalence of each pattern in various rheumatic diseases is discussed. This update underlines the practical benefits provided by a detailed semiological analysis of fatigue in patients with rheumatic disease and emphasizes the marked predominance of weariness due to stress and depression, on which the personality of the patient and inadequacy of social support systems may exert a major influence. Serotonin reuptake inhibitors (SSRIs) may be valuable in patients with fatigue not only because they improve the mental status, but also via their recently demonstrated anti-inflammatory effects.
疲劳是许多风湿性疾病的突出症状。许多因素都会导致疲劳，这可能会给患者和医生带来挫折感，因为治疗往往无法产生预期的改善。诊断指南对风湿性疾病中各种疲劳的症状模式关注不足。本更新描述了三种主要的疲劳模式，具体取决于疲劳的来源是身体上的还是精神上的：神经肌肉疾病患者的肌肉无力；与过度能量消耗、能量产生不足（如内分泌紊乱）或恢复不足相关的虚弱；以及由于压力和抑郁对生活质量的影响而导致的疲倦。讨论了每种模式在各种风湿性疾病中的患病率。本更新强调了对风湿性疾病患者的疲劳进行详细的症状学分析所带来的实际益处，并强调了由于压力和抑郁导致的疲劳的明显优势，患者的个性和社会支持系统的不足可能会对其产生重大影响。 5-羟色胺再摄取抑制剂（SSRIs）对疲劳患者可能具有重要价值，这不仅是因为它们可以改善精神状态，而且还因为它们最近显示出的抗炎作用。
