. 2023 Sep;43(9):1637-1649.

doi: 10.1007/s00296-023-05344-z. Epub 2023 Jun 14.

High fatigue scores in patients with idiopathic inflammatory myopathies: a multigroup comparative study from the COVAD e-survey

Silvia Grignaschi^{1

2}, Minchul Kim³, Giovanni Zanframundo^{1

2}, Naveen Ravichandran⁴, James B Lilleker^{5

6}, Parikshit Sen⁷, Mrudula Joshi⁸, Vishwesh Agarwal⁹, Sinan Kardes¹⁰, Jessica Day^{11

12

13}, Ashima Makol¹⁴, Marcin Milchert¹⁵, Tamer Gheita¹⁶, Babur Salim¹⁷, Tsvetelina Velikova¹⁸, Abraham Edgar Gracia-Ramos¹⁹, Ioannis Parodis^{20

21}, Elena Nikiphorou^{22

23}, Tulika Chatterjee³, Ai Lyn Tan^{24

25}, Miguel A Saavedra²⁶, Samuel Katsuyuki Shinjo²⁷, Nelly Ziade^{28

29}, Johannes Knitza³⁰, Masataka Kuwana³¹, Arvind Nune³², Oliver Distler³³, Hector Chinoy^{1

5

34

35}, Lorenzo Cavagna^{2

36}, Vikas Agarwal⁴, Rohit Aggarwal^#³⁷, Latika Gupta^#^{38

39

40}; COVAD study group

Collaborators, Affiliations

Collaborators

COVAD study group:
Bhupen Barman, Yogesh Preet Singh, Rajiv Ranjan, Avinash Jain, Sapan C Pandya, Rakesh Kumar Pilania, Aman Sharma, M Manesh Manoj, Vikas Gupta, Chengappa G Kavadichanda, Pradeepta Sekhar Patro, Sajal Ajmani, Sanat Phatak, Rudra Prosad Goswami, Abhra Chandra Chowdhury, Ashish Jacob Mathew, Padnamabha Shenoy, Ajay Asranna, Keerthi Talari Bommakanti, Anuj Shukla, Arunkumar R Pande, Kunal Chandwar, Döndü Üsküdar Cansu, John D Pauling, Chris Wincup, Nicoletta Del Papa, Gianluca Sambataro, Atzeni Fabiola, Marcello Govoni, Simone Parisi, Elena Bartoloni Bocci, Gian Domenico Sebastiani, Enrico Fusaro, Marco Sebastiani, Luca Quartuccio, Franco Franceschini, Pier Paolo Sainaghi, Giovanni Orsolini, Rossella De Angelis, Maria Giovanna Danielli, Vincenzo Venerito, Lisa S Traboco, Suryo Anggoro Kusumo Wibowo, Jorge Rojas Serrano, Ignacio García-De La Torre, Erick Adrian Zamora Tehozol, Jesús Loarce-Martos, Sergio Prieto-González, Raquel Aranega Gonzalez, Akira Yoshida, Ran Nakashima, Shinji Sato, Naoki Kimura, Yuko Kaneko, Stylianos Tomaras, Margarita Aleksandrovna Gromova, Or Aharonov, Ihsane Hmamouchi, Leonardo Santos Hoff, Margherita Giannini, François Maurier, Julien Campagne, Alain Meyer, Melinda Nagy-Vincze, Daman Langguth, Vidya Limaye, Merrilee Needham, Nilesh Srivastav, Marie Hudson, Océane Landon-Cardinal, Syahrul Sazliyana Shaharir, Wilmer Gerardo Rojas Zuleta, José António Pereira Silva, João Eurico Fonseca

Affiliations

¹ Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Lombardia, Italy.
² Rheumatology Division, IRCCS Policlinico San Matteo Foundation, Pavia, Lombardia, Italy.
³ Center for Outcomes Research, Department of Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, IL, USA.
⁴ Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
⁵ Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
⁶ Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK.
⁷ Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, 110002, India.
⁸ Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India.
⁹ Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India.
¹⁰ Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34093, Istanbul, Turkey.
¹¹ Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
¹² Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.
¹³ Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.
¹⁴ Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
¹⁵ Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Ul Unii Lubelskiej 1, 71-252, Szczecin, Poland.
¹⁶ Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.
¹⁷ Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan.
¹⁸ Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407, Sofia, Bulgaria.
¹⁹ Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Av. Jacaranda S/N, Col. La Raza, Del. Azcapotzalco, C.P. 02990, Mexico City, Mexico.
²⁰ Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
²¹ Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
²² Centre for Rheumatic Diseases, King's College Hospital, London, UK.
²³ Rheumatology Department, King's College Hospital, London, UK.
²⁴ NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK.
²⁵ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
²⁶ Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico.
²⁷ Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
²⁸ Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.
²⁹ Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
³⁰ Medizinische Klinik 3-Rheumatologie Und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
³¹ Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan.
³² Southport and Ormskirk Hospital NHS Trust, Southport, PR8 6PN, UK.
³³ Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
³⁴ National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK.
³⁵ Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.
³⁶ Rheumatology Unit, Dipartimento Di Medicine Interna E Terapia Medica, Università Degli Studi Di Pavia, Pavia, Lombardy, Italy.
³⁷ Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
³⁸ Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. drlatikagupta@gmail.com.
³⁹ Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK. drlatikagupta@gmail.com.
⁴⁰ City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. drlatikagupta@gmail.com.

