Format

Send to

Choose Destination
Arthritis Res Ther. 2019 Nov 4;21(1):223. doi: 10.1186/s13075-019-2013-9.

Fatigue severity in anti-nuclear antibody-positive individuals does not correlate with pro-inflammatory cytokine levels or predict imminent progression to symptomatic disease.

Author information

1
Division of Rheumatology, Department of Medicine, Faculty of Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Canada.
2
Division of Genetics and Development, Krembil Research Institute, University Health Network, 5KD402, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada.
3
Lakeridge Health Services, Oshawa, Canada.
4
Division of Rheumatology, Hospital for Sick Children, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.
5
Division of Rheumatology, Department of Medicine, Faculty of Medicine, University Health Network, University of Toronto, Toronto, Canada.
6
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
7
Division of Genetics and Development, Krembil Research Institute, University Health Network, 5KD402, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada. Joan.Wither@uhnresearch.ca.
8
Division of Rheumatology, Department of Medicine, Faculty of Medicine, University Health Network, University of Toronto, Toronto, Canada. Joan.Wither@uhnresearch.ca.
9
Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Canada. Joan.Wither@uhnresearch.ca.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Cytokines; Fatigue; Systemic autoimmune rheumatic disease

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center