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Fatigue an Overall Problem for Patients with RA

Rheumatol Int; ePub 2018 Jul 16; Walter, et al

Despite a strict treat-to-target strategy, fatigue remained an overall problem for patients with rheumatoid arthritis (RA) during the first year of treatment, and was mainly predicted by its baseline status. In subgroups, a small additional effect of depression was seen. Therefore, monitoring depression along with fatigue may be important in managing fatigue. 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. Researchers found:

  • 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 were previous fatigue levels.
  • Higher score on the depression scale and coping with limitations was associated with developing fatigue over time in the initially non-fatigued group.

Citation:

Walter MJM, Kuijper TM, Hazes JMW, Weel AE, Luime JJ. Fatigue in early, intensively treated and tight-controlled rheumatoid arthritis patients is frequent and persistent: A prospective study. [Published online ahead of print July 16, 2018]. Rheumatol Int. doi:10.1007/s00296-018-4102-5.

Commentary:

Although difficult to measure, excess fatigue is an important part of the disability experienced by patients with rheumatoid arthritis (RA). At entry, 113 patients in this study were considered fatigued and 133 were not fatigued. There was little difference in baseline disease activities scores and Fatigue Assessment Scale (FAS) scores improved in both groups but fatigue scores decreased by only 6% during the 12-month trial. At 12 months, 23% of the initial patients with fatigue had less fatigue, but 15% of the non-fatigue patients had become fatigued. The strongest predictor of fatigue at 12 months was the baseline fatigue level. With a multivariable analysis, depression and coping scales were the only characteristics significantly associated with higher levels of fatigue, but the effects of treatment of depression were not evaluated. This study demonstrates that fatigue can be measured, and documents its weak relationship with disease activity and probable interaction with depression.—Harold E. Paulus, M.D.; Emeritus Professor; University of California, Los Angeles; Division of Rheumatology.

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