Stress, Depression, Pain are Major Causes of Fatigue in SLE Patients, Study Shows

Stress, depression, and pain — but not disease activity, sleep, or physical health —  appear to be major contributors to fatigue among patients with systemic lupus erythematosus (SLE), a new study reports.

The findings support that screening and treatment of these measures are included in the usual care of SLE patients, particularly when fatigue is being addressed.

The study, “Fatigue in systemic lupus: the role of disease activity and its correlates,” was published in the journal Lupus.

Fatigue is one of the most common symptoms experienced by patients with SLE. Understanding how and why this symptom occurs in SLE patients might guide clinical care to help ease their discomfort.

In order to assess the factors that affect fatigue in SLE patients, the researchers recruited 116 SLE patients without fibromyalgia. The patients were mostly women, were ethnically diverse — 50% African-American, 21% Caucasian, 9% Asian, and 8% of other ethnicities — and the average age was about 40 years old.

Patients were given assessments for six variables that the researchers suspected might influence fatigue: disease activity, insomnia, depression, stress, pain, and physical health. Patients were questioned about their perceived experiences. For example, the Insomnia Severity Index, which asks questions about sleeping habits, was used to quantitatively measure insomnia.

The researchers then analyzed how each of these six variables correlated with fatigue.

In the investigators’ model, the six variables together explained 57% of the variance in fatigue. So, although other factors certainly play a role, much of the difference in fatigue could be explained by these factors.

Individually, some factors were much more strongly correlated with levels of fatigue than others. Specifically, stress seemed to have the greatest effect on fatigue, followed by depression and then pain. These three variables alone accounted for 56% of the variance in fatigue in the researchers’ model, and each one individually appeared to have a significant effect on patients’ reported fatigue.

“Stress, depression and pain account for a large majority of the presence of fatigue symptoms in this sample of individuals with SLE and many others, therefore it is appropriate to allocate further resources to examine and target individual’s experiences of stress, depression and pain,” researchers wrote.

“As current guidelines towards evaluating and targeting the treatment of fatigue do not exist, utilizing results identified in this analysis can provide guiding principles for physicians, healthcare providers and clinical trials,” they concluded.