The effect of exercise on fatigue in rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials

BackgroundFatigue is a common and disturbing symptom in patients with Rheumatoid arthritis (RA) (1,2). Measuring fatigue, understanding its contributory factors, and treating it lead to better patient outcome (3).ObjectivesThe aim...

ObjectiveFatigue in rheumatoid arthritis (RA) is hypothesised to be caused by inflammation. Still ~50% of the variance of fatigue in RA cannot be explained by the Disease Activity Score (DAS),...

BackgroundRheumatoid arthritis (RA) is the most common chronic inflammatory disease that affects about 1% of the population, and it is characterized by polyarthritis and widespread systemic manifestations [1]. Fatigue, sleep...

Although patients with rheumatoid arthritis (RA) experience fatigue, little is known about its causes and consequences, and a fully developed theoretical model explaining the experience of fatigue in RA is lacking. Our goal was to systematically review studies in RA that examined factors related to fatigue to gain more insight into its possible causes and consequences. Medline, Web of Science, Scopus, and PsycINFO were searched for relevant studies. All studies with RA samples about the relationship between fatigue and other variables that defined dependent and independent variables and used multivariate statistical methods were preliminarily included. After reviewing 129 full texts, we identified 25 studies on possible causes of fatigue and 17 studies on possible consequences of fatigue. The studies found possible causes of fatigue in illness-related aspects, physical functioning, cognitive/emotional functioning, and social aspects. Additionally, being a woman was related to higher levels of fatigue. Inflammatory activity showed an unclear relationship with fatigue in RA. Possible consequences of fatigue were also found among illness-related aspects, physical functioning, cognitive/emotional functioning, and social aspects. The strongest evidence for a relationship between fatigue and other variables was found regarding pain, physical functioning, and depression. This review summarizes the current knowledge in the field in order to inform future research on causes and consequences of fatigue in RA. However, the results are based on cross-sectional and longitudinal studies with different designs and different fatigue scales. For a better identification of causal associations between fatigue in RA and related factors, longitudinal prospective designs with adequate fatigue measurements are suggested.

BackgroundFatigue is one of the most commonly reported symptoms in rheumatoid arthritis (RA) and severe fatigue also occurs in patients with low disease activity. Many factors may play a role...

BackgroundThe mechanisms of fatigue in rheumatoid arthritis (RA) are still unclear and the effect of antirheumatic drugs on fatigue not fully established.ObjectivesTo analyse in a large cohort of RA the...

BackgroundDisability in early rheumatoid arthritis (RA) is correlated with disease activity. However, the relationship between these two clinical outcomes is relatively under-investigated. Understanding how disability is driven by disease activity...

Background:Fatigue in rheumatoid arthritis (RA) is hypothesized to be caused by inflammation. Still ~50% of fatigue in RA cannot be explained by the disease activity score (DAS), nor by generic or psychological factors.Objectives:Since MRI can detect joint inflammation more sensitively than DAS, we hypothesized that residual inflammation detected by MRI could aid in explaining fatigue in RA at diagnosis and during follow-up.Methods:526 consecutive RA-patients were followed longitudinally. Fatigue was assessed yearly on a numerical rating scale. Hand and foot MRIs were performed at inclusion, after 12 and 24-months in 199 patients and were scored for inflammation (synovitis, tenosynovitis and osteitis combined). We studied whether RA-patients with more MRI-inflammation were more fatigued at diagnosis (linear regression), whether the 2-year course of MRI-inflammation associated with the course of fatigue (linear mixed models) and whether decrease in MRI-inflammation in year-1 associated with subsequent improvement in fatigue in year-2 (cross-lagged models). Similar analyses were done with DAS as inflammation measure.Results:At diagnosis, higher DAS-scores were associated with more severe fatigue (p<0.001). However, patients with more MRI-inflammation were not more fatigued (p=0.94). During 2-year follow-up, DAS decrease associated with improvement in fatigue (p<0.001), but MRI-inflammation decrease did not (p=0.96). DAS decrease in year-1 associated with fatigue improvement in year-2 (p=0.012), as did MRI-inflammation decrease (p=0.039), with similar effect strength.Conclusion:Sensitive measurements of joint inflammation did not aid in explaining fatigue in RA at diagnosis and follow-up. This supports the concept that fatigue in RA is partly uncoupled from inflammation.Disclosure of Interests:None declared

BackgroundThe nature of the fatigue frequently experienced by patients with inflammatory joint diseases is not well understood (ref.).ObjectivesThe purpose of the present study was to examine associations between fatigue (FTG)...

