TYPE 2 LUPUS IS THE MAJOR PREDICTOR OF FATIGUE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A CROSS-SECTIONAL STUDY OF 200 PATIENTS
Bibliographic record
Abstract
PV175 / #503 Poster Topic: AS19 - Patient-Reported Outcome Measures Background/Purpose Fatigue is a major symptom in patients with systemic lupus erythematosus (SLE) significantly impacting health-related quality of life (HR-QoL). Causes of fatigue in SLE are multifactorial and not well understood. A novel framework categorizes SLE manifestations into type 1 and type 2. Type 1 manifestations can be ascribed to inflammation and captured in activity indexes, whereas type 2 symptoms (such as fatigue, pain, sleep, and mood disturbances) have no clear relation to disease activity. Type-2 SLE is defined using the polysymptomatic distress scale (PDSS). Objective: To identify predictors of fatigue in SLE patients. Methods Cross-sectional study of SLE patients fulfilling ACR/EULAR 2019 and/or SLICC 2012 classification criteria followed in a Rheumatology outpatient clinic. Inclusion was from December 2023 to May 2024. Results The study included 200 patients with SLE (female: 92.0%; mean age: 46.4±14.3 years; median age at diagnosis: 28.5 [16.0] years). Severe fatigue was present in 28.6%. In the study population, 87.5% fulfilled the LDA treatment target, 30.5% had type 2 SLE, 38.5% had organ damage, and 17.0% were diagnosed with fibromyalgia. Patients with severe fatigue had worse scores in both PDSS and aPDSS (p<0.0001). The aPDSS cut-off that better predicted SLE type 2 was ≥9.50 (sensitivity 96.9%, specificity 99.9%). Univariate analysis showed significant variables for severe fatigue: female sex (p=0.04), age (p=0.02), disease duration (p=0.02), SLE-DAS (p=0.03), type 2 SLE (PDSS and aPDSS definitions) (p<0.001), and fibromyalgia (p<0.001), while LDA was protective (p<0.01). SLEDAI and SDI were not significant. Multivariate analysis revealed type 2 SLE [OR 25.33; 95% CI(10.63-60.31); p<0.001) and diagnosis of fibromyalgia [OR 3.51; 95% CI(1.16-10.69); p<0.05] as independent predictors of severe fatigue. Similar findings were found when using aPDSS, [OR 16.16; 95% CI(7.22-36.13); p<0.001)] for type 2 SLE and [OR 4.44; 95% CI(1.51-12.26); p<0.05] for fibromyalgia. Conclusions In this cohort of SLE patients, type 2 lupus was the major predictor of severe fatigue. Physicians and patients should be careful not to attribute fatigue to inflammatory type 1 disease activity when the LDA treatment target is achieved. This should be taken into consideration for establishing the management strategy. * First and second authors listed share first authorship.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".