Is improvement of fatigue in rheumatoid arthritis a proper effect of biologics?

Abstract

Background: The objective of our present study is to assess the relation between persistent fatigue and rheumatoid arthritis (RA) disease activity and its functional impact and to determine if the positive effect of biologics on fatigue is due to good disease response or to a different pathway.Methods: A study cohort of patients with established RA was conducted. We included patients who were initiation a biologic after at least failure of one conventional synthetic Disease Modifying Anti-Rheumatic Drug synthetic (csDMARDs). At baseline, patients had a moderately to highly active disease. Demographic characteristics, disease activity and functional impact were assessed by disease activity score (DAS28CRP) and health assessment questionnaire (HAQ) scores. Fatigue was evaluated by the Functional Assessment of Chronic Illness Therapy–Fatigue scale questionnaire (FACIT-F). Patients were examined before initiating biotherapy, then after three months and six months.Results: Thirty women with RA, with a mean age of 52.5 years, were included. At baseline, 57% received anti-TNFα: Etanercept (n=9), Adalimumab (n=6), Infliximab (n=2) and 43% received Rituximab. Good Eular response was obtained in 80% of patients at the third month and 97% of patients at the sixth month. In the analytic study, a significant amelioration after 3 months of biotherapy was found in both disease response (DAS28CRP) and fatigue (FACITF), respectively (p=0.01,p<0.001 and p<0.001). The disease activity decreased significantly also after sixth month (p=0.01, p<0.001 and p=0.012). In the linear multivariate analysis, the regression of visual analogic pain (VAS pain) was the only predictors of the improvement of fatigue.Conclusion: Biologics contribute to improve fatigue in patients with established RA and this effect seems to be independent from the clinical efficacy of this treatment.

Fatigue in rheumatoid arthritis patients: The status, independent risk factors, and consistency of multiple scales

“…The main findings of our study were as follows: Although the exact mechanism is still unclear, evidence shows that disease-related factors (inflammation, pain, and so on), medication administration, cognitive and behavioral factors, and personal factors (personal responsibilities, personal environments, social support, personal health, and dietary patterns) can contribute to fatigue in RA patients. 4,[25][26][27] As a common chronic symptom in RA patients, fatigue brings great burdens to patients, including daily activity obstacles, decreased work ability, economic loss, and so on. 28,29 Previous studies show the prevalence of fatigue in RA is about 44.00%-71.25% and the fatigue score in RA patients is higher than in healthy controls, indicating that fatigue is widespread among RA patients.…”

“…Although the exact mechanism is still unclear, evidence shows that disease‐related factors (inflammation, pain, and so on), medication administration, cognitive and behavioral factors, and personal factors (personal responsibilities, personal environments, social support, personal health, and dietary patterns) can contribute to fatigue in RA patients 4,25–27 . As a common chronic symptom in RA patients, fatigue brings great burdens to patients, including daily activity obstacles, decreased work ability, economic loss, and so on 28,29 .…”

The Link between the Demographic and Clinical Factors and Fatigue Symptoms among Rheumatoid Arthritis Patients

“…Our studies did not show any relationship between pharmacological therapy and an increase in fatigue. Ines et al [ 32 ] conducted a cohort study where they assessed, among other things, the effect of biological treatment (anti-TNFα) on fatigue symptoms, and a significant decrease in the level of fatigue was noted. Janoudi et al [ 33 ] confirmed that several months’ use of adalimumab reduces the symptoms of fatigue as measured by the FACIT-F scale.…”