POS0956 A 5-YEAR FOLLOW-UP INVESTIGATION OF THE FATIGUE SCALE IN PATIENTS WITH SYSTEMIC SCLEROSIS

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Background: Fatigue is a characteristic symptom in systemic sclerosis (SSc) and substantially impacts health-related quality of life and social participation/ Objectives: Our aim was to follow the fatigue symptoms over a 5-year period among patients with SSc and to identify baseline factors associated with different outcomes. Methods: One hundred and sixty consecutive SSc patients and 62 healthy controls were examined at baseline and the SSc patients after 5 years, and were evaluated with physical, laboratory and radiology tests and with patient reported outcome measures. To assess fatigue, the 13-item Functional Assessment of Chronic Illness Therapy- Fatigue Scale (FACIT-FS) was used. The FACIT-FS score can range from 0 to 52 points, which case 0 indicates the worst, and 52 the best condition. As in an earlier study, we used 40 points as cutoff in FACIT-FS score to define significant fatigue [1]. To analyse changes in fatigue levels we used the previously described minimal clinically important difference values set by our research group for the FACIT-FS questionnaire [2]. Results: SSc patients had significantly lower score on FACIT-FS, when compared to healthy controls (37.1±11.0 vs. 46.4±5.7, p<0.001). Significant fatigue was present in 87 patients (54.4%) at baseline. 110 patients had complete questionnaire profile due to lost to follow up, or mortality (n=23). The baseline fatigue score of the 11 patients with SSc-related mortality was similar to the others (31.7±11.7 vs. 37.4±10.9, p=0.115), and also, we found the same results if we examined all patients who deceased during follow-up (33.9 ± 9.9 vs. 37.6±11.1 p=0.082). The overall fatigue in cohort level did not change during follow-up time (37.1±11.0 vs 38.4±10.9, p=0.526). We could differentiate four major subsets regarding the change levels of fatigue alterations: (A) those who had no significantly detectable fatigue (>40 points) and remained stable (n=24; 21.8%), (B) those who had more severe levels of fatigue (≤40 points), which also persisted at the fifth year (n=14; 12.7%), (C) whose fatigue improved during follow-up (n=37; 33.6%), and (D) whose fatigue worsened (n=35; 31.8%). The patients with stable-low levels of fatigue (A) had less likely sleeping disturbances (p=0.021), had significantly lower joint activity with the Disease Activity Score-28 (DAS-28) (p=0.003), had lower Health Assessment Questionnaire- Disability Index (HAQ-DI) scores (p<0.001), and significantly lower gastrointestinal symptoms with the UCLA Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 (UCLA GIT 2.0) questionnaire (p<0.001). In the stable-high fatigue level (B) group, the prevalence of severely decreased diffusing capacity for carbon monoxide (DLCO) was significantly higher compared to the other groups (p=0.014), and they also performed significantly worse at the 6-minute walk test (6MWT), when compared to the patients in the stable-low fatigue level (A) group (p=0.019). They had the poorest muscle strength on the Manual Muscle Testing -8 (MMT-8) test (p=0.002). Late pattern on nailfold video capillaroscopy was rare in the improved fatigue group (C), while it was significantly more frequent in the worsened (D) and the stable-high fatigue (B) groups (p=0.013). However, there were no significant differences in baseline characteristics between the four groups regarding the proportion of patients with limited or diffuse disease, disease duration, the presence of digital ulcers, the presence of major SSc-related autoantibodies (anticentromere, anti-DNA topoisomerase I, anti-RNA polymerase III), the presence of heart involvement or in the estimated right ventricular systolic pressure (RVSP). No differences were observed regarding age, the modified Rodnan skin score (MRSS) and in the results of the mini-mental state examination (MMSE) (Table 1). Conclusion: The Fatigue scale can be a useful and simple composite index. The course of fatigue does not depend on autoantibody profiles. Stable severe or worsening fatigue may be an indicator of serious organ involvements, such as cardiorespiratory, vascular and gastrointestinal manifestations or muscle weakness. REFERENCES: [1] Peralta, J. et al. (2022). AB0684 Fatigue Assessment in Systemic Sclerosis, Santo Domingo, Dominican Republic. Annals of the Rheumatic Diseases. 81. 1469.3-1470. 10.1136/annrheumdis-2022-eular.2880. [2] Kiss F et al.; Minimal Clinically Important Differences (MCID) for the Functional Assessment of Chronic Illness Therapy Fatigue Scale in Patients with Systemic Sclerosis. Int J Environ Res Public Health. 2022 Dec 31;20(1):771. doi: 10.3390/ijerph20010771. Acknowledgements: NIL . Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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