Abstract
Objective The assessment and treatment of fatigue remains a major challenge in Systemic Lupus Erythematosus (SLE), especially in patients with no or low disease activity. The aim of session is to provide physicians with a practical algorithm1 for the management of fatigue in SLE, incorporating the patient’s perspective.
Methods Data regarding fatigue and common predictors of fatigue, including self-reported disease activity, anxiety, depression, stress, pain and fibromyalgia, levels of physical activity were analyzed in various cohorts of SLE patients, including the use of the novel digital tool Lupus Expert System for the Assessment of Fatigue (LEAF2).
Results First, the intensity and main characteristics of fatigue should be assessed using validated Patient Reported Outcomes Measures (PROMs). Then, common but non-SLE-related causes of fatigue should be ruled out based on medical history, clinical examination and simple laboratory tests. Presence of disease activity or organ damage should be assessed and may explain fatigue in some patients. In those with active disease, remission is the most appropriate therapeutic target while symptomatic support is needed in case of damage. Both anxiety and depression are major independent predictors of fatigue in SLE and require dedicated assessment and care with psychological counselling and pharmacological intervention if needed.
Conclusions Incorporating the patient’s perspective and individuality is key to the successful management of fatigue in SLE. Using a structured algorithm as well as digital tools such as LEAF may help improving the management of one the most common and complex patient complaints in SLE.
Acknowledgements We would like to thank all participants with Lupus who have been involved in our various studies on fatigue, with a special thanks to Lupus Europe.
References
Mertz P, Schlencker A, Schneider M, et al. Towards a practical management of fatigue in systemic lupus erythematosus. Lupus Sci Med 2020;7(1):e000441.
Kawka L, Sarmiento-Monroy JC, Mertz P, et al. Assessment and personalised advice for fatigue in systemic lupus erythematosus using an innovative digital tool: the Lupus Expert system for the Assessment of Fatigue (LEAF) study. RMD Open 2023;9(4):e003476.
