Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Longitudinal Fatigue Severity Scale Scores Correlate with Modifiable Psychosocial Variables in Early Systemic Sclerosis.

Leyva3,  Astrud Lorraine, Assassi1,  Shervin, Mayes6,  Maureen D., Nair1,  Deepthi K., Fischbach2,  Michael, Sharif1,  Roozbeh, Reveille5,  John D.

Univ of Texas Health Science Center Houston, TX
Univ of Texas Health Science Center San Antonio, TX
Univ of Texas Medical Branch, Galveston, TX
Univ of Texas Medical Branch; Currently at Eli Lilly and Co, Indianapolis, IN
Univ Texas Health Sci Ctr, Houston, TX
University of Texas-Houston, TX


Fatigue is a major complication of Systemic Sclerosis (SSc). Longitudinal studies examining the baseline predictors of fatigue in SSc have not been reported previously. We analyzed the association of the baseline demographic, clinical and self-reported psychometric variables with longitudinally obtained Fatigue Severity Scale (FSS) scores to identify potentially modifiable factors to improve fatigue severity in SSc.


FSS scores in 266 patients enrolled in the Genetics versus Environment in Scleroderma Outcomes Study (GENISOS) were examined. GENISOS is a large multi-center, prospective observational cohort of patients with early SSc (disease duration <= 5 years at enrollment). The association of baseline variables with sequentially obtained FSS was investigated in a generalized linear mixed model. A comprehensive list of baseline variables including demographic characteristics, disease type, autoantibody status, pulmonary function test parameters and psychometric measures were examined. Initially a univariate analysis was conducted, followed by a multivariate analysis utilizing a hierarchical forward variable selection strategy. Internal consistency of the psychometric variables including the FSS was assessed and validated with Cronbach's alpha computation.


The mean age was 48.6 years, 83% of patients were female and 47% of patients were Caucasian. Fifty-nine percent had diffuse cutaneous involvement. The mean follow up time was 3.8 years, ranging up to 11.4 years. The average baseline FSS score was 4.7 ± 0.96, comparable to scores reported in systemic lupus erythematosus and multiple sclerosis patients. A total of 1090 FSS measurements obtained during the enrollment time were studied for the longitudinal analysis. The FSS did not show a consistent trend for change over time (p=0.221). Although a number of baseline variables were associated with longitudinally obtained FSS, only coping skills as measured by the Illness Behavior Questionnaire (p<0.001), Short Form-36 physical component summary (p<0.001), shortness of breath-visual analogue scale (p=0.011) and Gastrointestinal Medsger Severity Index (p=0.025) were independent predictors of FSS in the multivariable model.


Longitudinal FSS scores were strongly associated with perceived physical functioning and coping patterns of illness behavior. Our results emphasize the importance of potentially modifiable psychosocial factors in treatment of fatigue. For example, an interventional strategy targeting coping mechanisms in SSc patients may directly improve fatigue severity. Consideration of specific psychosocial and behavioral support may have more impact in managing fatigue severity than currently available traditional or pharmacologic interventions.

To cite this abstract, please use the following information:
Leyva, Astrud Lorraine, Assassi, Shervin, Mayes, Maureen D., Nair, Deepthi K., Fischbach, Michael, Sharif, Roozbeh, et al; Longitudinal Fatigue Severity Scale Scores Correlate with Modifiable Psychosocial Variables in Early Systemic Sclerosis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1219
DOI: 10.1002/art.28985

Abstract Supplement

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