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Managing Fatigue in Lupus: The Doctor’s perspective

MEDICINE OF THE HIGHEST ORDER. Managing Fatigue in Lupus: The Doctor’s perspective. Jennifer H. Anolik, MD, PhD Associate Professor of Medicine Division of Allergy, Immunology & Rheumatology University of Rochester Medical Center 2010. Fatigue is common. Lupus presenting symptoms.

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Managing Fatigue in Lupus: The Doctor’s perspective

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  1. MEDICINE OF THE HIGHEST ORDER Managing Fatigue in Lupus: The Doctor’s perspective Jennifer H. Anolik, MD, PhD Associate Professor of Medicine Division of Allergy, Immunology & Rheumatology University of Rochester Medical Center 2010

  2. Fatigue is common Lupus presenting symptoms

  3. Lupus Diagnosis: ACR Criteria • CLINICAL • Butterfly rash (face) • Discoid rash(anywhere on body) • Photosensitivity • Oral or nasal ulcers • Arthritis • Serositis (fluid around lungs or heart) • Kidney disease • Brain disease(seizures or psychosis) • LABORATORY • Low blood cell counts (white, red, platelets) • Antinuclear antibodies • Specific autoantibodies (anti-DNA, anti-Sm, antiphospholipid) • SUPPORTING FEATURES* • Alopecia • Fatigue • Fevers • Raynaud’s Definite diagnosis of lupus: 4 of 11 criteria present

  4. Causes of fatigue • Other • Sleep disorders • Depression • Pain • Fibromyalgia • Disease activity related • Constitutional symptoms of fever, weight loss, malaise, and severe fatigue are frequently seen in active lupus • Fatigue due to anemia

  5. Is fatigue due to active lupus? • Signs and symptoms • Mild: confined to skin (rash, ulcers) and joints • Diffuse ulcerating rash • Inflammation around heart and lungs (shortness of breath, chest pain) • Inflammation in the brain • Labs/other evaluation • Low platelet or red blood cell count or white blood cell count • Kidney disease • Autoantibodies, complement levels

  6. Usually fatigue is NOT due to active lupus • LUMINA cohort- fatigue is commonly seen- 92% of patients • Increased levels of fatigue associate with presence of pain, abnormal illness-related behaviors, helplessness, fibromyalgia, depression • NOT disease activity Burgos et al., Arthritis Care and Research 2009

  7. Treatment strategies • Active disease: steroids, immunosuppressives • Other • Depression • Pain • Sleep • Fibromyalgia Tench et al., Fatigue in systemic lupus erythematosus: a randomized controlled trial of exercise, Rheumatology 2003, 42: 1050

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