The following  study is currently being conducted at the Royal Brisbane Hospital by PhD student Kellie Stockton of the University of Queensland, School of Medicine.

Fatigue in Systemic Lupus Erythematosus (SLE) – Investigation of some unexplored factors.

By Kellie Stockton BAppSc (Physio) Post Grad Dip (Cardiothoracic)

Patients with SLE have reduced exercise capacity, reduced quality of life and elevated levels of fatigue. Greater than 50%1 of patients with SLE describe fatigue as the most disabling disease symptom. In addition greater than 80%2, 3 of patients with SLE report that fatigue is not adequately addressed in their management plan. Fatigue associated with SLE is extreme and persistent in nature and affects the person’s ability to perform activities of daily living.

The cause of fatigue in SLE is not known and is likely to be multi factorial. Fatigue is not necessarily related to disease severity in SLE. People with mild and/or well controlled SLE may still experience excessive fatigue. Factors such as co existing fibromyalgia, depression, pain and sleep disturbances have been shown to increase fatigue in SLE, however many other factors may also be involved.

There is very little information regarding the reliability of outcome measures measuring strength and physical function in SLE. Fluctuating hand, wrist and knee involvement is common in SLE thus outcomes across those joints may not be as reliable as other joints due to variability in disease presentation. Studies comparing strength, quality of life, fatigue and the reliability of these measures in women with SLE compared to healthy controls are underway at the Royal Brisbane & Women’s Hospital.

Studies have demonstrated myocardial (heart muscle) abnormalities in some patients with SLE who do not have a history of coronary artery disease. 4-6 The exact pathological mechanism underlying the development of SLE related myocardial disease is not clear, but may represent a combination of subclinical inflammatory and immunological processes rather than conventional coronary artery disease alone.5, 7, 8 Identifying patients with subacute myocardial abnormalities can be challenging. Clinical presentation may mimic other disorders varying from flu-like symptoms to acute heart failure.9 A common symptom is fatigue. The relationship of fatigue to myocardial abnormalities in SLE has not been explored.

A pilot study investigating myocardial (heart muscle) abnormalities in people with SLE and the correlation to physical capacity and fatigue has recently commenced. The aim of this study is to investigate the presence of myocardial abnormalities in people with SLE without symptoms of cardiac disease by using cardiac magnetic resonance imaging (MRI). Participants will also undergo a number of tests investigating strength, physical function, fatigue and blood tests.

Fatigue associated with SLE can be debilitating. This body of research aims to add to the body of evidence related to fatigue in SLE. Understanding this symptom more thoroughly will enable clinicians to better meet the needs of patients with SLE. An improved knowledge of fatigue will also assist with devising and evaluating more appropriate management strategies.

1.  Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 46: 1121-1123.

2.  Danoff-Burg S, Friedberg F (2009) Unmet needs of patients with systemic lupus erythematosus. Behav Med. 35: 5-13.

3.  Moses N, Wiggers J, Nicholas C, Cockburn J (2005) Prevalence and correlates of perceived unmet needs of people with systemic lupus erythematosus. Patient Educ Couns. 57: 30-38.

4.  Sella EM, Sato EI, Barbieri A (2003) Coronary artery angiography in systemic lupus erythematosus patients with abnormal myocardial perfusion scintigraphy. Arthritis Rheum. 48: 3168-3175.

5.  Abdel-Aty H, Siegle N, Natusch A, et al. (2008) Myocardial tissue characterization in systemic lupus erythematosus: value of a comprehensive cardiovascular magnetic resonance approach. Lupus. 17: 561-567.

6.  Nikpour M, Gladman DD, Ibanez D, Bruce IN, Burns RJ, Urowitz MB (2009) Myocardial perfusion imaging in assessing risk of coronary events in patients with systemic lupus erythematosus. J Rheumatol. 36: 288-294.

7.  Bidani AK, Roberts JL, Schwartz MM, Lewis EJ (1980) Immunopathology of cardiac lesions in fatal systemic lupus erythematosus. Am J Med. 69: 849-858.

8. Edwards NC, Ferro CJ, Townend JN, Steeds RP (2007) Myocardial disease in systemic vasculitis and autoimmune disease detected by cardiovascular magnetic resonance. Rheumatology (Oxford). 46: 1208-1209.

9.  Feldman AM, McNamara D (2000) Myocarditis. N Engl J Med. 343: 1388-1398.