POS1255 REAL WORLD FATIGUE VARIABILITY AND PATTERNS IN SJÖGREN’S SYNDROME
Authors: J. Chow, M. Elbahnasawi, K. Thompson, J. Casement, J. Berry, W. F. Ng
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Fatigue is a common and disabling symptom of Sjögren's Syndrome (SS), and often has a greater impact on quality of life than sicca features. Variability in fatigue symptoms have been poorly documented in the literature, despite the challenge this poses for patients. Further elucidation of this variability may improve our understanding of the symptom and its clinical management. <h3>Objectives:</h3> To explore the relationship between recall scores of validated weekly fatigue questionnaires with four-times daily Patient Diary scores To explore daily and weekly fatigue variability, characterising fatigue patterns in SS patients <h3>Methods:</h3> Four weekly fatigue questionnaires and two 7-day Patient Diaries were available in 102 SS patients from an observational study aiming to identify objective measures of fatigue. Participants were recruited from a large tertiary Sjögren's clinic in the UK. Four validated fatigue questionnaires – Profile of Fatigue (Pro-F), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Visual Analogue Scale (VAS), and the Multidimensional Fatigue Inventory (MFI) – were used at the beginning and end of both 7-day Patient Diary weeks, termed Visit 1 and 2 (V1, 2) for Week 1 (W1) Patient Diary and Visit 3 and 4 (V3, 4) for Week 2 (W2) Patient Diary. Patients recorded symptoms morning, afternoon, evening, and night on a 11-point (0-10) Likert scale in the diary. Correlation matrices and Pearson's correlation coefficient were used to explore the relationships between the validated fatigue scores, other clinical symptoms, and daily scores. Standard deviation (SD) of daily scores across the week, a proxy for variability, was used to note changes across six common symptoms (physical and mental fatigue, dryness, pain, anxiety, and depression). Daily score profiles were expressed as vectors of score changes between timepoints (Morning-Afternoon, Afternoon-Evening, Evening-Night). Pairwise Euclidean distances between vectors were calculated and hierarchal cluster analysis was performed. <h3>Results:</h3> Multivariate correlation showed moderate-to-strong positive correlation between all weekly and daily fatigue scores in both physical and mental fatigue (p&lt;0.01) (Figure 1). Examining physical fatigue, W1 physical fatigue mean and V2 ESSPRI physical fatigue score (r = 0.84) and W2 physical fatigue mean and V4 ESSPRI physical fatigue score (r = 0.90) had the strongest correlations. For mental fatigue, W1 mental fatigue mean and V2 ESSPRI mental fatigue score (r = 0.90) and W2 mental fatigue mean and V4 ESSPRI mental fatigue score (r = 0.91) had the strongest correlations. The strongest correlation between daily and weekly symptoms were observed in the appropriate recall period for ESSPRI in both weeks. Using the maximum SD value across both weeks, physical and mental fatigue scores were more variable throughout the day compared to other common SS symptoms (pain, dryness, anxiety, and depression). A potential method was used to describe daily patterns however no correlations were found between patterns across days and weeks (Figure 2). <h3>Conclusion:</h3> Although correlations between daily and weekly fatigue scores were moderate-strong, they are not perfect, justifying further exploration of daily scores. Further assessment of daily changes could help identify the pitfalls of fatigue assessment used in clinical trials and improve our understanding of the underlying pathophysiology of fatigue. Future methods to illustrate daily fatigue patterns need to be explored to find relevant associations within daily clusters. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Jocelyn Chow: None declared, Mahmoud Elbahnasawi: None declared, Kyle Thompson: None declared, John Casement: None declared, Joe Berry: None declared, Wan-Fai Ng Novartis, Bristol Myers Squibb, Sanofi, Janssen, IQVIA, Argenx, Resolve Therapeutics, and Abbvie.