Abstract
Aim: To evaluate the prevalence of fatigue and the factors associated with fatigue among patients with axial spondyloarthritis (axSpA) within an Asian population.Method: We used the baseline data from a clinic registry in a tertiary referral center. All patients fulfilled the 2009 Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA. Severe fatigue was defined as Bath Ankylosing Spondylitis Disease Activity Index-fatigue (BASDAI-fatigue) ≥5/10 and vitality domain of Short Form-36 Health Survey (SF-36 VT) ≤10th percentile of the general population.Results: We included 262 consecutive patients with axSpA (79% men, 82.4% Chinese). The mean (standard deviation, SD) age and duration of disease were 41.7 (13.7) and 10.1 (8.3) years, respectively. 145 (55.3%) and 52 (31.1%) patients reported severe fatigue by the BASDAI-fatigue and SF-36 VT criteria, respectively. Patients with severe fatigue had worse scores across all disease activity assessments and disease impact measures compared to those without severe fatigue. Using principal component analyses, disease activity and impact were associated with BASDAI-fatigue, while disease activity and impact, and disease chronicity were associated with SF-36 VT. In the univariable analyses, all disease activity assessments and disease impact measures correlated with both BASDAI-fatigue and SF-36 VT. In the multivariable analyses, BASDAI-axial pain, BASFI, BAS-G, and ethnicity were associated with BASDAI-fatigue, while ASQoL and BASDAI-morning stiffness were associated with SF-36 VT.Conclusion: Fatigue is prevalent amongst patients with axSpA in Asia and is associated with disease activity, disease impact as well as patient related factors.
Highlights
Axial spondyloarthritis is a chronic inflammatory rheumatic disease characterized by predominant involvement of the axial skeleton, with peak disease onset in late adolescence and early adulthood [1]
The importance of fatigue has been recognized as evidenced by its inclusion in the Assessment of SpondyloArthritis international Society (ASAS) core set for clinical practice [11]
A total of 262 consecutive patients with axSpA were included in this study, of which 262 had complete data for BASDAIfatigue, and only 167 had available data for SF-36 and SF-36 VT
Summary
Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease characterized by predominant involvement of the axial skeleton, with peak disease onset in late adolescence and early adulthood [1]. Often striking patients in their prime of life, axSpA has wide-ranging and long-lasting impacts on different aspects of life, including functional, psychological and social domains [3]. Fatigue is generally described as a subjective sensation of tiredness that is relentless, pervasive, unpredictable, and unresolving [12, 13]. It has adverse impacts on how axSpA patients function in daily activities [7,8,9, 14,15,16], work performance [9, 16], and quality of life [6, 9, 14, 15]. Current understanding holds that fatigue in spondyloarthritis is multi-factorial and associated with disease-specific parameters [5,6,7,8,9,10, 14, 15, 17], poor psychological health [7, 8, 10, 14, 15], sleep disturbance [10, 17], and women gender [5, 8], with disease activity being the single most important predictor
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