Pain, Depression, and Daytime Sleepiness Linked to Physical, Mental Fatigue in Sjögren’s

Pain, depression, and daytime sleepiness are significantly associated with both mental and physical fatigue in patients with primary Sjögren’s syndrome, even after adjusting for comorbidities and medication, a new study shows.

Management of fatigue in these patients should thus be tailored to each patient, depending on potential contributors, and focused on treating pain, depression, and sleep disorders.

The study, “Pain and depression are associated with both physical and mental fatigue independently of comorbidities and medications in primary Sjögren’s syndrome,” was published in the journal Rheumatic & Musculoskeletal disease.

Patients with primary Sjögren’s syndrome experience significant levels of fatigue and report it as a symptom that needs to be better managed by physicians.

Fatigue is defined as “an overwhelming sense of tiredness, lack of energy and a feeling of exhaustion.” High fatigue levels are associated with both poor health and functional problems.

Fatigue can be divided into two domains: physical and mental. Studies indicate that Sjögren’s patients experience more physical fatigue than mental fatigue. These patients also report higher daytime sleepiness scores, an indicator of physical fatigue.

For some patients, fatigue likely develops because of something other than Sjögren’s. For example, patients might be taking medications associated with drowsiness, or have comorbidities that cause fatigue — hypothyroidism, depression, obesity, celiac disease, diabetes, or anemia (low red blood cell count).

While previous studies have examined the relationship between Sjögren’s and fatigue, these studies were conducted using a small number of patients and without taking into account the effect of medications or comorbidities that could be causing fatigue.

Furthermore, few of these studies used the Profile of Fatigue scale (PROFAD), a measure of fatigue developed specifically for Sjögren’s patients.

Therefore, researchers in the United Kingdom conducted a study to evaluate the symptoms of fatigue in a large cohort of 608 patients using the American European Consensus Group (AECG) classification criteria.

Furthermore, they wanted to identify the factors associated with fatigue, and determine whether any comorbidities or medications were contributing to it.

First, researchers identified patients in the cohort with comorbidities associated with fatigue, and those taking medications associated with drowsiness. Next, they conducted statistical analysis to determine any significant associations.

Results indicated that pain, depression, and daytime sleepiness scores were all closely associated with both physical and mental fatigue. In addition, dryness, the hallmark of Sjögren’s syndrome, was strongly associated with physical fatigue.

These effects were observed even after adjusting for comorbidities associated with fatigue or medications associated with drowsiness.

Thus, “these findings support further research and clinical interventions targeting pain, dryness, depression and sleep to improve fatigue in patients with [primary Sjögren’s syndrome]. This finding is robust to both the effect of other comorbidities associated with fatigue and medications associated with drowsiness.”

They add that interventions targeted toward managing fatigue can likely significantly improve a patient’s quality of life.