Factors related to fatigue in women and men with early rheumatoid arthritis: The Swedish TIRA study

Thyberg, Ingrid; Dahlström, Örjan; Thyberg, Mikael

doi:10.2340/16501977-0444

Cited by 45 publications

(35 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, those clinical response studies do not examine fatigue response directly, and we have previously shown that female sex is associated with greater odds of improvement in fatigue (21). We suggest that because women report more fatigue than men (10,19,40,49), they have a greater capacity for change in this symptom.…”

Section: Discussionmentioning

confidence: 96%

Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Druce

Jones

Macfarlane

et al. 2015

Arthritis & Rheumatology

View full text Add to dashboard Cite

Objective There is debate as to the role of inflammatory disease activity in the etiology of rheumatoid arthritis (RA)–related fatigue. We undertook this study to determine the relationship of fatigue to disease activity by examining pathways associated with change in fatigue in subjects starting anti–tumor necrosis factor (anti‐TNF) therapy for the first time. Methods Participants who had been recruited to the British Society for Rheumatology Biologics Register for RA provided information on fatigue (Short Form 36 [SF‐36] vitality scale) and other health status variables at the start of anti‐TNF therapy and 6 months later. The Disease Activity Score in 28 joints (DAS28) and inflammation (erythrocyte sedimentation rate [ESR]/C‐reactive protein [CRP] level) were also reported. A path analysis model comprising changes in fatigue, pain, disease activity, disability, and mental health, along with effects of sex and a history of depression, was used to examine those with high levels of fatigue at baseline (score of ≤12.5 units on the SF‐36 vitality scale). The DAS28 was substituted for ESR/CRP to delineate the specific role of inflammation. Results With a total of 2,652 participants, we identified a well‐fitting model (χ2 = 0.18, P = 0.98) accounting for 40% of the variance in fatigue change. There was no direct pathway from change in inflammation to change in fatigue; instead, significant pathways to change in fatigue were observed from changes in disease activity, pain, mental health, and disability, along with effects of sex and a history of depression. A total of 82% of the effect of change in disease activity was indirect, of which ∼50% was mediated through a change in pain. Conclusion Improvements in fatigue do not appear to be driven by inflammatory disease activity; instead, they appear to result indirectly from improvements in pain. Additional significant pathways through disability and mental health suggest potentially modifiable factors that could be targeted to improve clinically important levels of fatigue.

show abstract

Section: Discussionmentioning

confidence: 96%

Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Druce

Jones

Macfarlane

et al. 2015

Arthritis & Rheumatology

View full text Add to dashboard Cite

show abstract

“…Women had slightly higher levels of fatigue than men even after correction for disease activity, whereas PaGl and pain were similar between the sexes. Other studies have also reported more fatigue in women than in men [20,21,32], but the clinical importance has been debated as the difference is small and not consistently significant [19].…”

Section: Discussionmentioning

confidence: 98%

“…Severe fatigue may occur in more than 40 % of the patients [16] and is as common and severe as pain and is considered harder to manage than pain [17]. On the other hand, in crosssectional studies, pain has almost universally been identified to be one of the most important predictors of fatigue [16,[18][19][20][21]. Pain has also been found to be the major contributor to one of the most commonly used patient-reported outcome: PaGl [22].…”

Section: Introductionmentioning

confidence: 98%

Interplay between patient global assessment, pain, and fatigue and influence of other clinical disease activity measures in patients with active rheumatoid arthritis

Egsmose

Madsen

2015

Clin Rheumatol

View full text Add to dashboard Cite

The interplay between patient-reported outcome measures in rheumatology is not well clarified. The objective of the study was to examine associations on the group level and concordance on the individual patient level between patient global assessment (PaGl), pain, and fatigue as scored on visual analog scales (VAS) in the daily clinic by patients with active rheumatoid arthritis (RA). Associations with other measures of disease activity were also examined. Traditional disease activity data on 221 RA patients with active disease planned to initiate biological treatment were extracted from the Danish DANBIO registry. Associations between VAS PaGl, pain, and fatigue (0-100) were examined using multiple regression analysis. Concordance between the VAS scores was expressed as the bias (mean difference between intra-individual scores) and the 95% lower and upper limits of agreement (LLoA; ULoA) according to the Bland-Altman method. Mean age was 57 ± 14 years, mean Disease Activity Score (DAS28-CRP4) 5.0 ± 0.9, and mean PaGl 63.6 ± 22.6. PaGl was most strongly predicted by pain and fatigue, pain by PaGl and fatigue, and fatigue by PaGl and pain (beta ranging from 0.17 to 0.69, p < 0.01-0.0001). More objective measures were not or far less predictive. LLoA;ULoA [bias] for PaGl vs. pain was -19.1; 29.5 [5.2], for PaGl vs. fatigue -22.8; 28.6 [2.9], and for fatigue vs. pain -29.2; 33.8 [2.3]. In conclusion, PaGl, pain, and fatigue were most strongly explained by each other, not by more objective clinical measures of disease activity and were nearly identical on the group level. On the individual patient level, however, differences between the scores varied considerably. The findings highlight the challenge of understanding and dealing with traditional patient-reported VAS measures when it comes to individual RA patients in the daily clinic.

show abstract

“…In the present study, the women had a higher fatigue score, pain score, and RA disease activity (16)(17)(18). Although women had a lower ADL score, clinical and functional remission were reported, and there were no significant differences between women and men for radiographic findings and CRP (19)(20)(21).…”

Section: Discussionmentioning

confidence: 66%

A study on characteristics of rheumatoid arthritis patients achieving remission in depression with 6 months of bDMARDs treatment

et al. 2018

View full text Add to dashboard Cite

Objective: To investigate the relationship between baseline factors and depression remission after a 6-month biological disease-modifying antirheumatic drugs (bDMARDs) treatment in rheumatoid arthritis (RA) patients. Methods: The study was conducted in 152 RA patients treated with bDMARDs. The following patient's characteristics were studied: gender, age, disease duration, baseline prednisolone dosage, and serum matrix metalloproteinase3 (MMP3) levels. For assessment, we used the simple disease activity index (SDAI) for RA disease activity, Health Assessment Questionnaire Disability Index (HAQ-DI) for activities of daily living (ADL), Short Form-36 for nonspecific health-related quality of life (QOL), and Hamilton Depression Rating Scale (HAM-D) scores for the depression status. Depressed remission was clarified using HAM-D ≤7 after 6 months of treatment. The patients were divided into two groups according to the presence or absence of depression, and a retrospective study was conducted. Results: Based on binominal logistic analyses, RA patients' with depression remission (n=124) compared to those without depression remission (n=28) had a younger age (p=0.0045, odd ratio: 0.94, 95% confidence interval [CI]:0.8-0.98), female sex (p=0.021, odd ratio:0.21, 95% CI:0.054-0.79), and lower HAM-D scores (p=0.0073, odd ratio:0.85, 95% CI:0.76-0.96) Conclusion: It was proposed that RA patients who are females, younger in age, and have lower depressed scores at baseline can achieve a depression remission status with the bDMARDs treatment.

show abstract

Factors related to fatigue in women and men with early rheumatoid arthritis: The Swedish TIRA study

Cited by 45 publications

References 32 publications

Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Interplay between patient global assessment, pain, and fatigue and influence of other clinical disease activity measures in patients with active rheumatoid arthritis

A study on characteristics of rheumatoid arthritis patients achieving remission in depression with 6 months of bDMARDs treatment

Contact Info

Product

Resources

About