Disability as a determinant of fatigue in MS patients

Taveira, Fernanda M.; Braz, Nayara F. T.; Comini-Frota, Elizabeth R.; Teixeira, Antônio L.; Domingues, Renan B.

doi:10.1590/0004-282X20190035

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Article • Arq. Neuro-Psiquiatr. 77 (4) • Apr 2019 • https://doi.org/10.1590/0004-282X20190035 copy

Disability as a determinant of fatigue in MS patients

Incapacidade como determinante da fadiga em pacientes com EM

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Fatigue is one of the most frequent and disabling symptoms in multiple sclerosis (MS). Central, psychological, and peripheral factors may contribute to the occurrence of fatigue.

Objectives:

The current study aimed to evaluate potential fatigue determinants in patients with relapsing-remitting MS with a low functional impairment.

Methods:

We compared inflammatory markers, respiratory pressures, disability, and quality of life in 39 relapsing-remitting MS patients with and without fatigue.

Results:

Patients with relapsing-remitting MS with fatigue had higher Expanded Disability Status Scale scores (p = 0.002). We observed a significant association between the results of the Guy Neurological Disability Scale, the Functional Assessment of MS Quality of Life Rating Scale and the presence of fatigue (p < 0.05).

Conclusions:

The degree of functional impairment is a determinant for the presence of fatigue in MS patients, but respiratory function and inflammatory markers are not.

Keywords:
Multiple sclerosis; fatigue; inflammation

Variable		Presence of Fatigue		p-value
Variable		No (n = 20)	Yes (n = 19)	p-value
Age				0.181^ Mann-Whitney test;
	Mean ± standard deviation	35.8 ± 7.2	42.6 ± 13.3
	Median (minimum - maximum)	35 (20–53)	38 (25 – 64)
Sex				1.000^* * Fisher's exact test;
	Women	17 (85.0%)	16 (84.2%)
	Men	3 (15.0%)	3 (15.8%)
Expanded Disability Status Scale				0.002^ Mann-Whitney test;
	Mean ± standard deviation	2.0 ± 0.8	2.8 ± 0.7
	Median (minimum - maximum)	1.8 (1.0 –4.0)	3.0 (1.5–4.0)
Diagnosis (months prior)				0.407^ Mann-Whitney test;
	Mean ± standard deviation	103.3 ± 71.2	84.7 ± 68.1
	Median (minimum - maximum)	102 (12–264)	60 (1–288)
Drug treatment				0.182^* * Fisher's exact test;
	Yes	19 (95.0%)	15 (78.9%)
	No	1 (5.0%)	4 (21.1%)
Smoking				0.182^* * Fisher's exact test;
	Ex-smoker	1 (5.0%)	4 (21.1%)
	Non-smoker	19 (95.0%)	15 (78.9%)
Body Mass Index				0.241^* ***** Student's t-test.
	Mean ± standard deviation	25.4 ± 4.8	23.8 ± 3.3
	Median (minimum - maximum)	25.6 (17.2–35.5)	23.5 (18.1–30.1)
Last relapse (months prior)				0.463^ Mann-Whitney test;
	Mean ± standard deviation	31.6 ± 16.4	33.4 ± 33.0
	Median (minimum - maximum)	31.8 (5–60)	22.8 (3–132)

Variable		Presence of Fatigue		p-value
Variable		No (n = 20)	Yes (n = 19)	p-value
Maximal inspiratory pressure				0.253^* * Mann-Whitney test;
	Mean ± standard deviation	93.6 ± 18.3	87.7 ± 15.8
	Median (minimum–maximum)	100 (56–120)	88 (60–116)
Maximum expiratory pressure				0.058^* * Mann-Whitney test;
	Mean ± standard deviation	94.8 ± 14.4	85.3 ± 18.9
	Median (minimum–maximum)	96 (60–120)	80 (48–116)
Peak expiratory fflow				0.084^ Student's t-test.
	Mean ± standard deviation	442.8 ± 126.3	382.6 ± 78.0
	Median (minimum–maximum)	445 (250–730)	360 (260–550)

Variable		Presence of Fatigue		p-value
Variable		No (n = 20)	Yes (n = 19)	p-value
TNF (pg/ml)				0.866^* * Mann-Whitney test; IL-6: interleukin 6; TNF: tumor necrosis factor.
	Mean ± standard deviation	10.6 ± 18.5	9.3 ± 28.4
	Median (minimum–maximum)	1.6 (0.9–71.0)	1.7 (0.7–125.3)
IL-6 (pg/ml)				0.285^* * Mann-Whitney test; IL-6: interleukin 6; TNF: tumor necrosis factor.
	Mean ± standard deviation	9.5 ± 15.4	9.7 ± 22.2
	Median (minimum–maximum)	2.0 (1.3–62.2)	3.2 (1.5–97.9)

Variable		Presence of Fatigue		p-value
Variable		No (n = 20)	Yes (n = 19)	p-value
Guy neurological disability scale				<0.001^ Student's t-test.
	Mean ± standard deviation	4.9 ± 3.7	14.8 ± 5.9
	Median (minimum–maximum)	4.5 (0–14)	14 (3–29)
Functional assessment of MS quality of life rating scale				<0.001^ Student's t-test.
	Mean ± standard deviation	138.8 ± 33.9	109.2 ± 22.5
	Median (minimum–maximum)	148 (13–169)	108 (59–148)

Variable	p-value	Odds Ratio	95%CI
Guy neurological disability scale	0.001	1.62	[1.20–2.18]

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[1] Correspondence: Fernanda Machado Taveira; Rua José Teixeira, 200 / apt. 1002 - Praia do Canto; 29055-310 Vitória ES, Brasil. E-mail: fernandamtaveira@gmail.com