Fatigue in psoriasis: a controlled study

• Published in: British journal of dermatology (1951) Vol. 177; no. 2; pp. 505 - 512
• Main Authors: Skoie, I.M., Dalen, I., Ternowitz, T., Jonsson, G., Kvivik, I., Norheim, K., Omdal, R.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.08.2017
• Subjects: Cancer; Case-Control Studies; Chronic Disease; Depression - etiology; Fatigue; Fatigue - etiology; Female; Humans; Inflammatory diseases; Male; Mental depression; Middle Aged; Mood; Multivariate analysis; Musculoskeletal Pain - etiology; Neurological diseases; Pain; Pain Measurement; Psoriasis; Psoriasis - complications; Psoriasis - psychology; Quality of Life; Severity of Illness Index; Signal transduction; Smoking; Smoking - adverse effects
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.15375

Summary Background Fatigue is associated with various chronic inflammatory diseases, but few studies have focused on its occurrence in psoriasis. Objectives To describe fatigue prevalence and degree among patients with chronic plaque psoriasis vs. age‐ and sex‐matched healthy subjects, and to examine how fatigue is influenced by essential clinical and demographic factors. Methods In 84 patients and 84 healthy subjects, fatigue severity was assessed using three different generic fatigue instruments: the fatigue Visual Analogue Scale (fVAS), the Fatigue Severity Scale (FSS) and the Short Form 36 (SF‐36) Vitality scale. Cut‐off scores for clinically important fatigue were defined as ≥ 4 for FSS, ≥ 50 for fVAS and ≤ 35 for the SF‐36 Vitality scale. Disease activity was evaluated using the Psoriasis Area and Severity Index (PASI), and the impact on quality of life with the Dermatology Life Quality Index (DLQI). Results Patients and healthy control subjects, respectively, showed median fVAS scores of 51 [interquartile range (IQR) 21–67] and 11 (IQR 3–20); FSS scores of 4 (IQR 2·5–5·3) and 1·6 (IQR 1·1–2·2); and SF‐36 Vitality scores of 43 (IQR 25–85) and 73 (IQR 65–85). The rates of clinically important fatigue among patients vs. healthy controls, respectively, were 51% vs. 4% (fVAS); 52% vs. 4% (FSS); and 42% vs. 2% (SF‐36 Vitality) (P < 0·001 for all differences). Fatigue was associated with DLQI scores, but not PASI scores, in univariate analysis but not in multivariate analysis. Conclusions Nearly 50% of patients with psoriasis suffered from substantial fatigue. Fatigue severity was associated with smoking, pain and depression, but not with psoriasis severity. What's already known about this topic? Fatigue is prevalent in patients with chronic inflammatory diseases, cancer and some neurological diseases. Depressive mood and pain are strong factors influencing fatigue. Emerging evidence points to genes and molecular signalling pathways as important contributors to fatigue. What does this study add? Clinically significant fatigue occurs in nearly 50% of patients with psoriasis. Objective measures of psoriasis disease activity do not correlate with fatigue severity. There is a need for more research to understand the factors that generate and regulate fatigue in psoriasis. Respond to this article Linked Comment: Rosen. Br J Dermatol 2017; 177:346–347