Systemic lupus erythematosus in three ethnic groups. VI: Factors associated with fatigue within 5 years of criteria diagnosis

Objective: To determine the frequency, degree and associated features of fa tigue among Hispanic (H), African American (AA) and Caucasian (C) patients with recent onset (less than or equal to 5 yr) systemic lupus erythematosus (SLE) at their baseline evaluation. Methods: H (n = 69), AA (n = 83) acid C (n = 71) patients from the LUMINA ( LUpus in MInority populations: NAture vs Nurture) cohort were studied. Fati gue [Fatigue Severity Scale (FSS)] was defined as present if FSS score grea ter than or equal to 3.0. Variables from functional, clinical, sociodemogra phic, health behaviors, behavioral and psychological and immunogenetics dom ains were ascertained at study entry. Associations were examined using regr ession models. Results: Eighty-six percent (85.7%) of patients reported having fatigue (82 .6% H; 85.5% AA; 88.7% C); median FSS score, 5.3. Factors from the psycholo gical and clinical domains were primarily associated with FSS; immunogeneti c (HLA Class II phenotypes) features were not. Increased fatigue was strong ly associated with decreasing function, both physical and mental. Variables associated with significantly greater degree of fatigue at baseline in the multivariable stepwise model in order of decreasing additional partial R-2 explained included: abnormal illness-related behaviors, older age, higher self-reported pain, greater degree of helplessness, greater disease activit y, Caucasian race, and lacking health insurance (model R-2 = 37%). Conclusions: Fatigue is one of the most prevalent clinical manifestations o f SLE across all ethnic groups. The perception of fatigue severity in SLE m ay be multifactorial in origin, including psychosocial factors and disease activity. If these prove causal, knowledge of their contribution may sugges t therapeutic and/or behavioral interventions, which could ameliorate this pervasive and often incapacitating symptom of SLE.