Fatigue severity in anti-nuclear antibody-positive individuals does not correlate with pro-inflammatory cytokine levels..., 2019, Hafiz et al

Fatigue severity in anti-nuclear antibody-positive individuals does not correlate with pro-inflammatory cytokine levels or predict imminent progression to symptomatic disease

• Waleed Hafiz,
• Rawad Nori,
• Ariana Bregasi,
• Babak Noamani,
• Dennisse Bonilla,
• Larissa Lisnevskaia,
• Earl Silverman,
• Arthur A. M. Bookman,
• Sindhu R. Johnson,
• Carolina Landolt-Marticorena &
• Joan Wither
  
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  • Published: 04 November 2019
    
    
    https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-019-2013-9
  
  

 

I checked the FACIT-F questionnaire (https://www.facit.org/FACITOrg/Questionnaires).

Not half-bad, but has a bunch of questions that poorly distinguish can't and won't. However, it's miles above the CFQ as it asks additional relevant questions and is an absolute scale. Big question mark on what the modifications were, especially as there already is a 13-item version specific for fatigue.

But without an accurate and reliable standardized test it's very hard to build a useful body of evidence of anything. As usual it's hard to say whether fatigue was measured, or some ersatz combination of various things that could relate to the actual symptom experience. Especially as some people use seriously weird definitions of fatigue.

 

Who smelt a rat here? These "lack of direct link between fatigue and biomarkers" studies are always a pretext for suggesting the fatigue is psychologically constructed and/or due to activity avoidance. And lo and behold, here is the article's concluding statement:

Usual stuff.

Hey, just 'cos something can't be measured using a few limited biomarkers does not make it behavioural/psychological... One does not necessarily follow from the other. Why do people continue to think that biomedical explanations require evidence, whereas psychological ones require no actual postive supporting evidence at all?

At least they mention drug therapy for fibro, that's something I suppose.

Also, the usual stuff about how doctors can "reassure" their patients that their fatigue doesn't imply worsening of their disease. If the fatigue is not linked to anything measurable, that means its not fixable, and there's nothing reassuring about that!

 

They should probably have known enough immunology to know that antinuclear antibodies are not expected to activate cytokines. They either form large immune complexes, which interact with complement, or interfere with DNA function within the cell, silently.

 

I read a review about fatigue in lupus a few years ago and the treatment recommendation was antidepressant drugs based on the fact that there is no correlation between fatigue and 'objective' disease markers like inflammation. Lol.