Objectives: Fatigue is common among individuals with systemic lupus erythematosus (SLE) but causes are not well understood. We examined perceived stress and depressive symptoms as predictors of fatigue in SLE.
Methods: Data from two years of the Lupus Outcomes Study (n=650), obtained through annual structured interviews, were used. Fatigue was measured with the SF-36 Vitality scale along with a variety of self-report measures of disease, depression, and stress. Multivariate linear regression models examined predictors of changes in fatigue. Model 1 tested the association of Time 1(T1) depression with Time 2(T2) fatigue; Model 2 added T1 perceived stress to Model 1; and final models added T1-T2 decrease in stress. All analyses controlled for T1 fatigue, age, sex, self-report of fibromyalgia, pain, and SLE duration, activity, and damage.
Results: Mean (SD) age was 51(12) years, 92% were women, 68% were Caucasian. Mean (SD) SF-36 Fatigue score was 55(24). T1 depression significantly predicted T2 fatigue. When T1 stress was added, stress (β 1.7, 95% CI [1.1, 2.2], p <0.0001) significantly predicted T2 fatigue but depression was no longer significance. The addition of T1-T2 decrease in stress was associated with clinically meaningful decline in fatigue (β -11.8, 95% CI [15.6, -8.9], p <0.0001).
Conclusion: While depressive symptoms initially predicted subsequent fatigue, the effects were mediated by stress. A decrease in stress, in addition, was associated with a clinically meaningful decrease in fatigue. These results suggest that perceived stress plays an important role in SLE fatigue and may be an important focus of interventions for fatigue.
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Fatigue in systemic lupus: the role of disease activity and its correlates.Lupus. 2019 Feb;28(2):163-173. doi: 10.1177/0961203318817826. Epub 2018 Dec 22. Lupus. 2019. PMID: 30580659 Clinical Trial.
Anxiety and depressive symptoms, and stress biomarkers in pregnant women after in vitro fertilization: a prospective cohort study.Hum Reprod. 2018 Jul 1;33(7):1237-1246. doi: 10.1093/humrep/dey109. Hum Reprod. 2018. PMID: 29796614
Fatigue in systemic lupus erythematosus: contributions of disease activity, pain, depression, and perceived social support.J Rheumatol. 2005 Sep;32(9):1699-705. J Rheumatol. 2005. PMID: 16142863
Measurement of fatigue in systemic lupus erythematosus: a systematic review.Arthritis Rheum. 2007 Dec 15;57(8):1348-57. doi: 10.1002/art.23113. Arthritis Rheum. 2007. PMID: 18050225 Review.
Patient-reported outcome measures for systemic lupus erythematosus clinical trials: a review of content validity, face validity and psychometric performance.Health Qual Life Outcomes. 2014 Jul 22;12:116. doi: 10.1186/s12955-014-0116-1. Health Qual Life Outcomes. 2014. PMID: 25048687 Free PMC article. Review.