Background: Fatigue is a disabling phenomenon in many patients with systemic lupus erythematosus (SLE). The pathophysiologic processes are unknown, and no known biological disease factors influence the phenomenon. Because depressive mood consistently is associated with fatigue, and drug treatment for SLE do not ameliorate fatigue, a psychological explanation could be an alternative. In search of a somatic fundament for fatigue, we looked for alternative markers of biologic activity associated with fatigue. Cerebral white matter hyperintensities (WMH) represent biochemical changes of brain tissue and are frequently encountered in patients with SLE, and are in multiple sclerosis patients associated with cognitive impairment. Presence of such an association between fatigue and WMH in SLE would favour a biological axis to fatigue.
Methods: A cross-sectional, case-control study with 62 unselected SLE patients and 62 age- and gender-matched healthy subjects. Fatigue was evaluated with the Fatigue Severity Scale (FSS) and a fatigue visual analogue scale (VAS). WMH were rated using Scheltens’ method.
Results: Greater fatigue and more WMH appeared in SLE patients versus healthy subjects. In the full group of patients (n = 62) fatigue VAS was associated with total WMH score (p = 0.009). In subgroup analysis of patients without clinical depression (n = 40) the association to total WMH remained (p = 0.035) while this was not the case in the depressed group (n = 18) (p = 0.211).
Conclusion: Increased cerebral WMH load is associated with increased fatigue, indicating a biological origin for some portion of fatigue in patients with SLE.
- magnetic resonance imaging
- systemic lupus erythematosus