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Dimensions of Fatigue in Systemic Lupus Erythematosus: Relationship to Disease Status and Behavioral and Psychosocial Factors
DEBORAH Da COSTA, MARIA DRITSA, SASHA BERNATSKY, CHRISTIAN PINEAU, HENRI A. MÉNARD, KABERI DASGUPTA, ANAHITA KESCHANI, NATALIE RIPPEN, and ANN E. CLARKE ABSTRACT. Objective. To characterize the experience of fatigue in patients with systemic lupus erythematosus (SLE) using a multidimensional assessment and to delineate contributors to physical and mental dimensions of fatigue. Methods. Fatigue in 130 women with SLE was assessed using the Multidimensional Fatigue Inventory (MFI-20). Participants completed standardized questionnaires assessing sleep quality, depressed mood, social support, and leisure-time physical activity. A clinical examination determined disease activity, cumulative damage, and whether patients fulfilled American College of Rheumatology criteria for fibromyalgia (FM). A series of hierarchical multiple regressions were computed to identify contributors to physical and mental fatigue. Results. Patients scored high on all 5 MFI-20 fatigue dimensions, with general fatigue and physical fatigue having the highest scores. A hierarchical multiple regression showed that greater disease damage and disease activity, the presence of FM, depressed mood, sleep disturbance, and less participation in leisure-time physical activity contributed to higher physical fatigue scores. The results of the second model found depressed mood to be the strongest determinant of mental fatigue. Disease-related variables were not associated with mental fatigue. Conclusion. Fatigue in SLE is multidimensional and multidetermined, with physical and mental aspects likely having different etiologies. A multidimensional assessment of fatigue in SLE is needed to tailor and optimize interventions aimed at alleviating fatigue. (First Release June 1 2006; J Rheumatol 2006;33:1282–8) Key Indexing Terms:
SYSTEMIC LUPUS
ERYTHEMATOSUS
From the Division of Clinical Epidemiology, Division of Rheumatology, and Division of Clinical Immunology/Allergy, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada. Supported by the Canadian Institutes of Health Research. Dr. Da Costa is a New Investigator Awardee of The Arthritis Society. D. Da Costa, PhD; M. Dritsa, MEd, PhD candidate; S. Bernatsky, MD, PhD; K. Dasgupta, MD, MSc; A. Keschani, BSc; N. Rippen, BA, BEd, Division of Clinical Epidemiology; C. Pineau, MD; H.A. Ménard, MD, MSc, Division of Rheumatology; A.E. Clarke, MD, MSc, Division of Clinical Epidemiology, Division of Clinical Immunology/Allergy. Address reprint requests to Dr. D. Da Costa, Division of Clinical Epidemiology, McGill University Health Centre, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada. E-mail: Deborah.DaCosta@mcgill.ca Accepted for publication February 21, 2006.
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