^# Contributed equally.

PMID: 37314497
PMCID: PMC10265550
DOI: 10.1007/s00296-023-05344-z

High fatigue scores in patients with idiopathic inflammatory myopathies: a multigroup comparative study from the COVAD e-survey

Silvia Grignaschi et al. Rheumatol Int. 2023 Sep.

. 2023 Sep;43(9):1637-1649.

doi: 10.1007/s00296-023-05344-z. Epub 2023 Jun 14.

Authors

Collaborators

COVAD study group:
Bhupen Barman, Yogesh Preet Singh, Rajiv Ranjan, Avinash Jain, Sapan C Pandya, Rakesh Kumar Pilania, Aman Sharma, M Manesh Manoj, Vikas Gupta, Chengappa G Kavadichanda, Pradeepta Sekhar Patro, Sajal Ajmani, Sanat Phatak, Rudra Prosad Goswami, Abhra Chandra Chowdhury, Ashish Jacob Mathew, Padnamabha Shenoy, Ajay Asranna, Keerthi Talari Bommakanti, Anuj Shukla, Arunkumar R Pande, Kunal Chandwar, Döndü Üsküdar Cansu, John D Pauling, Chris Wincup, Nicoletta Del Papa, Gianluca Sambataro, Atzeni Fabiola, Marcello Govoni, Simone Parisi, Elena Bartoloni Bocci, Gian Domenico Sebastiani, Enrico Fusaro, Marco Sebastiani, Luca Quartuccio, Franco Franceschini, Pier Paolo Sainaghi, Giovanni Orsolini, Rossella De Angelis, Maria Giovanna Danielli, Vincenzo Venerito, Lisa S Traboco, Suryo Anggoro Kusumo Wibowo, Jorge Rojas Serrano, Ignacio García-De La Torre, Erick Adrian Zamora Tehozol, Jesús Loarce-Martos, Sergio Prieto-González, Raquel Aranega Gonzalez, Akira Yoshida, Ran Nakashima, Shinji Sato, Naoki Kimura, Yuko Kaneko, Stylianos Tomaras, Margarita Aleksandrovna Gromova, Or Aharonov, Ihsane Hmamouchi, Leonardo Santos Hoff, Margherita Giannini, François Maurier, Julien Campagne, Alain Meyer, Melinda Nagy-Vincze, Daman Langguth, Vidya Limaye, Merrilee Needham, Nilesh Srivastav, Marie Hudson, Océane Landon-Cardinal, Syahrul Sazliyana Shaharir, Wilmer Gerardo Rojas Zuleta, José António Pereira Silva, João Eurico Fonseca

Affiliations

¹ Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Lombardia, Italy.
² Rheumatology Division, IRCCS Policlinico San Matteo Foundation, Pavia, Lombardia, Italy.
³ Center for Outcomes Research, Department of Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, IL, USA.
⁴ Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
⁵ Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
⁶ Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK.
⁷ Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, 110002, India.
⁸ Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India.
⁹ Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India.
¹⁰ Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34093, Istanbul, Turkey.
¹¹ Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
¹² Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.
¹³ Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.
¹⁴ Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
¹⁵ Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Ul Unii Lubelskiej 1, 71-252, Szczecin, Poland.
¹⁶ Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.
¹⁷ Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan.
¹⁸ Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407, Sofia, Bulgaria.
¹⁹ Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Av. Jacaranda S/N, Col. La Raza, Del. Azcapotzalco, C.P. 02990, Mexico City, Mexico.
²⁰ Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
²¹ Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
²² Centre for Rheumatic Diseases, King's College Hospital, London, UK.
²³ Rheumatology Department, King's College Hospital, London, UK.
²⁴ NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK.
²⁵ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
²⁶ Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico.
²⁷ Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
²⁸ Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.
²⁹ Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
³⁰ Medizinische Klinik 3-Rheumatologie Und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
³¹ Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan.
³² Southport and Ormskirk Hospital NHS Trust, Southport, PR8 6PN, UK.
³³ Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
³⁴ National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK.
³⁵ Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.
³⁶ Rheumatology Unit, Dipartimento Di Medicine Interna E Terapia Medica, Università Degli Studi Di Pavia, Pavia, Lombardy, Italy.
³⁷ Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
³⁸ Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. drlatikagupta@gmail.com.
³⁹ Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK. drlatikagupta@gmail.com.
⁴⁰ City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. drlatikagupta@gmail.com.

^# Contributed equally.

