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Open Access Research article

A five-year prospective study of fatigue in primary Sjögren's syndrome

Karstein Haldorsen12*, Ingvar Bjelland34, Anne Isine Bolstad2, Roland Jonsson15 and Johan Gorgas Brun56

Author Affiliations

1 Broegelmann Research Laboratory, The Gade Institute, Laboratory Bldg., Haukeland University Hospital, N-5021 Bergen, Norway

2 Department of Clinical Dentistry - Periodontics, University of Bergen, Aarstadveien 17, N-5009 Bergen, Norway

3 Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, N-5021 Bergen, Norway

4 Department of Clinical Medicine, University of Bergen, N-5020 Bergen, Norway

5 Department of Rheumatology, Haukeland University Hospital, N-5021 Bergen, Norway

6 Section for Rheumatology, Institute of Medicine, University of Bergen, N-5020 Bergen, Norway

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Arthritis Research & Therapy 2011, 13:R167  doi:10.1186/ar3487

Published: 13 October 2011

Abstract

Introduction

Fatigue is prevalent in primary Sjögren's syndrome (pSS), and contributes to the considerably reduced health related quality of life in this disease. The symptom is included in proposed disease activity and outcome measures for pSS. Several studies indicate that there is an inflammatory component of fatigue in pSS and other chronic inflammatory rheumatic diseases. The purpose of this study was to investigate fatigue change in pSS in a longitudinal study, and explore whether any clinical or laboratory variables at baseline, including serum cytokines, were associated with a change in fatigue scores over time.

Methods

A clinical and laboratory investigation of 141 patients fulfilling the American-European consensus criteria of pSS was undertaken in the period May 2004 to April 2005. Median time since diagnosis was 5.5 years. Examinations included the fatigue questionnaires: fatigue severity scale (FSS), fatigue visual analogue scale (VAS), functional assessment of chronic illness therapy - fatigue (FACIT-F) and medical outcome study short form-36 (SF-36) vitality, which were repeated in a follow-up investigation in January and February 2010.

Results

A total of 122 patients (87%) responded at both time-points. Thirty-five percent of patients experienced a clinically significant FSS increase. On the group level, fatigue measures did not change except that there was a slight deterioration in SF-36 vitality score. High serum anti-Sjögren's syndrome A antigen (anti-SSA) showed weak associations with high baseline fatigue, and patients with increasing fatigue had lower baseline unstimulated whole salivary volume. Weak associations between increasing fatigue and serum immunoglobulin G (IgG), and the pro-inflammatory cytokine interleukin-17 (IL-17), were observed. Baseline sicca symptoms correlated with higher fatigue both at baseline and with increasing fatigue over time. Linear regression analysis did not identify any predictive ability of clinical or laboratory measures on fatigue change over time.

Conclusions

Fatigue remained mainly unchanged over time. Using multivariate models did not reveal any clinical or laboratory predictors of fatigue change over time.