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Characterization of chronic fatigue in sarcoidosis in clinical remission – Source: Chest, Feb 17, 2011

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By Ingrid Korenromp, Cobi Heijnen, et al. • • February 23, 2011

[Note: Sarcoidosis (sar-koy-DO-sis) is a frequently undiagnosed disease of unknown cause, no longer considered rare. It involves an inflammatory process leading to clustering of immune cells that form lumps in different organs – usually starting in the lungs, skin, lymph nodes. It may or may not interfere with the function of affected organs and be detected. It sometimes produces arthritis, usually in the ankles. Half of diagnosed patients have 'remission' within 3 years; two-thirds within 10 years, though often severe fatigue persists.]

Background: Sarcoidosis patients frequently complain of fatigue, even when sarcoidosis has come into clinical remission.

Primary aim of this study was to assess the severity of fatigue in sarcoidosis patients in clinical remission and to characterize it according the international criteria for Chronic Fatigue Syndrome (CFS).

Furthermore, we evaluated whether fatigue is associated with depression and anxiety, health status, and patient-reported sleep quality, and recorded physical activity levels and muscle strength as objective assessments of fatigue.

Methods: Data on 75 patients with sarcoidosis in clinical remission were obtained by questionnaires (Checklist Individual Strength, Symptom Checklist-90, Beck Depression Inventory-primary care, Medical Outcome Score-short version-36), standardized interview (CFS-criteria), sleep diary, accelerometer and muscle strength tests.

Results: Fatigue severity mean score in sarcoidosis patients in clinical remission was high (CIS-Fatigue severity: 30.5 ± 15.5), and criteria for CFS were met in 47% of fatigued participants. Median time since diagnosis was 9 years. Fatigue was associated with depression (P = 0.01), anxiety (P = 0.013) and reduced health status (P < 0.001). Scores on sleep quality were normal. Physical activity levels were reduced in fatigued participants. Also muscle strength – particularly handgrip (P = 0.006) and quadriceps strength (P < 0.001) – was significantly associated with fatigue.

Conclusions: Fatigue in sarcoidosis patients in clinical remission is a frequent symptom and can be characterized as a severe and long-lasting problem, symptomatically similar to CFS. Psychological distress and reduced health status are associated with fatigue. Interestingly, we observed significantly reduced physical activity and muscle weakness in fatigued patients.

Source: Chest, Feb 2011. Korenromp IH, Heijnen CJ, Vogels OJ, van den Bosch JM, Grutters JC. Department of Pulmonology, St. Antonius Hospital Nieuwegein, Netherlands.  [Email:]

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