Dados do Trabalho

Título

Fatigue in Multiple Sclerosis Patients

Resumo

Introduction: Multiple Sclerosis (MS) is an inflammatory demyelinating disease that affects about 2.3 million people worldwide. Fatigue is characterized by lack of physical and mental energy, and can be of primary cause as a result of the underlying demyelinating disease or of secondary cause to comorbid conditions. Among the various impairments to the quality of life of patients with MS, this is one of the most frequent and debilitating conditions. Objective: This study aims to evaluate the impact of fatigue on patients monitored in a reference outpatient clinic for Demyelinating Diseases. Methods: Cross-sectional, single-center study conducted with patients meeting the 2017 McDonald criteria for the diagnosis of MS. Fatigue was measured by the Modified Fatigue Impact Scale (MFIS), with the patient being classified with fatigue at scores ≥ 38 and high-impact fatigue ≥ 59. The degree of disability was expressed by the Expanded Disability Status Scale (EDSS). Quality of life was quantified by the EQ-5D Quality of Life Questionnaire. Depression and anxiety were measured by the Hospital Anxiety and Depression Scale (HAD). Results: 195 patients were included with a mean age of 39.9 (±11.7), most female (71.8%). The clinical forms in the sample were relapsing-remitting (RRMS) and primarily progressive (PPMS), with the majority being RRMS (90.1%). The average MFIS in these patients was 44.8 (±21.1). Most patients (65.1%) achieved scores for presence of fatigue, of which 43.3% had high-impact fatigue. Patients with fatigue had worse quality of life [0.49 (±0.20) vs 0.80 (±0.17); p< 0.001], major functional disability [3.4 (±2.4) vs 1.4 (±1.9); p< 0.001], higher number of bouts [3.7 (±4.0) vs 2.4 (±1.8); p= 0.014], higher HAD scale scores for anxious symptoms [9.3 (±4.6) vs 5.4 (±3.7); p< 0.001] and depressive symptoms [7.5 (±4.0) vs 4.0 (±3.1); p< 0.001]. We detected no difference related to length of illness [10.2 (±7.5) vs 8.8 (±6.3); p= 0.201], and age [40.6 (±11.2) vs 38.6 (±12.4); p= 0.263]. Conclusions: Fatigue is a common symptom in MS patients and manifests itself mainly in those with major disease severity and more psychiatric symptoms. It is still a poorly measured condition in clinical practice, delaying access to available treatments. For being a cross-sectional study, it cannot state the primary or secondary origin of fatigue. Therefore, prospective studies are needed to clarify how fatigue and comorbid conditions are truly related in these patients.

Palavras Chave

Multiple Sclerosis; Fatigue; Psychiatric Symptoms