Fatiga en pacientes con lupus eritematoso sistémico: datos del registro RELESSAR prospectivo
Resumen
Introducción: la fatiga es una manifestación frecuente y poco comprendida del lupus eritematoso sistémico (LES) presente en hasta el 86% de los pacientes y con impacto negativo en la calidad de vida. Su evaluación sistemática sigue siendo una necesidad no cubierta en la práctica clínica. Objetivos: evaluar el grado de fatiga en pacientes con LES mediante una escala visual análoga (EVA), y analizar su asociación con variables sociodemográficas y clínicas. Materiales y métodos: estudio transversal basado en los datos de la visita basal del registro RELESSAR prospectivo de la Sociedad Argentina de Reumatología. Se incluyeron pacientes ≥18 años con diagnóstico de LES ≤5 años. Se consideró fatiga significativa una EVA ≥4. Se realizaron análisis univariados y multivariados para determinar factores asociados. Resultados: se incluyeron 198 pacientes; el 53% presentó fatiga ≥4. En el análisis multivariado, la fatiga se asoció con la actividad de la enfermedad (SLEDAI-2K) (OR 1,18; IC 95% 1,10-1,28; p<0,001) y con el tiempo al diagnóstico (OR 2,08; IC 95% 1,35-3,40; p=0,002). También se observó mayor frecuencia de hospitalizaciones y peor valoración global. Conclusiones: la fatiga es prevalente en pacientes con LES y se asocia con mayor actividad, por lo cual se destaca la necesidad de su evaluación sistemática.Citas
I. Mertz P, Schlencker A, Schneider M, Gavand PE, Martin T, Arnaud L. Towards a practical management of fatigue in systemic lupus erythematosus. Lupus Sci Med. 2020;7(1):1-5. doi:10.1136/lupus-2020-000441.
II. Arnaud L, Gavand PE, Voll R, Schwarting A, Maurier F, Blaison G, et al. Predictors of fatigue and severe fatigue in a large international cohort of patients with systemic lupus erythematosus and a systematic review of the literature. Rheumatol (United Kingdom). 2019;58(6):987-96. doi:10.1093/rheumatology/key398.
III. Cleanthous S, Tyagi M, Isenberg DA, Newman SP. What do we know about self-reported fatigue in systemic lupus erythematosus? Lupus. 2012;21(5):465-76. doi:10.1177/0961203312436863.
IV. Ahn GE, Ramsey-Goldman R. Fatigue in systemic lupus erythematosus. Int J ClinRheumatol. 2012;7(2):217-27. doi:10.2217/IJR.12.4.
V. Kawka L et al. Fatigue in systemic lupus erythematosus. An update on its impact, determinants and therapeutic management. J Clin Med 2021;10(17):3996. doi: 10.3390/jcm10173996.
VI. Moses N, Wiggers J, Nicholas C, Cockburn J. Prevalence and correlates of perceived unmet needs of people with systemic lupus erythematosus. Patient Educ Couns. 2005 Apr;57(1):30-8. doi:10.1016/j.pec.2004.03.015.
VII. Da Costa D, Dritsa M, Bernatsky S, Pineau C, Ménard HA, et al. Dimensions of fatigue in systemic lupus erythematosus: relationship to disease status and behavioral and psychosocial factors. J Rheumatol. 2006 Jul;33(7):1282-8.
VIII. 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 Sep;32(9):1699-705.
IX. Wysenbeek AJ, Leibovici L, Weinberger A, Guedj D. Fatigue in systemic lupus erythematosus. Prevalence and relation to disease expression. Br J Rheumatol. 1993 Jul;32(7):633-5. doi:10.1093/rheumatology/32.7.633.
X. Tayer WG, Nicassio PM, Weisman MH, Schuman C, Daly J. Disease status predicts fatigue in systemic lupus erythematosus. J Rheumatol. 2001 Sep;28(9):1999-2007.
XI. Dures E, Farisoğulları B, Santos EJF, Molto A, Feldthusen C, Harris C, et al. 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. Ann Rheum Dis. 2023;1260-7. doi:10.1136/ard-2023-224514.
XII. Pons-Estel BA, Catoggio LJ, Cardiel MH, Soriano ER, Gentiletti S, Villa AR, et al. The GLADEL multinational Latin American prospective inception cohort of 1,214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among Hispanics. Medicine (Baltimore). 2004 Jan;83(1):1-17. doi:10.1097/01.md.0000104742.42401.e2.
