Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, SC, USA.
Ther Clin Risk Manag. 2014 Oct 1;10:775-86. doi: 10.2147/TCRM.S56063. eCollection 2014.
Among the host of distressing pathophysiological and psychosocial symptoms, fatigue is the most prevalent complaint in patients with systemic lupus erythematosus (SLE). This review is to update the current findings on non-pharmacological, pharmacological, and modality strategies to manage fatigue in patients with SLE and to provide some recommendations on optimal management of fatigue based on the best available evidence. We performed a systematic literature search of the PubMed and Scopus databases to identify publications on fatigue management in patients with SLE. Based on the studies reported in the literature, we identified nine intervention strategies that have the potential to alleviate fatigue in patients with SLE. Of the nine strategies, aerobic exercise and belimumab seem to have the strongest evidence of treatment efficacy. N-acetylcysteine and ultraviolet-A1 phototherapy demonstrated low-to-moderate levels of evidence. Psychosocial interventions, dietary manipulation (low calorie or glycemic index diet) aiming for weight loss, vitamin D supplementation, and acupuncture all had weak evidence. Dehydroepiandrosterone is not recommended due to a lack of evidence for its efficacy. In addition to taking treatment efficacy and side effects into consideration, clinicians should consider factors such as cost of treatment, commitments, and burden to the patient when selecting fatigue management strategies for patients with SLE. Any comorbidities, such as psychological distress, chronic pain, sleep disturbance, obesity, or hypovitaminosis D, associated with fatigue should be addressed.
在系统性红斑狼疮（SLE）患者众多令人痛苦的病理生理和心理社会症状中，疲劳是最常见的主诉。本篇综述旨在更新目前关于非药物、药物和方法策略在 SLE 患者疲劳管理中的应用，并根据现有最佳证据为疲劳的最佳管理提供一些建议。我们对 PubMed 和 Scopus 数据库进行了系统的文献检索，以确定 SLE 患者疲劳管理方面的文献。根据文献中报告的研究，我们确定了 9 种有潜力缓解 SLE 患者疲劳的干预策略。在这 9 种策略中，有氧运动和贝利尤单抗似乎具有最强的治疗效果证据。N-乙酰半胱氨酸和紫外线 A1 光疗具有低至中等水平的证据。心理社会干预、旨在减肥的饮食控制（低热量或血糖指数饮食）、维生素 D 补充剂和针灸都有较弱的证据。由于缺乏疗效证据，不推荐使用脱氢表雄酮。除了考虑治疗效果和副作用外，临床医生在为 SLE 患者选择疲劳管理策略时，还应考虑治疗成本、患者的承诺和负担等因素。任何与疲劳相关的合并症，如心理困扰、慢性疼痛、睡眠障碍、肥胖或维生素 D 缺乏症，都应得到解决。
