ID31685018
Published Date2019-11-04
JournalArthritis research & therapy, 2019-11-04, Volume 21 Find other publications in this journal
Author Info
  • Division of Rheumatology, Department of Medicine, Faculty of Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Canada.
  • Division of Genetics and Development, Krembil Research Institute, University Health Network, 5KD402, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada.
  • Lakeridge Health Services, Oshawa, Canada.
  • Division of Rheumatology, Hospital for Sick Children, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.
  • Division of Rheumatology, Department of Medicine, Faculty of Medicine, University Health Network, University of Toronto, Toronto, Canada.
  • Division of Genetics and Development, Krembil Research Institute, University Health Network, 5KD402, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada. Joan.Wither@uhnresearch.ca.

Abstract

Fatigue is a common symptom of systemic autoimmune rheumatic disease (SARD). Patients with SARD have a protracted pre-clinical phase during which progressive immunologic derangements occur culminating in disease. In this study, we sought to determine when fatigue develops and whether its presence correlates with inflammatory factors or predicts disease progression.Anti-nuclear antibody (ANA)-negative healthy controls (HCs) and ANA-positive participants with no criteria, at least one clinical criteria (undifferentiated connective tissue disease, UCTD), or meeting SARD classification criteria were recruited. Fatigue was assessed using a modified version of the FACIT-F questionnaire and the presence of fibromyalgia determined using a questionnaire based on the modified 2010 ACR criteria. Peripheral blood expression of five IFN-induced genes was quantified by NanoString and the levels of IL-1β, IL-6, or TNF-α by ELISA.Fatigue was as prevalent and severe in individuals lacking SARD criteria as it was in UCTD and SARD. Overall, ~ 1/3 of ANA subjects met fibromyalgia criteria, with no differences between sub-groups. Although fatigue was more severe in these individuals, those lacking fibromyalgia remained significantly more fatigued than ANA HC. However, even in these subjects, fatigue correlated with the widespread pain index and symptom severity scores on the fibromyalgia questionnaire. Fatigue was not associated with elevated cytokine levels in any of the ANA sub-groups and did not predict imminent disease progression.Fatigue is common in ANA individuals lacking sufficient criteria for a SARD diagnosis, correlates with fibromyalgia-related symptoms, and is not associated with inflammation or predictive of disease progression.