PMID: 37314497
PMCID: PMC10265550
DOI: 10.1007/s00296-023-05344-z

Abstract

Idiopathic inflammatory myopathies (IIMs) confer a significant risk of disability and poor quality of life, though fatigue, an important contributing factor, remains under-reported in these individuals. We aimed to compare and analyze differences in visual analog scale (VAS) scores (0-10 cm) for fatigue (VAS-F) in patients with IIMs, non-IIM systemic autoimmune diseases (SAIDs), and healthy controls (HCs). We performed a cross-sectional analysis of the data from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) international patient self-reported e-survey. The COVAD survey was circulated from December 2020 to August 2021, and details including demographics, COVID-19 history, vaccination details, SAID details, global health, and functional status were collected from adult patients having received at least one COVID-19 vaccine dose. Fatigue experienced 1 week prior to survey completion was assessed using a single-item 10 cm VAS. Determinants of fatigue were analyzed in regression models. Six thousand nine hundred and eighty-eight respondents (mean age 43.8 years, 72% female; 55% White) were included in the analysis. The overall VAS-F score was 3 (IQR 1-6). Patients with IIMs had similar fatigue scores (5, IQR 3-7) to non-IIM SAIDs [5 (IQR 2-7)], but higher compared to HCs (2, IQR 1-5; P < 0.001), regardless of disease activity. In adjusted analysis, higher VAS-F scores were seen in females (reference female; coefficient -0.17; 95%CI -0.21 to -13; P < 0.001) and Caucasians (reference Caucasians; coefficient -0.22; 95%CI -0.30 to -0.14; P < 0.001 for Asians and coefficient -0.08; 95%CI -0.13 to 0.30; P = 0.003 for Hispanics) in our cohort. Our study found that patients with IIMs exhibit considerable fatigue, similar to other SAIDs and higher than healthy individuals. Women and Caucasians experience greater fatigue scores, allowing identification of stratified groups for optimized multidisciplinary care and improve outcomes such as quality of life.

Keywords: Autoimmune diseases; COVID-19; Fatigue; Myositis; Surveys and questionnaires.

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Conflict of interest statement

ALT has received honoraria for advisory boards and speaking for Abbvie, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB. EN has received speaker honoraria/participated in advisory boards for Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, and Lilly, and holds research grants from Pfizer and Lilly. HC has received grant support from Eli Lilly and UCB, consulting fees from Novartis, Eli Lilly, Orphazyme, Astra Zeneca, speaker for UCB, and Biogen. IP has received research funding and/or honoraria from Amgen, AstraZeneca, Aurinia Pharmaceuticals, Elli Lilly and Company, Gilead Sciences, GlaxoSmithKline, Janssen Pharmaceuticals, Novartis and F. Hoffmann-La Roche AG. JBL has received speaker honoraria/participated in advisory boards for Sanofi Genzyme, Roche, and Biogen. None is related to this manuscript. JD has received research funding from CSL Limited. NZ has received speaker fees, advisory board fees, and research grants from Pfizer, Roche, Abbvie, Eli Lilly, NewBridge, Sanofi-Aventis, Boehringer Ingelheim, Janssen, and Pierre Fabre; none are related to this manuscript. MK has received speaker honoraria/participated in advisory boards for Abbvie, Asahi-Kasei, Astellas, AstraZeneca, Boehringer-Ingelheim, Chugai, Corbus, Eisai, GSK, Horizon, Kissei, BML, Mochida, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi. TV has received speaker honoraria from Pfizer and AstraZeneca, non-related to the current manuscript. OD has/had consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: 4P-Pharma, Abbvie, Acceleron, Alcimed, Altavant, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galderma, Galapagos, Glenmark, Gossamer, iQvia, Horizon, Inventiva, Janssen, Kymera, Lupin, Medscape, Merck, Miltenyi Biotec, Mitsubishi Tanabe, Novartis, Prometheus, Redxpharma, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143). RA has a consultancy relationship with and/or has received research funding from the following companies: Bristol Myers-Squibb, Pfizer, Genentech, Octapharma, CSL Behring, Mallinckrodt, AstraZeneca, Corbus, Kezar, Abbvie, Janssen, Kyverna Alexion, Argenx, Q32, EMD-Serono, Boehringer Ingelheim, Roivant, Merck, Galapagos, Actigraph, Scipher, Horizon Therepeutics, Teva, Beigene, ANI Pharmaceuticals, Biogen, Nuvig, Capella Bioscience, and CabalettaBio. Rest of the authors have no conflict of interest relevant to this manuscript.

Figures

**Fig. 1**
Distribution of VAS-F scores in the three-population evaluated. *IIMs* idiopathic inflammatory myopathies, *SAIDs* systemic autoimmune diseases, *HCs* healthy controls. * P < 0.05

See this image and copyright information in PMC

References

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High fatigue scores in patients with idiopathic inflammatory myopathies: a multigroup comparative study from the COVAD e-survey

Collaborators

Affiliations

High fatigue scores in patients with idiopathic inflammatory myopathies: a multigroup comparative study from the COVAD e-survey

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical