Abstract
Objective: Fatigue is considered a frequent and characteristic feature of sarcoidosis. This
study was designed to determine the prevalence of fatigue in patients with sarcoidosis and
to determine its potential clinical correlations in relation to symptom severity.
Methods: A total of 56 sarcoidosis patients were included. Data on patient demographics,
anthropometrics, disease characteristics, pulmonary function tests, 6-min walking distance
(6MWD), blood biochemistry and hemogram findings were retrieved from hospital records.
Psychometric instruments involved the fatigue assessment scale (FAS), Beck Depression
Inventory (BDI) and Short Form-36 (SF-36) for health-related QOL (HRQOL).
Results: Mean±SD patient age was 50.9±11.9 years. Of 56 patients, 44 were females and
12 were males. When compared to FAS score <22 and FAS score ≥22-34 subgroups, FAS
score ≥35 (severe fatigue) subgroup was associated with significantly higher patient age
and significantly lower SF-36 physical health scores. Total FAS scores were correlated
positively with age (r=0.349, p=0.008) and BDI scores (r=0.515, p<0.001), while
negatively with MIP (r=-0.321, p=0.019) and SF-36 physical health (r=-0.402, p=0.003)
and mental health (r=-0.351, p=0.009) scores. BDI score (OR 1.146, 95% CI: 1.020 to
1.288, p=0.021) was determined to be the single independent predictor of the increased
likelihood of a patient with sarcoidosis having FAS score ≥22.
Conclusions: Our findings emphasize that deterioration in respiratory functions may
contribute to the development of fatigue among sarcoidosis patients, and besides the fatigue,
depressive symptoms and anxiety should also be an integral part of the multidisciplinary
management of sarcoidosis patients.
References
- 1. Hunninghake G.W, Costabel U, Ando M, Baughman R, Cordier, J.F, du Bois R et al. ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc. Diffuse Lung Dis. 1999;16(2):149-73.
- 2. Yıldız Gülhan P, Güleç Balbay E, Erçelik M, Yıldız Ş, Yılmaz MA. Is sarcoidosis related to metabolic syndrome and insulin resistance? Aging Male. 2020. 23 (1), 53-8 .
- 3. Bahmer T, Watz H, Develaska M, Waschki B, Rabe KF, Magnussen H et al. Physical Activity and Fatigue in Patients with Sarcoidosis. Respiration. 2018;95(1):18–26.
- 4. Strookappe B, De Vries J, Elfferich M, Kuijpers P, Knevel T, Drent M: Predictors of fatigue in sarcoidosis: the value of exercise testing. Respir Med. 2016;116:49-54.
- 5. Cho PSP, Vasudevan S, Maddocks M, Spinou A, Chamberlain Mitchell S, Wood C et al. Physical Inactivity in Pulmonary Sarcoidosis. Lung. 2019 Jun;197(3):285-93.
- 6. Górski W, Piotrowski WJ. Fatigue syndrome in sarcoidosis. Pneumonol Alergol Pol. 2016; 84(4):244–50.
- 7. Michielsen HJ, Drent M, Peros-Golubicic T, De Vries J. Fatigue is associated with quality of life in sarcoidosis patients. Chest 2006;130:989–94.
- 8. Drent M, Lower EE, De Vries J. Sarcoidosis-associated fatigue. Eur Respir J. 2012;40(1):255-263.
- 9. De Vries J, Michielsen H, Van Heck GL, Drent M. Measuring fatigue in sarcoidosis: the Fatigue Assessment Scale (FAS). Br J Health Psychol 2004;9(Pt 3):279–91.
- 10. Beck AT. An inventory for measuring depression. Arch Gen Psychiatry .1961;4:561-71.
- 11. Górski W, Mokros Ł, Kumor-Kisielewska A, Pietras T, Piotrowski WJ. The utility of selected questionnaires in the assessment of fatigue, depression and health quality in post-sarcoidosis fatigue syndrome. Adv Respir Med 2017;85(6):313-21.
- 12. Goracci A, Fagiolini A, Martinucci M, Calossi S, Rossi S, Santomauro T, et al. Quality of life, anxiety and depression in sarcoidosis. Gen Hosp Psychiatry.2008;30(5):441–445.
- 13. Kleijn WPE, Drent M, De Vries J. Nature of fatigue moderates depressive symptoms and anxiety in sarcoidosis. Br J Health Psychol. 2013;18(2):439–52.