XIII. Méndez-Castellano H. Sociedad y estratificación: método Graffar-Méndez Castellano. Caracas (Venezuela): FUNDACREDESA; 1994. 206 p. ID: lil-335634.
XIV. Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002 Feb;29(2):288-91.
XV. Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012 Aug;64(8):2677-86. doi:10.1002/art.34473.
XVI. Kapsala NN, Nikolopoulos DS, Flouda SP, Chavatza AP, Tseronis DD, Aggelakos MD, et al. From first symptoms to diagnosis of systemic lupus erythematosus: mapping the journey of patients in an observational study. Clin Exp Rheumatol. 2023 Jan;41(1):74-81. doi:10.55563/clinexprheumatol/x3s9td.
XVII. Aranow C, Askanase A, Oon S, Huq M, Calderone A, Morand EF, Nikpour M. Laboratory investigation results influence Physician's Global Assessment (PGA) of disease activity in SLE. Ann Rheum Dis. 2020 Jun;79(6):787-792. doi:10.1136/annrheumdis-2019-216753.
XVIII. Pons-Estel GJ, Quintana R, Ugarte-Gil MF, Harvey GB, Wojdyla D, Serrano-Morales R, et al. Predictors of first hospitalization due to disease activity and infections in systemic lupus erythematosus patients. Lupus. 2024 Nov;33(13):1492-1501. doi:10.1177/09612033241283551.
XIX. Murimi-Worstell IB, Lin DH, Kan H, Tierce J, Wang X, Nab H, et al. Healthcare utilization and costs of systemic lupus erythematosus by disease severity in the United States. J Rheumatol. 2021 Mar;48(3):385-393. doi:10.3899/jrheum.191187.
XX. Jönsen A, Hjalte F, Willim M, Carlsson KS, Sjöwall C, Svenungsson E, et al. Direct and indirect costs for systemic lupus erythematosus in Sweden. A nationwide health economic study based on five defined cohorts. Semin Arthritis Rheum. 2016 Jun;45(6):684-90. doi:10.1016/j.semarthrit.2015.11.013.
XXI. Strand V, Berry P, Lin X, Asukai Y, Punwaney R, Ramachandran S. Long-term impact of belimumab on health-related quality of life and fatigue in patients with systemic lupus erythematosus: six years of treatment. Arthritis Care Res (Hoboken). 2019 Jun;71(6):829-838. doi:10.1002/acr.23788.
XXII. Tench CM, McCurdie I, White PD, D’Cruz DP. The prevalence and associations of fatigue in systemic lupus erythematosus. Rheumatology. 2000;39(11):1249-54. 10.1093/rheumatology/39.11.1249.
XXIII. Azizoddin DR, Gandhi N, Weinberg S, Sengupta M, Nicassio PM, Jolly M. Fatigue in systemic lupus: the role of disease activity and its correlates. Lupus. 2019;28(2):163-73. doi:10.1177/0961203318817826
XXIV. Carrión-Barberà I, Salman-Monte TC, Castell S, Castro F, Ojeda F, Carbonell J. Prevalence and factors associated with fatigue in female patients with systemic lupus erythematosus. Med Clin. 2018;151(9):353-8. doi:10.1016/j.medcli.2017.12.007.
XXV. Bruce IN, Buie J, Bloch L, Bae SC, Costenbader K, Levy RA, et al. Lupus spectrum ambiguity has long-term negative implications for patients. Lupus Sci Med. 2023;10(1):1–6. doi:10.1136/lupus-2022-000856.
XXVI. Kernder A, Richter JG, Fischer-Betz R, Winkler-Rohlfing B, Brinks R, Aringer M, et al. Delayed diagnosis adversely affects outcome in systemic lupus erythematosus: Cross sectional analysis of the LuLa cohort. Lupus. 2021;30(3):431-8. doi:10.1177/0961203320983445.
XXVII. Al Sawah S, Daly RP, Foster S, Naegeli A, Benjamin K, Doll H, et al. Understanding delay in diagnosis, access to care and the satisfaction care in Lupus: Findings from a cross-sectional online survey in the United States. Ann Rheum Dis. 2015;74(Suppl 2):812.2-812. doi: 10.1136/annrheumdis-2015-eular.1159.
