Fatigue levels and associated factors in systemic sclerosis: a cross-sectional study of 2385 SPIN Cohort participants
Authors: Kwakkenbos Linda , Levis Brooke , Henry Richard S , Virgili-Gervais Gabrielle , Carrier Marie-Eve , Bartlett Susan J , Gietzen Amy , Gottesman Karen , Guillot Geneviève , Lawrie-Jones Amanda , Hummers Laura K , Malcarne Vanessa L , Mayes Maureen D , Richard Michelle , Wojeck Robyn K , Worron-Sauvé Maureen , Hudson Marie , Mouthon Luc , Benedetti Andrea , Thombs Brett D ,   Scleroderma Patient-centered Intervention Network Investigators, Adams Claire E , El-Baalbaki Ghassan , Fligelstone Kim , Frech Tracy , Harel Daphna , Hinchcliff Monique , Johnson Sindhu R , Larche Maggie , Leite Catarina , Nguyen Christelle , Nielsen Karen , Pope Janet , Rannou François , Rodriguez-Reyna Tatiana Sofia , Schouffoer Anne A , Suarez-Almazor Maria E , Agard Christian , Alric Laurent , André Marc , Beaslay Floryan , Bernstein Elana J , Berthier Sabine , Bissonnette Lyne , Blaise Sophie , Bories Eva , Bruns Alessandra , Cacciatore Carlotta , Carreira Patricia , Casadevall Marion , Chaigne Benjamin , Chung Lorinda , Crichi Benjamin , Deltombe Thylbert , Denton Christopher , Desroche Tannvir , Domsic Robyn , Dunne James V , Dunogue Bertrand , Fare Regina , Farge-Bancel Dominique , Fortin Paul R , Gauzère Loraine , Gerber Anne , Gordon Jessica K , Granel-Rey Brigitte , Guffroy Aurélien , Gyger Geneviève , Hachulla Eric , Hoa Sabrina , Hughes Michael , Ikic Alena , Khalidi Nader , Lakin Kimberly S , Lambert Marc , Launay David , Lee Yvonne C , Legendre Paul , Maillard Hélène , Maltez Nancy , Manning Joanne , Marie Isabelle , Lopez Maria Martin , Martin Thierry , Masetto Ariel , Mekinian Arsène , Díaz Sheila Melchor , Mourguet Morgane , Nikpour Mandana , Olagne Louis , Poindron Vincent , Proudman Susanna , Pugnet Grégory , Raffray Loïc , Régent Alexis , Renou Frederic , Rivière Sébastien , Robinson David , Almazar Esther Rodríguez , Roux Sophie , Smets Perrine , Sobanski Vincent , Spiera Robert F , Steen Virginia , Sutton Evelyn , Thorne Carter , Vagner Damien , Varga John , Wilcox Pearce , Ayala Mara Cañedo , Cook Vanessa , Santo Cassidy Dal , Dal Santo Tiffany , D'onofrio Monica , Hu Sophie , Nassar Elsa-Lynn , Neyer Marieke Alexandra , Provencher Sabrina 
Published: October 2024

Abstract

Objectives
The objectives of this study were to compare fatigue in a large multinational SSc cohort with general population data and identify associated sociodemographic, lifestyle and SSc disease factors.

Methods
Scleroderma Patient-centered Intervention Network Cohort participants completed the Patient-Reported Outcomes Measurement Information System-29 v2.0 fatigue domain. T-scores were compared with the USA general population (mean = 50; s.d. = 10). Multivariable linear regression was used to assess associations with sociodemographic, lifestyle, and disease-related variables.

Results
Among the 2385 participants [mean age 54.9 (s.d. = 12.6) years, 87% female, 38% dcSSc], the mean fatigue T-score was 54.6 (s.d. = 11.0); 438 (18%) reported mild fatigue, 641 (27%) moderate fatigue, and 180 (8%) severe fatigue. Fatigue was independently associated with sociodemographic factors age [−0.10 points per year, (95% CI −0.14, −0.07)], male sex [−1.67 points, (−2.96, −0.37)], non-married status [0.97 points (0.04, 1.89)] and country [reference USA; France −2.35 points (−3.48, −1.21) and UK 2.38 points (0.80, 3.97)], and lifestyle factors smoking [4.16 points (2.52, 5.80)], alcohol consumption [−0.18 points per drink per week (−0.28, −0.07)] and BMI [0.34 points per unit (0.27, 0.42)]. Fatigue was associated with disease-related factors, including gastrointestinal involvement [4.21 points (2.99, 5.43)], digital ulcers [1.51 points, (0.25, 2.77)], moderate small joint contractures (1.41 points [0.13, 2.69]), RA [4.34 points (2.37, 6.31)] and SS [1.89 points (0.23, 3.55)]. When pain was included in the model, its association was large [2.19 points (2.03, 2.34)], and interstitial lung disease was also associated [1.21 points (0.42, 2.00)].

Conclusion
In people with SSc, fatigue scores were substantially higher than in the general population and associated with multiple disease factors, including gastrointestinal involvement, several painful disease manifestations, and lung involvement.