Fatigue in early, intensively treated and tight-controlled rheumatoid arthritis patients is frequent and persistent: a prospective study

Abstract

Fatigue has a large impact on quality of life and is still unmanageable for many patients. Study aims were describe (1) the prevalence and pattern of fatigue over time in patients with early rheumatoid arthritis under a treat-to-target strategy and (2) identify predictive factors for worsening and recovering of fatigue over time. Data from the tREACH study were used, comparing different treatment strategies with fatigue as secondary objective. Patient outcomes on fatigue, quality of life, depression, and coping were obtained every 6 months and clinically assessed every 3 months. Prediction of fatigue at 12 months was investigated with an ROC curve. Analysis was stratified into non-fatigue and fatigue at baseline. Logistic regression was used for the evolution of fatigue in relation with the covariates over time. Almost half of all patients (n = 246) had high fatigue levels at baseline, decreasing slightly over time. At 12 months, 43% of patients were fatigued; while 23% of the initially fatigued patients showed lower levels of fatigue, the fatigue level had increased in 15% of the initially non-fatigued patients. The strongest predictor of fatigue was the previous fatigue levels (AUC 0.89). Higher score on the depression scale and coping with limitations was associated with developing fatigue over time in the initially non-fatigued group. Despite a strict treat-to-target strategy, fatigue remained an overall problem during the first year of treatment, and was mainly predicted by its baseline status. In subgroups, a small additional effect of depression was seen. Monitoring fatigue and depression may be important in managing fatigue.

Management of Fatigue in Rheumatoid Arthritis

“…Nearly one in four who were fatigued at the onset of the study showed lower levels of fatigue by 1 year, but one in six of the patients who were not initially fatigued recorded increased fatigue. 30…”

Reducing arthritis fatigue impact: two-year randomised controlled trial of cognitive behavioural approaches by rheumatology teams (RAFT)

“…Fatigue is a significant problem for people with rheumatoid arthritis,1 incorporating physical exhaustion and cognitive impairment, with impacts on lifestyle, roles, relationships and emotions 2 3. RA fatigue is persistent,4 patients feel unsupported by rheumatology teams and rheumatology nurses want help regarding fatigue management 2 5.…”

Predictors of fatigue in rheumatoid arthritis

“…Mental health may typically be defined in many ways, such as previous diagnosis of depression [10, 21, 28, 54–56], current levels of dysphoria [54–56] or position on a mental health continuum (e.g. Short Form 36 Mental Health Scale) [10, 21, 22, 28, 57], or use of anti-depressants [10, 21]. Irrespective of the definition, the evidence indicates that higher depression scores, or ratings of dysphoria, in combination with previous history of depression is associated with an exacerbation of, or failure to improve, fatigue [10, 21, 29, 54–57].…”

“…It is clear that the measures used may have substantial impacts on the associations observed if a predictor is differentially associated with distinct dimensions of fatigue [9]. It is notable that few studies have used scales that capture the multidimensionality of fatigue, instead relying on single-item visual analogue scales, or numerical rating scales [5, 10, 24, 26, 27, 29, 30, 37, 41, 49, 54, 56, 57]. Equally, there is no consistency in the definitions and measures used to capture exposures of interest and no single study has investigated all predictors of interest, making it likely that residual confounding exists and precluding the development of an evidence-based causal model/diagram of fatigue.…”