New research suggests that depression, pain, and perceived lack of social support are often-overlooked predictors of fatigue in patients with systemic lupus erythematosus (SLE)—findings that may lead to a better understanding of psychosocial factors and a more specific therapeutic target for the treatment of this debilitating disease.
The new study of 127 SLE patients, published in the Journal of Rheumatology,1 found that pain and depression were most predictive of fatigue; antidepressant and anxiolytic use and SLE Disease Activity Index (SLEDAI) score did not adequately capture the psychosocial component of the disease.
"SLEDAI does not correlate in any way with patient-perceived fatigue, which is a major [issue] that our patients complain about," researcher Hanno B. Richards, MD, of the division of rheumatology and clinical immunology at the University of Florida in Gainesville, Florida, tells CIAOMed. "Therefore, additional factors must contribute to the fatigue ... pain, depression, and social support are things that should probably be assessed," Dr. Richards indicates, adding that this cannot be done in the traditional office practice setting. "Referral to a psychologist will probably help patients reduce fatigue," he says.
Pain and depression were unique predictors of fatigue in this select SLE patient population, according to the study, which found that fatigue had a modest association with pain intensity (r = .43, P <.001) and depression (r = .48, P <.001). Low perceived social support ratings were also modestly associated with higher levels of fatigue.
Associated with a loss of energy, sluggishness, and lethargy, fatigue interferes with daily activities and can be exacerbated by pain. Moreover, fatigue can also be a secondary symptom brought about by depression and sleep disturbances, the study authors point out.
As fatigue is one of the most widely reported symptoms of SLE, "both pain and depression represent therapeutic targets for treatment that could result in reduction in fatigue," the researchers note. Going forward, "nonpharmacologic and pharmacologic interventions can be integrated into a comprehensive, multidisciplinary treatment plan to reduce SLE-related fatigue by reducing depression and decreasing pain levels." For example, pharmacologic and psychological interventions for depression may reduce fatigue and improve quality of life in SLE patients, and nonpharmacologic pain treatments such as cognitive behavioral therapy may provide patients with a better understanding of how pain and mood are interrelated, helping them to better manage pain and enhance activity levels, the study suggests.
Multidisciplinary approach warranted
"We can provide services related to pain management ... addressing [the] symptoms of anxiety, depression, and general distress that come with diseases like lupus should have an impact on overall health," co-author Rebecca L. Jump, MA, a postdoctoral associate in the department of clinical and health psychology at the University of Florida College of Health Professions in Gainesville, Florida, tells CIAOMed.
Ms. Jump and colleagues conclude that "in light of the detrimental impact of pain, depression, and fatigue on quality of life, the development of biopsychosocial interventions might offer meaningful advances and become part of a multidisciplinary approach to the treatment of SLE."
Reference
- Jump RL, Robinson ME, Armstrong AE, Barnes EV, Kilbourn KM, Richards HB. Fatigue in systemic lupus erythematosus: contributions of disease activity, pain, depression, and perceived social support. J Rheumatol. 2005;32:1699-1705.