- 14. Chang B, Steimel J, Moller DR, Baughman RP, Judson MA, Yeager H Jr, et al. Depression in sarcoidosis. Am J Respir Crit Care Med. 2001;163(2):329–34.
- 15. Wirnsberger RM, de Vries J, Wouters EF, Drent M. Clinical presentation of sarcoidosis in the Netherlands: an epidemiological study. Neth J Med. 1998;53(2):53–60.
- 16. De Vries J, Van Heck GL, Drent M. Gender differences in sarcoidosis: symptoms, quality of life, and medical consumption. Women Health 1999;30(2):99–114.
- 17. Bullinger M, Anderson R, Cella D, Aaronson N. Developing and evaluating cross-cultural instruments from minimum requirements to optimal models. Qual Life Res. 1993;2(6):451–9.
- 18. Cox CE, Donohue JF, Brown CD, Kataria YP, Judson MA. Health-Related Quality of Life of Persons With Sarcoidosis. Chest. 2004;125(3):997-1004.
- 19. Sharma OP. Fatigue and sarcoidosis. Eur Respir J. 1999;13(4):713-4.
- 20. Lloyd A, Gandevia S, Brockman A, Hales J, Wakefield D. Cytokine production and fatigue in patients with chronic fatigue syndrome in response to exercise. Clin Infect Dis. 1994;18 Suppl 1:142-6.
- 21. Peterson PK, Sirr SA, Grammith FC, Schenck CH, Pheley AM, Shuxian H, et al.Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients. Clin Diagn Lab Immunol. 1994;1(2): 222–6.
- 22. Baydur A, Alavy B, Nawathe A, et al. Fatigue and plasma cytokine concentrations at rest and during exercise in patients with sarcoidosis. Clin Respir J. 2011;5(3):156-64.
- 23. Karadallı MN, Boşnak-Güçlü M, Burcu Camcıoğlu C, Kokturk N, Haluk Türktaş H. Effects of Inspiratory Muscle Training in Subjects With Sarcoidosis: A Randomized Controlled Clinical Trial. Respiratory Care.2016;61(4):483-94.
- 24. Marcellis R, Lenssen A, Kleynen S, De Vries J, Drent M. Exercise capacity, muscle strength and fatigue in sarcoidosis. Eur Respir J. 2011;38(3):628–34.
- 25. Jamal MM, CiLursu AH, Hoffman EL. Sarcoidosis presenting as acute myositis: report and review of literature. J Rheumatol. 1988;15(12):1868–78.
- 26. Ost D, Yeldandi A, Cugell D. Acute sarcoid myositis with respiratory muscle involvement: case report and review of the literature. Chest 1995;107(3):879–82.
- 27. Brancaleone P, Perez T, Robin S, Neviere R, Wallaert B. Clinical impact of inspiratory muscle impairment in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2004;21(3):219-7.
- 28. Spruit MA, Thomeer MJ, Gosselink R, et al. Skeletal muscle weakness in patients with sarcoidosis and its relationship with exercise intolerance and reduced health status. Thorax 2005; 60:32–8.
- 29. Baughman RP, Lower EE. Six minute walk test in managing and monitoring sarcoidosis patients. Curr Opin Pulm Med. 2007;13(5):439-44.
- 30. Baughman RP, Sparkman BK, Lower EE. Six-minute walk test and health status assessment in sarcoidosis. Chest. 2007;132(1):207-13.
- 31. Wagner MT, Marion SD, Judson MA. The effects of fatigue and treatment with methylphenidate on sustained attention in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2005; 22(3):235.
- 32. Lower EE, Malhotra A, Surdulescu V, Baughman RP. Armodafinil for Sarcoidosis-Associated Fatigue: A Double-Blind, Placebo-Controlled, Crossover Trial. Pain Symptom Manage. 2013;45(2):159–69.
- 33. Fouchier SM, Möller GM, Van Santen-Hoeufft M, Faber CG, Smeenk FW, Drent M. . Successful treatment with infliximab of a patient with refractory sarcoidosis. Ned Tijdschr Geneeskd 2004;148(49):2446–50.
Abstract
Amaç: Yorgunluk, sarkoidozun sık ve karakteristik bir özelliği olarak kabul edilir. Bu
çalışma, sarkoidozlu hastalarda yorgunluk prevalansını belirlemek ve semptom şiddeti ile
ilişkili potansiyel klinik korelasyonlarını belirlemek için tasarlanmıştır.
