Fatigue is highly associated with poor health‐related quality of life, disability and depression in newly‐diagnosed patients with inflammatory bowel disease, independent of disease activity

Abstract

BackgroundFatigue is common in Crohn's disease (CD) and ulcerative colitis (UC). Data on fatigue in newly diagnosed patients are unavailable.AimTo report prevalence of fatigue in newly diagnosed CD and UC patients and examine its association with health-related quality of life (HRQOL), depression and disability.MethodsThe Ocean State Crohn's and Colitis Area Registry (OSCCAR) is a statewide cohort of newly diagnosed inflammatory bowel disease patients in Rhode Island. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Patients were administered instruments measuring HRQOL, overall disability and work impairment, and depression.ResultsFatigue was prevalent in 26.4% of 220 subjects. Cohen's d effect sizes for fatigue were large: Short-Form 36 Health Survey mental health component (CD 1.5, UC 1.4) and physical health component (CD 1.4, UC 1.4), EuroQol-5D valuation of current health state (CD 1.2, UC 1.0), Inflammatory Bowel Disease Questionnaire (CD 1.9, UC 1.6) and Patient Health Questionnaire depression scale (CD 1.8, UC 1.7). Fatigued patients reported more work impairment (Score difference: CD 29.5%, UC 23.8%) and activity impairment (score difference: CD 32.3%, UC 25.7%) on the Work Productivity and Activity Impairment Questionnaire. Fatigue's association with all scores remained highly significant despite controlling for disease activity.ConclusionsFatigue is strongly associated with poor HRQOL, disability and depression similarly in CD and UC even when controlling for disease activity. Fatigue's association with a wide range of patient-reported outcome measures suggests that monitoring fatigue is a simple way to screen for overall disruption in patient life.

Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): Determining Therapeutic Goals for Treat-to-Target

“…Th e group agreed that the ultimate goal in both CD and UC must be to restore the patient's QoL, because IBD can have a profound impact on PROs such as QoL, disability, or fatigue ( 17,170,171 ). Th e primary therapeutic target to achieve this in both UC and CD patients must be to achieve the composite end point of clinical/symptomatic and endoscopic remission, while also addressing the patient's individual goals ( 11,12 ).…”

Conventional treatment regimens for ulcerative colitis alleviate fatigue – an observational cohort study

“…These findings are analogous with those of several previous studies in which only subjective disease activity scales were applied. [22][23][24][25] Patients with more extensive disease, indicating elevated disease burden, had higher fecal calprotectin levels. However, neither widespread disease nor high calprotectin levels were associated with higher fatigue scores, pointing to a discrepancy between the severity of fatigue and objective markers of inflammation and disease activity.…”

Utmattelse ved inflammatorisk tarmsykdom

“…I én studie var sykdomsaktivitet assosiert med fatigue ved Crohns sykdom, men ikke ved ulcerøs kolitt (10).…”

“…I fire studier (9,10,13,28) hadde man vurdert depresjon i forhold til fatigue, og i alle var det en signifikant positiv assosiasjon. Andre undersøkte faktorer var tett knyttet opp mot depresjon, slik som sykdomsrelaterte bekymringer, angst, stress og psykososiale forhold (13,15,19,21,34).…”