Fatigue levels and associated factors in systemic sclerosis: a cross-sectional study of 2,385 SPIN Cohort participants

Linda Kwakkenbos; Brooke Levis; Richard S Henry; Gabrielle Virgili-Gervais; Marie-Eve Carrier; Susan J Bartlett; Amy Gietzen; Karen Gottesman; Geneviève Guillot; Amanda Lawrie-Jones; Laura K Hummers; Vanessa L Malcarne; Maureen D Mayes; Michelle Richard; Robyn K Wojeck; Maureen Worron-Sauvé; Marie Hudson; Luc Mouthon; Andrea Benedetti; Brett D Thombs

doi:10.1093/rheumatology/keae570

Fatigue levels and associated factors in systemic sclerosis: a cross-sectional study of 2,385 SPIN Cohort participants

Rheumatology (Oxford). 2024 Oct 24:keae570. doi: 10.1093/rheumatology/keae570. Online ahead of print.

Authors

Linda Kwakkenbos^{1

2

3}, Brooke Levis⁴, Richard S Henry⁴, Gabrielle Virgili-Gervais⁴, Marie-Eve Carrier⁴, Susan J Bartlett^{5

6}, Amy Gietzen⁷, Karen Gottesman⁸, Geneviève Guillot⁹, Amanda Lawrie-Jones^{10

11}, Laura K Hummers¹², Vanessa L Malcarne^{13

14}, Maureen D Mayes¹⁵, Michelle Richard¹⁶, Robyn K Wojeck¹⁷, Maureen Worron-Sauvé^{18

19}, Marie Hudson^{4

5}, Luc Mouthon^{20

21}, Andrea Benedetti^{5

22

23}, Brett D Thombs^{4

5

24

25

26}

Affiliations

¹ Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.
² Department of IQ Health, Radboud University Medical Center, Nijmegen, the Netherlands.
³ Centre for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands.
⁴ Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
⁵ Department of Medicine, McGill University, Montreal, Quebec, Canada.
⁶ Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
⁷ National Scleroderma Foundation, Tri-State Chapter, Buffalo, New York, USA.
⁸ National Scleroderma Foundation, Los Angeles, California, USA.
⁹ Sclérodermie Québec, Longueuil, Quebec, Canada.
¹⁰ Scleroderma Australia, Melbourne, Victoria, Australia.
¹¹ Scleroderma Victoria, Melbourne, Victoria, Australia.
¹² Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹³ Department of Psychology, San Diego State University, San Diego, California, USA.
¹⁴ San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA.
¹⁵ Department of Internal Medicine, University of Texas McGovern School of Medicine, Houston, Texas, USA.
¹⁶ Scleroderma Atlantic, Halifax, Nova Scotia, Canada.
¹⁷ University of Rhode Island, Kingston, Rhode Island, USA.
¹⁸ Scleroderma Society of Ontario, Hamilton, Ontario, Canada.
¹⁹ Scleroderma Canada, Hamilton, Ontario, Canada.
²⁰ Service de Médecine Interne, Centre de Référence Maladies Autoimmunes et Autoinflammatoires Systémiques Rares d'Ile de France, de l'Est et de l'Ouest, Hôpital Cochin, Paris, France.
²¹ Assistance Publique Hopitaux de Paris-Centre, Hôpital Cochin, Université Paris Cité, Paris, France.
²² Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada.
²³ Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Québec, Canada.
²⁴ Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
²⁵ Department of Psychology, McGill University, Montreal, Quebec, Canada.
²⁶ Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada.

PMID: 39447026
DOI: 10.1093/rheumatology/keae570

Abstract

Objectives: To compare fatigue in a large multinational systemic sclerosis (SSc) cohort to general population data and identify associated sociodemographic, lifestyle and SSc disease factors.

Methods: Scleroderma Patient-centered Intervention Network Cohort participants completed the Patient-Reported Outcomes Measurement Information System-29 v2.0 fatigue domain. T-scores were compared with the USA general population (mean = 50; SD = 10). Multivariable linear regression was used to assess associations with sociodemographic, lifestyle, and disease-related variables.

Results: Among 2,385 participants (mean age 54.9 (SD = 12.6) years, 87% female, 38% diffuse SSc), mean fatigue T-score was 54.6 (SD = 11.0); 438 (18%) reported mild fatigue, 641 (27%) moderate, and 180 (8%) severe fatigue. Fatigue was independently associated with sociodemographic factors age (-0.10 points per year, [95% CI -0.14;-0.07]), male sex (-1.67 points, [-2.96;-0.37]), non-married status (0.97 points [0.04; 1.89]), and country (reference USA; France -2.35 points [-3.48;-1.21] and UK 2.38 points [0.80; 3.97]), and lifestyle factors smoking (4.16 points [2.52; 5.80]), alcohol consumption (-0.18 points per drink per week [-0.28;-0.07]), and body-mass index (0.34 points per unit [0.27; 0.42]). Fatigue was associated with disease-related factors gastrointestinal involvement (4.21 points [2.99; 5.43]), digital ulcers (1.51 points, [0.25; 2.77]), moderate small joints contractures (1.41 points [0.13; 2.69]), rheumatoid arthritis (4.34 points [2.37-6.31]) and Sjögren's syndrome (1.89 points [0.23; 3.55]). When pain was included in the model, its association was large (2.19 points [2.03; 2.34]) and interstitial lung disease was also associated (1.21 points [0.42; 2.00]).

Conclusions: In people with SSc, fatigue scores were substantially higher than the general population and associated with multiple disease factors including gastrointestinal involvement, several painful disease manifestations, and lung involvement.

Keywords: Fatigue; Patient Reported Outcome Measures; Patient-Centred Care; Scleroderma; Systemic.