{
  "abstract": "Introduction We used a multifactorial explanatory model to assess the impact of several parameters including quality of life, disease activity, perceived disease symptoms, haemoglobin levels, depression and anxiety, upon fatigue in patients with SSc.Material and Methods We performed an observational, cross-sectional study, in a single tertiary Rheumatology outpatient department. Fatigue was assessed using the FACIT scale. Disease activity was measured with the modified Disease Activity Index. QoL was evaluated through the SF-36 and EQ5D, and, functional ability by the HAQ. Depressive and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale.Disease specific symptoms and overall disease severity were measured by the six visual analogue scales of the SHAQ. Haemoglobin (mg/dl) was also collected.We used a structural equation modelling (SEM) estimation to analyse the associations between fatigue and the other parameters assessed. Descriptive and correlational analyses were performed using SPSS®, v. 29; and SEM were performed using SPSS® Amos software. Statistically significant effects were assumed for p<0.05.Results One hundred and twenty-one patients, 87.6% female; mean age 59.3 [SD 12.1] years, mean disease duration 9.6 [13.3] years) with SSc were included, 61,3% having the limited cutaneous form of the diseaseThe results obtained in the structural equation model indicated a good fit to the data ([X2(112) =178.85, X2/df=1.59, p<0.005; CFI=0.93; TLI=0.92; RMSEA=0.07, p=0.04]), explaining 53% of the variance of the fatigue (R2=0.53) (figure 1).Perceived disease symptoms, disease activity and depression explained 53% of the variance of quality-of-life (R2=0.53).We found a direct negative association between disease activity (mDAI) and quality of life (B=-0.15; p=0.04). Furthermore, a higher quality of life showed a significant direct relation with lower fatigue (B=0.52; p<0.001).The model also showed a direct negative relation between perceived disease symptoms and quality of life (B=-0.58; p<0.001); and fatigue (B=-0.27; p=0.01).Furthermore, depression showed a significant negative direct negative relation with quality of life disease (B=-0.23; p=0.009) and a significant positive direct relation with perceived disease symptoms (B=0.45; p=0.001). Anxiety was excluded from the model as it was not statistically significant.In our model, haemoglobin has a slight indirect effect through disease activity.Conclusions These results suggest that quality of life, perceived disease symptoms and depression plays a contribute role for fatigue in patients with SSc. Disease activity, perceived disease symptoms, and depression may play an indirect role.This highlights the importance of expanding beyond disease activity in the management of SSc, and the need for a multidisciplinary approach.Abstract P.292 Figure 1Estimated standardised direct effects for the proposed model. mDAI= modified disease activity index using tendon friction rubs, CRP, digital ulcers, mRSS and Dlco <70% of predicted value. Circles represent latent factors. Squares represent measured variables (the scale scores). Arrows connecting circles and rectangles in one direction show a hypothesized direct relationship between the two variables. Circles with the letter ‘e’ written in it represent the associated error",
  "authors": [
    {
      "affiliations": [
        "Medicine Faculty, University of Coimbra, Coimbra, Portugal"
      ],
      "name": "Ana Francisca"
    },
    {
      "affiliations": [
        "Medicine Faculty, University of Coimbra, Coimbra, Portugal"
      ],
      "name": "Pedro Matos"
    },
    {
      "affiliations": [
        "Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal",
        "Escola Superior de Enfermagem de Coimbra, Health Sciences Research Unit: Nursing, Coimbra, Portugal"
      ],
      "name": "Eduardo Santos"
    },
    {
      "affiliations": [
        "Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, ULS de Coimbra, Coimbra, Portugal"
      ],
      "name": "Anabela Silva"
    },
    {
      "affiliations": [
        "Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, ULS de Coimbra, Coimbra, Portugal"
      ],
      "name": "Paula Vicente"
    },
    {
      "affiliations": [
        "Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, ULS de Coimbra, Coimbra, Portugal"
      ],
      "name": "JAP Da Silva"
    },
    {
      "affiliations": [
        "Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, ULS de Coimbra, Coimbra, Portugal"
      ],
      "name": "Maria João Salvador"
    },
    {
      "affiliations": [
        "Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, ULS de Coimbra, Coimbra, Portugal"
      ],
      "name": "Tânia Santiago"
    }
  ],
  "title": "P.292 Multifactorial explanatory model of fatigue in patients with systemic sclerosis: a structural equation approach",
  "uid": "f0621832-4c31-5a1b-b577-25166973a58c"
}