Gereç ve Yöntem: Toplam 56 sarkoidoz hastası dahil edildi. Hastane kayıtlarından hasta
demografisi, antropometri, hastalık özellikleri, solunum fonksiyon testleri, 6 dakikalık
yürüme mesafesi (6DYM), kan biyokimyası ve hemogram bulgularına ilişkin veriler elde
edildi. Psikometrik araçlar, sağlıkla ilgili yaşam kalitesi (HRQOL) için yorgunluk
değerlendirme ölçeği (FAS), Beck Depresyon Ölçeği (BDÖ) ve Kısa Form-36 (SF-36)
kullanıldı.
Bulgular: Ortalama ± SS hasta yaşı 50.9 ± 11.9 yıldı. 56 hastanın 44'ü kadın, 12'si erkekti.
FAS skoru <22 ve FAS skoru ≥22-34 alt grupları ile karşılaştırıldığında, FAS skoru ≥35
(şiddetli yorgunluk) alt grubu, daha yüksek hasta yaşı (p = 0.037) ve anlamlı olarak daha
düşük SF-36 fiziksel sağlık skorları (p = 0.029 ) ile anlamlı bulundu. Toplam FAS skorları
yaş (r = 0.349, p = 0.008) ve BDÖ skorları (r = 0.515, p <0.001) ile pozitif korelasyon
gösteriyor iken; MIP (r = -0.321, p = 0.019) ve SF-36 fiziksel sağlık (r = -0.402, p = 0.003)
ve mental sağlık(r = -0.351, p = 0.009) puanları sağlık ile negatif korelasyon gösteriyordu.
BDÖ skorunun (OR 1.146,% 95 CI: 1.020 - 1.288, p = 0.021), sarkoidoz hastalarının FAS
skorunun ≥22 olması olasılığının artmasının tek bağımsız prediktörü olduğu belirlendi.
Sonuç: Bulgularımız, solunum fonksiyonlarındaki bozulmanın sarkoidoz hastalarında
yorgunluğun gelişimine katkıda bulunabileceğini ve yorgunluğun yanı sıra depresif
belirtiler ve anksiyetenin sarkoidoz hastalarının multidisipliner yönetiminin ayrılmaz bir
parçası olması gerektiğini vurgulamaktadır.
References
- 1. Hunninghake G.W, Costabel U, Ando M, Baughman R, Cordier, J.F, du Bois R et al. ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc. Diffuse Lung Dis. 1999;16(2):149-73.
- 2. Yıldız Gülhan P, Güleç Balbay E, Erçelik M, Yıldız Ş, Yılmaz MA. Is sarcoidosis related to metabolic syndrome and insulin resistance? Aging Male. 2020. 23 (1), 53-8 .
- 3. Bahmer T, Watz H, Develaska M, Waschki B, Rabe KF, Magnussen H et al. Physical Activity and Fatigue in Patients with Sarcoidosis. Respiration. 2018;95(1):18–26.
- 4. Strookappe B, De Vries J, Elfferich M, Kuijpers P, Knevel T, Drent M: Predictors of fatigue in sarcoidosis: the value of exercise testing. Respir Med. 2016;116:49-54.
- 5. Cho PSP, Vasudevan S, Maddocks M, Spinou A, Chamberlain Mitchell S, Wood C et al. Physical Inactivity in Pulmonary Sarcoidosis. Lung. 2019 Jun;197(3):285-93.
- 6. Górski W, Piotrowski WJ. Fatigue syndrome in sarcoidosis. Pneumonol Alergol Pol. 2016; 84(4):244–50.
- 7. Michielsen HJ, Drent M, Peros-Golubicic T, De Vries J. Fatigue is associated with quality of life in sarcoidosis patients. Chest 2006;130:989–94.
- 8. Drent M, Lower EE, De Vries J. Sarcoidosis-associated fatigue. Eur Respir J. 2012;40(1):255-263.
- 9. De Vries J, Michielsen H, Van Heck GL, Drent M. Measuring fatigue in sarcoidosis: the Fatigue Assessment Scale (FAS). Br J Health Psychol 2004;9(Pt 3):279–91.
- 10. Beck AT. An inventory for measuring depression. Arch Gen Psychiatry .1961;4:561-71.
- 11. Górski W, Mokros Ł, Kumor-Kisielewska A, Pietras T, Piotrowski WJ. The utility of selected questionnaires in the assessment of fatigue, depression and health quality in post-sarcoidosis fatigue syndrome. Adv Respir Med 2017;85(6):313-21.
- 12. Goracci A, Fagiolini A, Martinucci M, Calossi S, Rossi S, Santomauro T, et al. Quality of life, anxiety and depression in sarcoidosis. Gen Hosp Psychiatry.2008;30(5):441–445.
