Abstract
Fatigue has a large impact on quality of life and is still unmanageable for many patients. Study aims were describe (1) the prevalence and pattern of fatigue over time in patients with early rheumatoid arthritis under a treat-to-target strategy and (2) identify predictive factors for worsening and recovering of fatigue over time. 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. Prediction of fatigue at 12 months was investigated with an ROC curve. Analysis was stratified into non-fatigue and fatigue at baseline. Logistic regression was used for the evolution of fatigue in relation with the covariates over time. 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 was the previous fatigue levels (AUC 0.89). Higher score on the depression scale and coping with limitations was associated with developing fatigue over time in the initially non-fatigued group. Despite a strict treat-to-target strategy, fatigue remained an overall problem during the first year of treatment, and was mainly predicted by its baseline status. In subgroups, a small additional effect of depression was seen. Monitoring fatigue and depression may be important in managing fatigue.
Highlights
Studies have shown good results concerning remission and structural radiographic damage of the joints by tight control and treat-to-target management [1, 2]
Baseline fatigue data were available for 246–270 individuals participating in the tREACH trial
Almost half of the early rheumatoid arthritis (RA) patients were fatigued over the first year after diagnosis, they had been treated by an early, intensive, and tight-controlled
Summary
Studies have shown good results concerning remission and structural radiographic damage of the joints by tight control and treat-to-target management [1, 2] Despite these effective strategies and reaching remission of disease activity, patients with rheumatoid arthritis (RA) still may experience a burden of the diseases like pain and fatigue [3]. Fatigue is associated with a reduced health-related quality of life and depression [8, 9] and is the most limiting factor for the ability to work [10]. Because of this large impact, it is important to study fatigue. According to patients, reducing fatigue is an important treatment target, but is not often addressed during consultations [11, 12]
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