1458: Systemic Lupus Erythematosus (SLE) Patients with Cognitive Impairment Experience More Fatigue Compared to Patients Without Impairment

Delansie Lawrence¹, Jiandong Su¹, Andrea Knight², Kathleen Bingham³, Mahta Kakvan¹, Maria Carmela Tartaglia⁴, Leslet Ruttan⁵, Joan Wither⁶, May Choi⁷, Simone Appenzeller⁸, Nicole Anderson¹, Dennisse Bonilla¹, Patricia Katz⁹, Dorcas Beaton¹⁰, Robin Green⁵, Zahi Touma¹ and Michelle Barraclough¹¹, ¹Schroeder Arthritis Institute, Krembil Research Institute, University Health Network and University of Toronto, Toronto, ON, Canada, ²The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada, ³Centre for Mental Health, University Health Network; Department of Psychiatry, University of Toronto, Toronto, ON, Canada, ⁴University of Toronto Krembil Neurosciences Centre, Toronto, ON, Canada, ⁵University Health Network-Toronto Rehabilitation Institute, Toronto, ON, Canada, ⁶Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada, ⁷Brigham and Women's Hospital | University of Calgary, Calgary, AB, Canada, ⁸Unicamp, Campinas, São Paulo, Brazil, ⁹UCSF, San Rafael, CA, ¹⁰Institute for Work & Health, Toronto, ON, Canada, ¹¹Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, University of Toronto, Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Toronto, ON, Canada

Background/Purpose: Cognitive impairment (CI) is highly prevalent in patients with systemic lupus erythematosus (SLE). Objective prevalence rates are reported as 38% [range: 20% to 80%] and subjective even higher. Additionally, SLE patients frequently identify fatigue as a component of their clinical syndrome. Studies have shown that SLE patients with CI may experience more cognitive fatigue. Therefore, we hypothesized that patients with subjective CI will report more fatigue compared to patients without subjective CI.

Methods: Data on 228 consecutive consenting SLE patients (18 - 65 years old) attending a single centre between July 2018 to July 2020 was analysed. Three PROMIS-CAT (Patient reported outcomes measurement information system - computerized adaptive tests) questionnaires were applied:

- PROMIS Bank v 1.0- Fatigue
- PROMIS Item Bank v 2.0- Cognitive function abilities sub-set
- PROMIS Item Bank v 2.0- Cognitive function general

Additionally, we administered the FACIT questionnaire, which is a 13-item tool that measures an individual's level of fatigue using a 4-point Likert scale. Descriptive analyses were used to describe the patients' characteristics. We studied the association between subjective CI and fatigue measures using a Pearson correlation coefficient matrix. The association between subjective CI (PROMIS cognitive function general) and fatigue (FACIT) was further assessed using univariable and multivariable linear regression analyses, with clinical relevant variables, sex, ethnicity and immunosuppressant use included.

Results: Among the 228 participants, 89.5% were females with a mean age of 47.9 ± 14.0 years. The mean disease duration was 18.4 ± 12.3 years (Table 1).

The mean score for PROMIS Fatigue was 57.3±10.6 and the mean scores for PROMIS cognitive abilities and cognitive general were 47.0±9.4 and 46.6±8.9, respectively (indicating that both fatigue and subjective CI is worse in our SLE cohort compared to the general population). Subjective CI function and fatigue correlated with each other, as patients with more subjective CI displayed more fatigue (Table 2). Multivariable regression analysis confirmed a negative relationship in which a higher PROMIS cognitive general score was associated with lower FACIT total score: adjusted parameter estimate -0.69 (95% confidence interval -0.80 to -0.57), p< 0.0001, (Table 3).

Conclusion: Our results showed that there is an association between subjective CI with higher fatigue levels when measured by the PROMIS Fatigue tool and the FACIT questionnaire. This information highlights how SLE affects both fatigue and subjective CI and that these aspects should be targeted in the multifaceted care of SLE patients.
Table 1. Patient characteristics at time of study

Table 2. Matrix table summarizing four correlations for cognition and fatigue (N = 228):
(Pearson correlation coefficient/p value)

Table 3. Multivariable linear regression result for variables associated with higher FACIT
total score with cognitive general scores as the main in-dependent variable
Disclosures: D. Lawrence, None; J. Su, None; A. Knight, None; K. Bingham, None; M. Kakvan, None; M. Tartaglia, None; L. Ruttan, None; J. Wither, AstraZeneca, Pfizer; M. Choi, AstraZeneca, MitogenDx, mallinckrodt, Janssen, AbbVie/Abbott, Alimentiv, Amgen, AVIR Pharma Inc, BioJAMP, Bristol-Myers Squibb(BMS), Celltrion, Ferring, Fresenius Kabi, McKesson, Mylan, Takeda, Pendopharm, Pfizer, Roche; S. Appenzeller, None; N. Anderson, None; D. Bonilla, None; P. Katz, None; D. Beaton, None; R. Green, None; Z. Touma, None; M. Barraclough, None.