Fatigue is undoubtedly one of the most common and disabling symptoms in people with Sjögren's syndrome. This observation was well documented in a quality of life survey, conducted five years ago, by Dr. Evelyn Bromet, epidemiologist and member of the SSF Board of Directors. Questionnaires were sent to all SSF members and more than 3,300 people responded. Members ranked fatigue as the third most bothersome symptom after dry eyes and dry mouth. Dry skin, musculoskeletal pain and poor sleep were on that list. This article will take stock of the main causes of fatigue I in Sjögren's syndrome as well as the diagnostic approach and treatments.

Definition

Fatigue is defined as a state of insufficient energy characterized by physical or mental weariness. It typically has a fluctuating intensity in most patients since affected people can have good and bad periods during the same day. Some of the most important causes of fatigue in Sjögren's syndrome are listed here:

• Systemic inflammation
• Poor sleep
• Fibromyalgia
• Depression
• Side effects of medications
• Hypothyroidism
• Myositis
• Myopathy due to corticosteroids

Sleep disorder

The survey mentioned above also indicated that the majority of patients suffering from Sjögren's syndrome are poor sleepers and this can contribute to fatigue. Symptoms may include difficulty falling asleep, difficulty staying asleep, or just waking up most days feeling tired but not really aware that you have a sleep problem (due to poor sleep). repairer). In Sjögren's syndrome, sleep abnormalities may be a consequence of the disease itself or related to side effects of treatment. Causes of poor sleep include dry eyes, dry mouth, pain from arthritis, poor sleep habits, or pain from co-occurring fibromyalgia. Frequent use of corticosteroids can also lead to insomnia. One study also suggested an increased incidence of restless legs syndrome in patients with Sjögren's syndrome compared to other groups. This syndrome is characterized by involuntary movements of the arms or legs during sleep and can be difficult to recognize if you sleep alone. However, it can be identified by carrying out a sleep analysis.

Treatment of sleep disturbances in Sjögren's syndrome must be tailored to each person. Everyone should be encouraged to develop good “sleep hygiene,” or good sleeping habits. For eye discomfort at night, eye lubricants last longer than artificial tears and provide better relief. The regular use of secretagogues (a substance, whether biological or chemical, is called a secretagogue if it causes or increases the secretion of an endocrine gland) such as pilocarpine (Salagen) or cevimeline (Evoxac), one dose before the bedtime, will reduce the need to ingest fluids during the day and the sleep disruption associated with the need to drink and urinate at night. Low doses of clonazepan (Klonopin, valium) or carbidopa/levodopa (Sinemet) can effectively treat restless legs syndrome.

What is recommended for restful sleep:

• Keep a regular sleep schedule
• Exercise regularly, at least 20 minutes a day.
• Create a dark, cool and quiet environment for sleeping.
• Take a warm bath to relax sore muscles or relieve stress at bedtime.

What is not recommended:

• Take naps during the day.
• Take caffeine 6 hours before bed.
• Drink alcohol or smoke within 2 hours before going to bed.
• Exercise just before bed.
• Go to bed hungry or work in your room.

The second part of “Fatigue in Sjögren's Syndrome” will cover depression, medication side effects, hypothyroidism, muscle weakness, and will also present some new approaches to combat fatigue. fatigue.

Depression

Depression can complicate all chronic illnesses, including Sjögren's syndrome, and may explain fatigue, pain, a recent weight change, headaches or other symptoms, when no other reason is apparent. During their daily activities, doctors can screen for the main symptoms of depression using mini-questionnaires. The patient is asked: “Have you felt any of the following almost every day for the past two weeks? “examples: sleep disorder, anhedonia (loss of interest in doing things), low self-esteem or decreased appetite? »

Studies have shown that the presence of two or more of the main symptoms is strongly correlated with the diagnosis of depression. Management of depressive syndrome through psychological help, membership in a support group, regular physical activity and in certain cases medication. (St. John's Wort may help with depression, but it may also worsen dry mouth in patients with Sjögren's syndrome.)

Hypothyroidism

Hypothyroidism (thyroid hormone deficiency) is common in people with Sjögren's syndrome. It is caused by a combination of causes, including the autoimmune thyroid disease called “Hashimoto’s thyroiditis.”

What are the general symptoms of Hashimoto's disease?

• chronic fatigue,
• weight gain,
• a singular thickening on the face and fingers,
• pale complexion, constipation,
• joint pain,
• nervousness,
• irritability.

How is Hashimoto's disease treated?

Treatment for hypothyroidism involves increasing the production of the thyroid gland by giving a thyroid hormone called levothyroxine. This treatment also helps reduce the size of the enlarged thyroid gland.

Means to combat fatigue

Regardless of the cause, common ways to help almost all patients combat fatigue include reducing stress, learning relaxation techniques, planning rest periods during the day, and engaging in regular physical activity. moderate (such as walking or swimming) and adapt your daily life as best as possible. Fatigue associated with Sjögren's syndrome is common and is caused by multiple factors. Can a given patient have multiple causes for their fatigue? An assessment is necessary to identify the cause(s) of fatigue. It may take several months to improve and learn to live with this common and debilitating problem in Sjögren's syndrome.

Source: AFGS Bulletin

2023-04-07