FATIGUE IN SYSTEMIC LUPUS PATIENTS Fatigue in Systemic Lupus Patients: The Role of Disease Activity and Correlating Factors Bryanna Murray NUR4165 Nursing Research Christine E. Lynn College of Nursing, Florida Atlantic University Faculty: Teresa Sakraida, PhD, RN February 26, 2021 1 FATIGUE IN SYSTEMIC LUPUS PATIENTS Fatigue in Systemic Lupus Patients: The Role of Disease Activity and Correlating Factors Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that results in a variety of symptoms due to the inflammation it causes throughout the human body. One of those symptoms include fatigue, which is the most poorly understood and addressed patient complaints (Azizoddin et al., 2019). During the nurse-patient interaction, it is important that the nurse properly assesses the patient to help determine possible interventions that may help relieve these symptoms. The aim of this paper is to review a research study that examines the correlation of six variables to fatigue symptoms in SLE patients as it relates to a nursing situation with a patient. It also provides suggestions for further research of interventions. Nursing Situation of Fatigue in Systemic Lupus Patients Mrs. K, a 30-year-old woman, has been diagnosed with systemic lupus for two years now. Lately, she has been struggling with her symptoms and decided to make an earlier appointment to visit her Rheumatologist office. When she arrived for her appointment, the nurse began assessing Mrs. K. The nurse noticed that she appeared very tired and quiet. The nurse then asked how she was feeling. She stated that she has been feeling more tired than usual and has not had the energy or strength to do her usual daily activities. It has not been improving. Appraisal of a Research Study: Implications and Recommendations Azizoddin et al. (2019) designed a cross-sectional pilot study surveying 116 ethnically diverse participants who were diagnosed with SLE without concomitant fibromyalgia (FM). The mean participant age was 39.80 and the ethnicities included 50% African American, 21% Caucasian, 13% Hispanic, 9% Asian, and 8% other (Azizoddin et al., 2019). Of these participants, a total of 91% were female. The study evaluated six variables (disease activity, insomnia, depression, stress, pain, and physical health) to see how they were related to fatigue in 2 FATIGUE IN SYSTEMIC LUPUS PATIENTS lupus patients (Azizoddin et al., 2019). The nursing situation describes how the nurse can attend to these needs and help manage symptoms. At each visit to the Rheumatologist office, the nurse would have the patient complete self-administered surveys. To measure each variable related to the patient’s condition, the study used the following: the FACIT-Fatigue (FACIT-FT) scale to measure the severity of the patient’s fatigue, the Pain Inventory survey, the Insomnia Severity Index for sleep, the Patient Health Questionnaire-9 (PHQ-9) for depression, the Perceived Stress Scale (PSS-4) and the LupusPRO v1.8 assessment for physical health (Azizoddin et al., 2019). The Rheumatologist would then measure disease activity during the assessment using the Safety of Estrogens in Lupus Erythematosus: National Assessment trial SLE Disease Activity Index (SELENA-SLEDAI), which is a cumulative index that evaluates 24 different disease factors (Azizoddin et al., 2019). All six of the variables evaluated were shown to be individually associated with fatigue in lupus. However, only depression, stress and pain were significantly correlated in this sample (Azizoddin et al., 2019). In the multivariate model of analysis, stress had the largest magnitude of effect on fatigue (β 0.77, 95% confidence interval (CI) 0.17– 1.38, p= 0.01), followed by depression (β 0.66, 95% CI 0.21–1.10, p= 0.005) and pain (β 0.22, 95% CI 0.01–0.43, p= 0.04). Disease activity surprisingly had the least significant association with fatigue (Azizoddin et al., 2019). Throughout this study and prior research, it was believed that disease activity or disease flares would most likely explain fatigue symptoms in SLE patients. The primary correlation of disease activity and fatigue continues to elicit inconclusive results (Azizoddin et al., 2019). Using the gathered information from the study, the nurse can begin to explore intervention options and review current treatment practices. Fatigue is a poorly addressed symptom related to SLE and can be much more severe than individuals with cancer, strokes, and 3 FATIGUE IN SYSTEMIC LUPUS PATIENTS HIV (Azizoddin et al., 2019). After assessing Mrs. K, the nurse found that the patient experienced high levels of stress and pain, which could therefore be contributing to her feelings of fatigue. The nurse recommended behavioral medicine interventions that targeted her stress and pain levels to see if that would then improve her fatigue symptoms. Another treatment option for fatigue in individuals with SLE is to utilize a biopsychosocial approach, but behavioral medicine interventions have been shown to be most effective (Azizoddin et al., 2019). As a result of this study, the nurse will continue to support the patients’ needs by addressing fatigue with a behavioral medicine approach. Since the study is limited by the small sample size and crosssectional analysis, further research still needs to be done to better understand the complex relationship between systemic lupus and fatigue (Azizoddin et al., 2019). Conclusion Overall, the data collection of this research study provided clarity into the variables affecting fatigue symptoms in SLE patients without FM. Stress, pain and depression were found to be the main correlating factors (Azizoddin et al., 2019). The nurse can integrate this screening with current treatment practices to help improve her patients’ symptoms. In this situation, the nurse was able to recommend behavioral medicine interventions which ended up helping her patient. To be able to fully address fatigue in SLE patients, further evaluation and evidence through long-term clinical trials will need to be conducted as it is still a symptom that is difficult to treat. The ingredients of caring (Mayeroff, 1971) that are important to this research study are hope and knowing. The main purpose of the study was to investigate the poorly addressed symptom of fatigue in hopes of gaining a better understanding of correlating factors to help SLE patients. The nurse was able to use the ingredient of knowing to apply the current interventions in this research study to the patient’s situation and possibly improve her symptoms. 4 FATIGUE IN SYSTEMIC LUPUS PATIENTS References Azizoddin, D. R., Gandhi, N., Weinberg, S., Sengupta, M., Nicassio, P. M., & Jolly, M. (2019). Fatigue in systemic lupus: the role of disease activity and its correlates. Lupus, 28(2), 163–173. https://doi.org/10.1177/0961203318817826 Mayeroff, M. (1971). On caring. New York: Harper & Row. 5