- 13. Kleijn WPE, Drent M, De Vries J. Nature of fatigue moderates depressive symptoms and anxiety in sarcoidosis. Br J Health Psychol. 2013;18(2):439–52.
- 14. Chang B, Steimel J, Moller DR, Baughman RP, Judson MA, Yeager H Jr, et al. Depression in sarcoidosis. Am J Respir Crit Care Med. 2001;163(2):329–34.
- 15. Wirnsberger RM, de Vries J, Wouters EF, Drent M. Clinical presentation of sarcoidosis in the Netherlands: an epidemiological study. Neth J Med. 1998;53(2):53–60.
- 16. De Vries J, Van Heck GL, Drent M. Gender differences in sarcoidosis: symptoms, quality of life, and medical consumption. Women Health 1999;30(2):99–114.
- 17. Bullinger M, Anderson R, Cella D, Aaronson N. Developing and evaluating cross-cultural instruments from minimum requirements to optimal models. Qual Life Res. 1993;2(6):451–9.
- 18. Cox CE, Donohue JF, Brown CD, Kataria YP, Judson MA. Health-Related Quality of Life of Persons With Sarcoidosis. Chest. 2004;125(3):997-1004.
- 19. Sharma OP. Fatigue and sarcoidosis. Eur Respir J. 1999;13(4):713-4.
- 20. Lloyd A, Gandevia S, Brockman A, Hales J, Wakefield D. Cytokine production and fatigue in patients with chronic fatigue syndrome in response to exercise. Clin Infect Dis. 1994;18 Suppl 1:142-6.
- 21. Peterson PK, Sirr SA, Grammith FC, Schenck CH, Pheley AM, Shuxian H, et al.Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients. Clin Diagn Lab Immunol. 1994;1(2): 222–6.
- 22. Baydur A, Alavy B, Nawathe A, et al. Fatigue and plasma cytokine concentrations at rest and during exercise in patients with sarcoidosis. Clin Respir J. 2011;5(3):156-64.
- 23. Karadallı MN, Boşnak-Güçlü M, Burcu Camcıoğlu C, Kokturk N, Haluk Türktaş H. Effects of Inspiratory Muscle Training in Subjects With Sarcoidosis: A Randomized Controlled Clinical Trial. Respiratory Care.2016;61(4):483-94.
- 24. Marcellis R, Lenssen A, Kleynen S, De Vries J, Drent M. Exercise capacity, muscle strength and fatigue in sarcoidosis. Eur Respir J. 2011;38(3):628–34.
- 25. Jamal MM, CiLursu AH, Hoffman EL. Sarcoidosis presenting as acute myositis: report and review of literature. J Rheumatol. 1988;15(12):1868–78.
- 26. Ost D, Yeldandi A, Cugell D. Acute sarcoid myositis with respiratory muscle involvement: case report and review of the literature. Chest 1995;107(3):879–82.
- 27. Brancaleone P, Perez T, Robin S, Neviere R, Wallaert B. Clinical impact of inspiratory muscle impairment in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2004;21(3):219-7.
- 28. Spruit MA, Thomeer MJ, Gosselink R, et al. Skeletal muscle weakness in patients with sarcoidosis and its relationship with exercise intolerance and reduced health status. Thorax 2005; 60:32–8.
- 29. Baughman RP, Lower EE. Six minute walk test in managing and monitoring sarcoidosis patients. Curr Opin Pulm Med. 2007;13(5):439-44.
- 30. Baughman RP, Sparkman BK, Lower EE. Six-minute walk test and health status assessment in sarcoidosis. Chest. 2007;132(1):207-13.
- 31. Wagner MT, Marion SD, Judson MA. The effects of fatigue and treatment with methylphenidate on sustained attention in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2005; 22(3):235.
- 32. Lower EE, Malhotra A, Surdulescu V, Baughman RP. Armodafinil for Sarcoidosis-Associated Fatigue: A Double-Blind, Placebo-Controlled, Crossover Trial. Pain Symptom Manage. 2013;45(2):159–69.
- 33. Fouchier SM, Möller GM, Van Santen-Hoeufft M, Faber CG, Smeenk FW, Drent M. . Successful treatment with infliximab of a patient with refractory sarcoidosis. Ned Tijdschr Geneeskd 2004;148(49):2446–50.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | October 20, 2022 |
| Acceptance Date | October 1, 2022 |
| Published in Issue | Year 2022 Volume: 14 Issue: 3 |
