Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Lupus. 2021 Jun;30(7):1124-1132. doi: 10.1177/09612033211005014. Epub 2021 Mar 28.
We aimed to investigate risk factors for fatigue in patients with systemic lupus erythematosus (SLE) and neuropsychiatric symptoms in order to identify potential interventional strategies.
Patients visiting the neuropsychiatric SLE (NPSLE) clinic of the Leiden University Medical Center between 2007-2019 were included. In a multidisciplinary consensus meeting, SLE patients were classified as having neuropsychiatric symptoms of inflammatory origin (inflammatory phenotype) or other origin (non-inflammatory phenotype). Fatigue was assessed with the SF-36 vitality domain (VT) since 2007 and the multidimensional fatigue inventory (MFI) and visual analogue scale (VAS) since 2011. Patients with a score on the SF-36 VT ≥1 standard deviation (SD) away from the mean of age-related controls of the general population were classified as fatigued; patients ≥2 SD away were classified as extremely fatigued. Disease activity was measured using the SLE disease activity index-2000. The influence of the presence of an inflammatory phenotype, disease activity and symptoms of depression and anxiety as measured by the hospital anxiety and depression scale (HADS) was analyzed using multiple regression analyses corrected for age, sex and education.
348 out of 371 eligible patients filled in questionnaires and were included in this study . The majority was female (87%) and the mean age was 43 ± 14 years. 72 patients (21%) had neuropsychiatric symptoms of an inflammatory origin. Fatigue was present in 78% of all patients and extreme fatigue was present in 50% of patients with an inflammatory phenotype vs 46% in the non-inflammatory phenotype. Fatigue was similar in patients with an inflammatory phenotype compared to patients with a non-inflammatory phenotype on the SF-36 VT (β: 0.8 (95% CI -4.8; 6.1) and there was less fatigue in patients with an inflammatory phenotype on the MFI and VAS (β: -3.7 (95% CI: -6.9; -0.5) and β: -1.0 (95% CI -1.6; -0.3)). There was no association between disease activity and fatigue, but symptoms of anxiety and depression (HADS) associated strongly with all fatigue measurements.
This study suggests that intervention strategies to target fatigue in (NP)SLE patients may need to focus on symptoms of anxiety and depression rather than immunosuppressive treatment.
我们旨在研究系统性红斑狼疮（SLE）患者出现神经精神症状的相关因素，以便确定潜在的干预策略。
我们纳入了 2007 年至 2019 年期间在莱顿大学医学中心神经精神性 SLE（NPSLE）诊所就诊的患者。在一次多学科共识会议上，SLE 患者被分为具有炎症性起源的神经精神症状（炎症表型）或其他起源（非炎症表型）。自 2007 年起，使用 SF-36 活力量表（VT）评估疲劳，自 2011 年起使用多维疲劳量表（MFI）和视觉模拟量表（VAS）评估疲劳。SF-36 VT 得分距同龄人群的平均值相差 1 个标准差（SD）以上的患者被归类为疲劳；相差 2 个 SD 以上的患者被归类为极度疲劳。采用 SLE 疾病活动指数-2000 来衡量疾病活动度。使用医院焦虑和抑郁量表（HADS）评估的炎症表型、疾病活动度以及抑郁和焦虑症状的存在，采用多元回归分析进行分析，并对年龄、性别和教育进行了校正。
371 名符合条件的患者中，有 348 名填写了问卷并纳入了本研究。大多数患者为女性（87%），平均年龄为 43±14 岁。72 名患者（21%）有炎症性起源的神经精神症状。所有患者中有 78%存在疲劳，炎症表型患者中有 50%存在极度疲劳，而非炎症表型患者中有 46%存在极度疲劳。炎症表型患者的 SF-36 VT 评分与非炎症表型患者的疲劳评分相似（β：0.8（95%CI -4.8；6.1），且 MFI 和 VAS 评分的炎症表型患者的疲劳程度较低（β：-3.7（95%CI：-6.9；-0.5）和β：-1.0（95%CI：-1.6；-0.3））。疾病活动度与疲劳无相关性，但焦虑和抑郁症状（HADS）与所有疲劳测量均有强烈相关性。
本研究表明，针对（NP）SLE 患者的疲劳的干预策略可能需要集中于焦虑和抑郁症状，而不是免疫抑制治疗。
