Fatigue in Patients with Systemic Lupus Erythematosus: The Psychosocial Aspects

ROALD OMDAL, KNUT WATERLOO, WENCHE KOLDINGSNES, GUNNAR HUSBY, and SVEIN IVAR MELLGREN

ABSTRACT.

Objective. Studies to prove a relationship between fatigue and immunological, inflammatory, or other disease characteristics of systemic lupus erythematosus (SLE) have shown no consistent findings. To further elucidate the basis for fatigue in SLE, we examined the affective states, personality traits, and mental health status in an unselected group of patients with SLE.

Methods. Fifty-seven Caucasian patients with SLE were examined. Fatigue was measured by the Fatigue Severity Scale. Personality traits and psychological function were evaluated by the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the affective states by Beck Depression Inventory, and mental health status by the General Health Questionnaire version 30 (GHQ-30).

Results. Fatigue was closely associated with high scores on subscales Depression (D-2) and Hysteria (Hy-3) on MMPI-2 (R² = 0.31; p = 0.0002), as well as with high scores on BDI (R² = 0.22; p = 0.0006) and GHQ (R² = 0.33; p < 0.0001).

Conclusion. Fatigue does not seem to be caused by any easily recognizable single or multiple factor(s) of an inflammatory or immunological state. Our results point to fatigue being a multifaceted phenomenon where several psychosocial factors are strongly related, and indicate that fatigue is part of a complex response to chronic disease. (J Rheumatol 2003;30:283-7)

Key Indexing Terms:

SYSTEMIC LUPUS ERYTHEMATOSUS
FATIGUE
NEUROPSYCHIATRIC SLE
PSYCHOLOGICAL FUNCTION
MMPI-2
GENERAL HEALTH QUESTIONNAIRE-30

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From the Departments of Clinical Medicine/Neurology, University of Tromsø; Departments of Neurology and Rheumatology, University Hospital of North Norway; and Department of Rheumatology, National Hospital, Oslo, Norway.

R. Omdal was supported as a postdoctoral research fellow by the Norwegian Foundation for Health and Rehabilitation.

R. Omdal, MD, PhD, Professor, Departments of Clinical Medicine/Neurology, University of Tromsø; K. Waterloo, PsyD, Professor, Department of Neurology; W. Koldingsnes, MD, Research Fellow, Department of Rheumatology, University Hospital of North Norway; G. Husby, MD, PhD, Professor, Department of Rheumatology, National Hospital, Oslo; S.I. Mellgren, MD, PhD, Professor, Department of Neurology, University Hospital of North Norway.

Address reprint requests to Dr. R. Omdal, Clinical Immunology Unit, Department of Medicine, Rogaland Central Hospital, N-4068 Stavanger, Norway. E-mail: romdal@online.no

Submitted March 11, 2002; revision accepted July 30, 2002.

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