Abstract
Fatigue is a common symptom in patients with rheumatoid arthritis (RA) and in patients with cancer (CA). The aim was to investigate the degree of fatigue in RA patients as compared to CA patients as well as potential influencing factors on RA-related fatigue. This was a retrospective analyses of two prospective cohort studies that used the EORTC QLQ-FA12 as a common instrument to assess fatigue. The cohort of RA patients was based on a nationwide survey in Germany. The cohort of CA patients was recruited in the context of an international validation field study. Multivariable ANCOVAs compared levels of fatigue between the two cohorts, also including various subgroup analyses. Regression analyses explored influencing factors on RA patients’ fatigue. Data of n = 705 RA patients and of n = 943 CA patients were available for analyses. RA patients reported significantly higher Physical Fatigue (mean difference = 7.0, 95% CI 4.2–9.7, p < 0.001) and Social Sequelae (mean difference = 7.5, 95% CI 4.7–10.2, p < 0.001). CA patients reported higher Cognitive Fatigue (mean difference = 3.5, 95% CI 1.4–5.6, p = 0.001). No differences in Emotional Fatigue (p = 0.678) and Interference with Daily Life (p = 0.098) were found. In RA patients, mental health and pain were associated with fatigue (p values < 0.001). RA patients showed a considerable level of fatigue that is comparable to and in certain cases even higher than that of CA patients. The implementation of standardized diagnostic procedures and interventions to reduce fatigue in RA patients are recommended.
Highlights
Fatigue is common in patients with rheumatoid arthritis (RA) as well as in patients with cancer (CA)
Three patients were excluded from the present analyses due to missing fatigue assessment, resulting in 705 RA patients
946 CA patients with a broad range of tumor sites were included in the original study [20,21,22], but three patients were excluded due to missing fatigue assessment, resulting in 943 CA patients
Summary
Fatigue is common in patients with rheumatoid arthritis (RA) as well as in patients with cancer (CA). Fatigue is associated with the severity of pain and psychosocial factors such as depression [4]. A complex interaction of clinical factors such as disease activity, pain, and disability as well as of psychosocial and personal factors such as coping, working, beliefs, and behaviors have to be taken into account [2, 5, 6]. Since 2006, fatigue has been included as an important outcome measure in RA by the “Outcome Measures in Rheumatoid Arthritis Clinical Trials” (OMERACT) [7]. Biologic disease-modifying anti-rheumatic drugs (DMARDs) and targeted synthetic DMARDs have been shown to have a moderate effect on improving fatigue by reducing pain and inflammation [2, 8].
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