Disease activity and damage are not associated with increased levels of fatigue in systemic lupus erythematosus patients from a multiethnic cohort: LXVII

Arthritis Rheum. 2009 Sep 15;61(9):1179-86. doi: 10.1002/art.24649.


Objective: To determine the factors associated with increased levels of fatigue over the course of the disease in systemic lupus erythematosus (SLE) patients from LUpus in MInorities: NAture versus nurture, a longitudinal multiethnic cohort.

Methods: Patients with SLE (according to the American College of Rheumatology revised and updated criteria) age >/=16 years with a disease duration </=5 years at entry into the cohort, and of Hispanic (Texan or Puerto Rican), African American, or Caucasian ethnicity were studied. The association between socioeconomic/demographic characteristics, health behaviors, behavioral and psychological, functional and clinical characteristics, and fatigue was examined using generalized estimating equations to account for the longitudinal nature of the data.

Results: A total of 515 patients ( approximately 91% female) contributed 2,609 visits to these analyses. Of these patients, 93 (18.1%) were Texan-Hispanic, 101 (19.6%) were Puerto Rican-Hispanic, 169 (32.8%) were African Americans, and 152 (29.5%) were Caucasian. The mean +/- SD patient age and followup time were 37.2 +/- 12.6 years and 4.7 +/- 3.2 years, respectively. Variables associated with increased levels of fatigue in the multivariable analyses were Caucasian ethnicity, the presence of constitutional symptoms (fever, weight loss), and higher levels of pain, abnormal illness-related behaviors, and helplessness (P values between 0.0018 and <0.0001).

Conclusion: The presence of pain, abnormal illness-related behaviors, helplessness, and constitutional manifestations were associated with increased levels of fatigue. However, SLE-specific measures, such as disease activity and damage, were not. Interventions aimed at decreasing fatigue need to take into account these findings.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Black or African American / ethnology
  • Black or African American / psychology
  • Cohort Studies
  • Fatigue / ethnology*
  • Fatigue / etiology*
  • Fatigue / physiopathology
  • Female
  • Follow-Up Studies
  • Hispanic or Latino / ethnology
  • Hispanic or Latino / psychology
  • Humans
  • Illness Behavior / physiology
  • Longitudinal Studies
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / ethnology*
  • Lupus Erythematosus, Systemic / physiopathology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pain / physiopathology
  • Severity of Illness Index*
  • Socioeconomic Factors
  • White People / ethnology
  • White People / psychology