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Rheumatology Advance Access originally published online on December 23, 2008
Rheumatology 2009 48(2):165-169; doi:10.1093/rheumatology/ken455
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Fatigue: an overlooked determinant of physical function in scleroderma

S. B. Sandusky1, L. McGuire1, M. T. Smith2, F. M. Wigley3 and J. A. Haythornthwaite2

1Department of Psychology, University of Maryland, Baltimore County, 2Department of Psychiatry and Behavioral Sciences and 3Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Correspondence to: L. McGuire, Department of Psychology, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Baltimore, MD 21250, USA. E-mail: lmcguire{at}umbc.edu


  Abstract

Objectives. To examine the frequency and correlates of fatigue and its impact on physical and social functioning in patients with scleroderma, and to investigate whether fatigue mediates an association between pain and physical function.

Methods. One hundred and seven scleroderma patients attending an academic scleroderma specialty centre completed measures of fatigue, sleep, pain, depressive symptoms, and physical and social functioning. Patients had received a comprehensive clinical assessment with a diagnosis of limited or diffuse scleroderma from their attending rheumatologist.

Results. In this sample of scleroderma patients, 76% reported experiencing fatigue and 61% of these patients reported fatigue as one of their three most distressing symptoms. Patients endorsing greater pain had higher levels of self-reported fatigue, as did those reporting greater depression and poorer functioning. Multiple regression analyses indicated that global fatigue was a significant cross-sectional correlate of physical, but not social, functioning after controlling for depressive symptoms, level of education, poor sleep quality and disease subtype. However, global fatigue did not predict physical function when pain was included in the analyses.

Conclusions. Our findings indicate that fatigue is common in scleroderma and that pain and fatigue are significant determinants of physical functioning for patients with limited and diffuse disease subtypes. Future research should investigate whether effective pain treatments reduce symptoms of fatigue, as well as identify other possible causes of fatigue in order to improve quality of life for scleroderma patients.

KEY WORDS: Scleroderma, Fatigue, Quality of life, Pain, Sleep, Mood

Submitted 10 December 2007; revised version accepted 18 November 2008.
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