Fatigue in rheumatoid arthritis: time for a conceptual model

Hewlett, Sarah; Chalder, Trudie; Choy, Ernest; Cramp, Fiona; Davis, Bev; Dures, Emma; Nicholls, Claire; Kirwan, John R.

doi:10.1093/rheumatology/keq282

Cited by 178 publications

(197 citation statements)

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“…Fatigue is highly prevalent in patients with RA, and for some patients it is as severe as pain (1). Health professionals have previously underestimated the impact of fatigue, even though many patients experience fatigue as uncontrollable and overwhelming (1).…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Fatigue in Rheumatoid Arthritis Patients in Remission or in a Low Disease Activity State

Olsen

Lie

Kvien

et al. 2016

Arthritis Care & Research

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ObjectiveFatigue is a frequently occurring symptom in patients with rheumatoid arthritis (RA). Our aims were to assess the level of reported fatigue in RA patients who had achieved remission or low disease activity after 6 months of treatment with disease‐modifying antirheumatic drugs (DMARDs), and to explore associations between fatigue and demographics, disease activity, and other patient‐reported outcomes in this patient group.MethodsA total of 2,193 RA patients (ages ≥18 years) starting either methotrexate (MTX) monotherapy or a tumor necrosis factor inhibitor in combination with MTX were retrieved from the Norwegian Disease‐Modifying Antirheumatic Drugs Register (NOR‐DMARD). At the 6‐month followup, 699 patients (31.9%) were in remission or in a low disease activity state. Bivariate and multivariate linear regression analyses were conducted, with the fatigue visual analog scale (VAS) at 6 months as the dependent variable. Age, sex, disease duration, treatment group, erythrocyte sedimentation rate (ESR), the swollen and tender joint count in 28 joints, the pain VAS score, and disability at baseline and at 6 months were tested as predictors of fatigue at 6 months.ResultsAt 6 months, the median (25th, 75th percentile) level of fatigue was 20.0 mm (6.0, 43.0), and a fatigue VAS score of ≥40 mm was reported by 27.9% of patients. In the multivariate analysis, lower ESR and higher pain at baseline were statistically significant predictors of higher levels of fatigue (P < 0.001). In the multivariate cross‐sectional analysis at 6 months, younger age and greater pain were significantly associated with higher levels of fatigue (P < 0.001).ConclusionPain levels at baseline and at 6 months were associated with a higher level of fatigue. Patients in remission or in a low disease activity state may need nonpharmacologic interventions to manage their pain and fatigue.

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Section: Introductionmentioning

confidence: 99%

“…Since 2006 there has been an international consensus to measure and report fatigue in all RA clinical trials, in addition to the core set of outcome measures implemented in the 1990s (1,3).…”

Section: Introductionmentioning

confidence: 99%

Predictors of Fatigue in Rheumatoid Arthritis Patients in Remission or in a Low Disease Activity State

Olsen

Lie

Kvien

et al. 2016

Arthritis Care & Research

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“…RA is a chronic autoimmune disorder causing inflammation, stiffness, and pain in the joints (55). Fatigue is a common symptom among patients with RA and can be associated with pain, disability, depressive mood, anxiety, sleep disturbances, and limitations in social activities (53,56,57). Fatigue is found in at least 40% of patients with RA (58).…”

Section: Reviewmentioning

confidence: 99%

“…Fatigue is found in at least 40% of patients with RA (58). Fatigue in patients with RA is associated with numerous factors such as inflammation, pain, disability, and psychosocial factors (56,59). Pain and depression are important factors associated with fatigue, and there is no association with age, disease duration, and other comorbidities (60).…”

Section: Reviewmentioning

confidence: 99%

Fatigue in rheumatic diseases

Sandıkçı

Özbalkan

2015

Eur J Rheumatol

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Fatigue is a common and important problem in many diseases including rheumatologic illnesses, and it has a negative impact on health-related quality of life. Fatigue is described as having an impact on multiple aspects of a patient's life. There is a need for knowledge about causes of and treatments for fatigue to ensure that patient outcomes are improved. There are several effective treatment strategies available for fatigue including pharmacological and non-pharmacological therapies. We aim to provide an overview of fatigue in rheumatologic disorders and some recommendations on its optimal management.

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“…More recent studies have suggested the link is there, with fatigue being an independent contributor to assessments of disease activity 13 , or that the link exists indirectly through pain 14 15 . This model contains 3 main components: inflammatory activity, cognitive/behavioral issues, and personal context.…”

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confidence: 99%