Members of the Ad Hoc Committee on SLE Response Criteria for Fatigue are as follows: J. Antonio Aviña-Zubieta, MD, MSc: Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada; Graciela S. Alarcón, MD: University of Alabama at Birmingham; Heike A. Bischoff-Ferrari, MD, MPH: Boston University School of Medicine, Boston, Massachusetts; Rebecca Fischer-Betz, MD, Matthias Schneider, MD: Heinrich-Heine-University, Düsseldorf, Germany; Victoria Gall, MD, Matthew H. Liang, MD, MPH, Peter Schur, MD: Brigham and Women's Hospital, Boston, Massachusetts; Gabor Illei, MD: NIH, NIDCR, Bethesda, Maryland; Jamal Mikdashi, MD: University of Maryland, College Park; Michelle Petri, MD, MPH: Johns Hopkins School of Medicine, Baltimore, Maryland; Charlotte Phillips, RN, MPH, CCRC: New England Baptist Hospital, Boston, Massachusetts; Jacques Pouchot, MD: European Georges Pompidou Hospital, Paris, France; William St.Clair, MD: Duke University Medical Center, Durham, North Carolina.
Measurement of fatigue in systemic lupus erythematosus: A systematic review
Article first published online: 29 NOV 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis Care & Research
Volume 57, Issue 8, pages 1348–1357, 15 December 2007
How to Cite
Ad Hoc Committee on Systemic Lupus Erythematosus Response Criteria for Fatigue (2007), Measurement of fatigue in systemic lupus erythematosus: A systematic review. Arthritis & Rheumatism, 57: 1348–1357. doi: 10.1002/art.23113
- Issue published online: 29 NOV 2007
- Article first published online: 29 NOV 2007
- Manuscript Accepted: 7 JUN 2007
- Manuscript Received: 21 DEC 2006
- American College of Rheumatology
- Kirkland Scholar Award
- SLE Foundation of New York
- The Lupus Erythematodes Selbsthilfegemeinschaft e.V. Germany
- NIH. Grant Numbers: AR-47782, R13-AR-47584-01
- Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center (Harvard University)
- Heinrich-Heine-University in Düsseldorf
- Arthritis Research Centre of Canada (University of British Columbia)
- Massachusetts Veterans Epidemiology Research and Information Center
- Center for Advanced Methodological Support for Innovative SLE Clinical Trials
- CONACYT (Mexico)
- Canadian Arthritis Network
- Michael Smith Foundation for Health Research
- Canadian Institutes for Health Research
- Systemic lupus erythematosus;
- Fatigue Severity Scale;
- Systemic Lupus Activity Measure;
- Systemic Lupus Erythematosus Disease Activity Index
To systematically review fatigue instruments used in patients with systemic lupus erythematosus (SLE) and to seek consensus on which instruments should be recommended for future studies and which data on comorbid conditions should be reported when evaluating fatigue in patients with SLE.
We used data from Medline and EMBase databases (from January 1970 to June 2006), clinical experts, and bibliographies. Data were extracted independently by 4 authors and reviewed by a working group and larger expert panel to produce a recommendation. Instruments were examined for construct validity, reliability, and responsiveness to change. Correlations between fatigue and some components of the Medical Outcomes Study Short Form 36 (SF-36), disease activity, and comorbidities were reviewed.
We identified 34 studies that used 15 fatigue instruments in patients with SLE. The Fatigue Severity Scale (FSS) was used in 56% of the studies. The Systemic Lupus Activity Measure was significantly correlated with fatigue, but the Systemic Lupus Erythematosus Disease Activity Index was not. Fatigue was also correlated with pain, poor quality of sleep, depression, and with each subscale of the SF-36.
The working group and expert panel recommend the 9-item FSS for evaluating fatigue in SLE patients. Responsiveness to change of fatigue instruments has not been well established in SLE and needs further study. The panel suggested that an important improvement or response could be a 15% decrease in the FSS. The effect of several important confounding factors of fatigue such as sleep disorders, depression, fibromyalgia, and anemia needs to be collected and reported.