Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Rheumatol Int. 2019 Nov;39(11):1867-1873. doi: 10.1007/s00296-019-04354-0. Epub 2019 Jun 27.
Primary Sjögren's syndrome (pSS) is a chronic autoimmune rheumatic disease with symptoms including dryness, fatigue, and pain. The previous work by our group has suggested that certain proinflammatory cytokines are inversely related to patient-reported levels of fatigue. To date, these findings have not been validated. This study aims to validate this observation. Blood levels of seven cytokines were measured in 120 patients with pSS from the United Kingdom Primary Sjögren's Syndrome Registry and 30 age-matched healthy non-fatigued controls. Patient-reported scores for fatigue were classified according to severity and compared to cytokine levels using analysis of variance. The differences between cytokines in cases and controls were evaluated using Wilcoxon test. A logistic regression model was used to determine the most important identifiers of fatigue. Five cytokines, interferon-γ-induced protein-10 (IP-10), tumour necrosis factor-α (TNFα), interferon-α (IFNα), interferon-γ (IFN-γ), and lymphotoxin-α (LT-α) were significantly higher in patients with pSS (n = 120) compared to non-fatigued controls (n = 30). Levels of two proinflammatory cytokines, TNF-α (p = 0.021) and LT-α (p = 0.043), were inversely related to patient-reported levels of fatigue. Cytokine levels, disease-specific and clinical parameters as well as pain, anxiety, and depression were used as predictors in our validation model. The model correctly identifies fatigue levels with 85% accuracy. Consistent with the original study, pain, depression, and proinflammatory cytokines appear to be the most powerful predictors of fatigue in pSS. TNF-α and LT-α have an inverse relationship with fatigue severity in pSS challenging the notion that proinflammatory cytokines directly mediate fatigue in chronic immunological conditions.
原发性干燥综合征(pSS)是一种慢性自身免疫性风湿病,其症状包括干燥、疲劳和疼痛。我们小组之前的工作表明,某些促炎细胞因子与患者报告的疲劳水平呈负相关。迄今为止,这些发现尚未得到验证。本研究旨在验证这一观察结果。在英国原发性干燥综合征登记处的 120 名 pSS 患者和 30 名年龄匹配的非疲劳健康对照者中测量了七种细胞因子的血液水平。根据严重程度对患者报告的疲劳评分进行分类,并使用方差分析比较细胞因子水平。使用 Wilcoxon 检验评估病例和对照组之间细胞因子的差异。使用逻辑回归模型确定疲劳的最重要标识符。与非疲劳对照组(n=30)相比,干扰素-γ诱导蛋白-10(IP-10)、肿瘤坏死因子-α(TNFα)、干扰素-α(IFNα)、干扰素-γ(IFN-γ)和淋巴毒素-α(LT-α)在 pSS 患者(n=120)中显着升高。两种促炎细胞因子 TNF-α(p=0.021)和 LT-α(p=0.043)的水平与患者报告的疲劳水平呈负相关。细胞因子水平、疾病特异性和临床参数以及疼痛、焦虑和抑郁被用作我们验证模型的预测因子。该模型正确识别疲劳水平的准确率为 85%。与原始研究一致,疼痛、抑郁和促炎细胞因子似乎是 pSS 疲劳的最强预测因子。TNF-α 和 LT-α 与 pSS 疲劳严重程度呈负相关,这挑战了促炎细胞因子直接介导慢性免疫性疾病中疲劳的观点。
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