Assessment of fatigue and its relationships with disease-related parameters in patients with systemic sclerosis

We aimed to assess the prevalence and severity of fatigue in Moroccan patients with systemic sclerosis (SSc) and its relationship with disease-related parameters of activity and severity and quality of life (QoL). Patients with SSc according to the American College of Rheumatology criteria (diffuse disease) and/or the LeRoy and Medsger criteria (limited disease) for SSc were recruited. The multidimensional assessment of fatigue (MAF), a self-administered questionnaire developed to measure five dimensions of fatigue with a total score ranged from 0 (no fatigue) to 50 (severe fatigue), was used to assess fatigue. The activity of disease was assessed by evaluating the severity of skin involvement, vascular manifestations, pulmonary involvement, joint and/or muscle involvement, and the erythrocyte sedimentation rate. Functional disability was assessed by using the scleroderma health assessment questionnaire. QoL was assessed using the SF-36 generic instrument. Sixty-four patients (91% women) were included. The mean age of patients was 49.5 ± 12.4 years. Fifty-nine patients (92.1%) had diffuse SSc and 5 (7.8%) had limited disease. Among our patients, 89% experienced severe fatigue with a VAS fatigue ≥50 mm. The mean total score of the MAF was 28 ± 8.6 (10-44.8) and all domains of fatigue were affected. In univariate and multivariate analysis, fatigue was correlated with severe joint involvement, pain intensity, low vital capacity, high level of ESR, and with functional disability (for all p ≤ 0.01). There were statistically significant correlations between fatigue and the deterioration of all domains of SF-36. Fatigue is a disabling symptom in our SSc patients and is associated with poor QoL. Pain, joint involvement, functional impairment, and pulmonary involvement seem to be the most important factors that predict severe fatigue. Large studies are necessary in order to confirm those findings.