Fatigue in Systemic Lupus Erythematosus
Fatigue in Systemic Lupus Erythematosus
Fatigue is a frequent and pervasive problem with multiple adverse consequences for patients with SLE, but to date there have only been a few clinical trials that have addressed the pharmacologic and nonpharmacologic management of fatigue in SLE populations.
Psychoeducational intervention has been used in trials compared to placebo, with reported improvement in social support between patients and their partners, better self-efficacy and lower fatigue after 1 year of therapy, calling for a role of behavioral therapy in the management of fatigue in SLE.
A pilot study to investigate the feasibility and safety of acupuncture for SLE explored the benefits of acupuncture in reducing pain and fatigue. Twenty four patients were randomized to receive acupuncture with electrical stimulation, minimal needling, which involves shallow insertion of needles into nonacupuncture body points, or usual care during ten sessions. No serious side effects occurred, although some minor transient side effects were reported, mainly needle insertion pain, dizziness or lightheadedness, or local bruising. A total of 40% of patients receiving active intervention with acupuncture or minimal needling reported more than a 30% improvement in pain scores measured by the Arthritis Impact Measurement Scale revised Pain Scale or the 36-item Short-Form Health Survey bodily pain scale. Only 13% in the minimal needling group, but 25% in the acupuncture group showed improvement in fatigue, measured with FSS or 36-item Short-Form Health Survey vitality score, suggesting that a brief course of acupuncture may be a useful nonpharmacologic alternative for managing pain and fatigue for SLE patients.
A recent pilot study evaluated the effectiveness of home-based exercise programs using the Wii Fit® system in SLE patients. Fifteen patients who had moderate-to-severe fatigue measured by FSS participated in Wii Fit®, a fitness gaming module, 3 days a week for 30 min each time. Even though the mean adherence was 64% across the 10-week period, patients' perceived fatigue severity significantly improved by average of 18.4%, with added benefits of reduced body weight and waist circumference. Other improvements were seen including reduced anxiety level and pain, and the authors concluded that this method was safe and feasible and may be a viable option to encourage physical activity and reduce fatigue, body weight, waist circumference, anxiety and overall intensity of pain.
Hartkamp et al. investigated the role of dehydroepiandrosterone (DHEA) in improving fatigue and reduced wellbeing in patients with SLE in a randomized placebo-controlled trial of 60 patients. Patients with SLE have frequently been found to have low levels of DHEA, which is a major steroidal product in the adrenal gland. Previous research studies observed a relationship between physiologic decline in serum DHEA and DHEA sulfate levels during aging with atherosclerosis, global changes in metabolism, decline in cerebral function and immunocompetence, potentially linking the DHEA to rheumatic diseases. DHEA has shown some beneficial effects when administrated in older patients and in patients with other disease states including cardiovascular disease. This study was conducted in patients with quiescent SLE to avoid other confounding factors, with daily oral administration of 200 mg DHEA. Fatigue was measured using the Multidimensional Fatigue Inventory, with both placebo and DHEA groups improving on fatigue scores with no proven benefit of DHEA over placebo in improving fatigue.
A recent randomized, double-blind, placebo-controlled clinical trial of a newly approved B-lymphocyte stimulator, belimumab, has assessed fatigue as a secondary end point using the Functional Assessment of Chronic Illness Therapy Fatigue scale, and 52-week and 76-week studies showed a significant improvement in fatigue compared to placebo.
Treatment of Fatigue
Fatigue is a frequent and pervasive problem with multiple adverse consequences for patients with SLE, but to date there have only been a few clinical trials that have addressed the pharmacologic and nonpharmacologic management of fatigue in SLE populations.
Psychoeducational intervention has been used in trials compared to placebo, with reported improvement in social support between patients and their partners, better self-efficacy and lower fatigue after 1 year of therapy, calling for a role of behavioral therapy in the management of fatigue in SLE.
A pilot study to investigate the feasibility and safety of acupuncture for SLE explored the benefits of acupuncture in reducing pain and fatigue. Twenty four patients were randomized to receive acupuncture with electrical stimulation, minimal needling, which involves shallow insertion of needles into nonacupuncture body points, or usual care during ten sessions. No serious side effects occurred, although some minor transient side effects were reported, mainly needle insertion pain, dizziness or lightheadedness, or local bruising. A total of 40% of patients receiving active intervention with acupuncture or minimal needling reported more than a 30% improvement in pain scores measured by the Arthritis Impact Measurement Scale revised Pain Scale or the 36-item Short-Form Health Survey bodily pain scale. Only 13% in the minimal needling group, but 25% in the acupuncture group showed improvement in fatigue, measured with FSS or 36-item Short-Form Health Survey vitality score, suggesting that a brief course of acupuncture may be a useful nonpharmacologic alternative for managing pain and fatigue for SLE patients.
A recent pilot study evaluated the effectiveness of home-based exercise programs using the Wii Fit® system in SLE patients. Fifteen patients who had moderate-to-severe fatigue measured by FSS participated in Wii Fit®, a fitness gaming module, 3 days a week for 30 min each time. Even though the mean adherence was 64% across the 10-week period, patients' perceived fatigue severity significantly improved by average of 18.4%, with added benefits of reduced body weight and waist circumference. Other improvements were seen including reduced anxiety level and pain, and the authors concluded that this method was safe and feasible and may be a viable option to encourage physical activity and reduce fatigue, body weight, waist circumference, anxiety and overall intensity of pain.
Hartkamp et al. investigated the role of dehydroepiandrosterone (DHEA) in improving fatigue and reduced wellbeing in patients with SLE in a randomized placebo-controlled trial of 60 patients. Patients with SLE have frequently been found to have low levels of DHEA, which is a major steroidal product in the adrenal gland. Previous research studies observed a relationship between physiologic decline in serum DHEA and DHEA sulfate levels during aging with atherosclerosis, global changes in metabolism, decline in cerebral function and immunocompetence, potentially linking the DHEA to rheumatic diseases. DHEA has shown some beneficial effects when administrated in older patients and in patients with other disease states including cardiovascular disease. This study was conducted in patients with quiescent SLE to avoid other confounding factors, with daily oral administration of 200 mg DHEA. Fatigue was measured using the Multidimensional Fatigue Inventory, with both placebo and DHEA groups improving on fatigue scores with no proven benefit of DHEA over placebo in improving fatigue.
A recent randomized, double-blind, placebo-controlled clinical trial of a newly approved B-lymphocyte stimulator, belimumab, has assessed fatigue as a secondary end point using the Functional Assessment of Chronic Illness Therapy Fatigue scale, and 52-week and 76-week studies showed a significant improvement in fatigue compared to placebo.
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