Background:Physical activity is an important non-pharmacological intervention that has a combination of biological, physical and psycho-social benefits and can positively influence chronic fatigue in patients with rheumatoid arthritis (RA) [1, 2, 3].Objectives:Evaluation of the effectiveness of the use of aerobic exercise (walking) to reduce fatigue in RA patients.Methods:The study included 111 women with RA (mean age 54.4 ± 11.03 years old, mean duration of illness - 11.9 ± 9.3 years old). The DAS28-ESR indicator in RA patients was 2.84 [2.32; 3.05] points: low disease activity was diagnosed in 61.3% of patients, and remission in 38.7%. The average level of fatigue according to the VAS screening scale was 71.6 ± 8.93 points. Fatigue was assessed using the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS V2). To assess the patient’s tolerance to physical activity, a 6-minute walking distance (6MWD) test was used. A walking test at 50 meters was used to assess the functional state of patients in dynamics. The rehabilitation program (RP) of patients (for 21 days) included morning hygienic gymnastics, dosed walking (daily, duration 30-60 minutes) and walking in the air up to 3-3.5 hours a day. Vigorous movements “through pain” were contraindicated.Results:No association was found between the duration of RA and all of the used numerical fatigue scales (p> 0.05), but there was a weak positive relationship between VAS and NRS-overcoming with age (r = 0.21 and r = 0.28). An association between DAS28-ESR and numerical fatigue scales VAS (r = 0.21), NRS effect (r = 0.25) and NRS - overcoming (r = 0.24) was found, despite the fact that this study did not include patients with moderate and high RA activity.There was a significant correlation between the walking time and the number of steps during the 50-meter test (r = 0.6, p <0.001), as well as an association between the fatigue and the walking time (r = 0.33, p = 0.001 for VAS and r = 0.41, p <0.001 for NRS-severity) and the number of steps (r = 0.39, p <0.001 for VAS; r = 0.47, p <0.001 for NRS-severity; r = 0.44, p <0.001 for NRS-bridging).Table 1.Dynamics of fatigue levels and physical indicators in RA patientsBefore RPIn the end of RPрVAS fatigue level71,2 ± 9,08 (71,5; 64–78)70,4 ± 9,15 (70; 64–78)p>0,05BRAF-NRS: severity6,83 ± 1,21 (7; 6–8)6,51 ± 1,18 (7; 6–7)p<0,01BRAF-NRS: effect6,24 ± 1,07 (5; 4–6)5,95 ± 1,08 (6; 5–7)p<0,05BRAF-NRS: overcoming5,0 ± 1,7 (7; 6–8)7,76 ± 1,37 (5; 4–5)p>0,0550 meter test, number of steps79,3 ± 8,64 (78; 73–84)78,91 ± 8,15 (78; 73–83)p>0,0550-meter test, walking time, seconds56,7 ± 8,72 (57; 50–63)55,9 ± 8,59 (56; 51–60)р=0,01* The data are presented as mean ± standard deviation (median; interquartile range)After the completion of RP (Table), RA patients showed a significant reduction in the aspects of fatigue according to the NRS-severity (Z = 2.98, p = 0.003) and NRS-effect (Z = 2.08, p = 0.037) scales. There was also a decrease in the time spent by patients performing the 50 m walking test (t = 2.63, p = 0.01), but the total number of steps did not change (t = 1.44, p = 0.154). Fatigue and pain are important barriers to physical activity, but it is severe fatigue that reduces physical activity in patients with RA [4]. At the same time, physical activity itself can become a factor in reducing fatigue [5], including by reducing the activity of the disease [6].Conclusion:The severity of fatigue in RA patients can be reduced by actively using non-pharmacological treatment strategies. Walking is a simple and effective solution to increase physical activity and it has a significant effect on fatigue in RA.

BackgroundPatients with rheumatoid arthritis (RA) complain about fatigue. However, little is still known about its causes and consequences. A fully developed theoretical model explaining the experience of fatigue in RA...

Rheumatoid arthritis (RA) fatigue is not being well-managed currently, and evidence of effective interventions is limited. Aerobic exercise may provide benefit to treat fatigue in RA. Therefore, the purpose of this meta-analysis is to analyze the effect of aerobic land-based exercise on fatigue in RA. A literature search was conducted using PubMed, Cochrane Library, Embase, and trial registers to identify randomized controlled trials (RCTs) with a supervised land-based aerobic exercise program performed with an intensity between 50% and 90% of maximal heart rate, of at least 15 minutes' duration, performed at least 2 times a week, and lasting for a time period of at least 4 consecutive weeks. Risk of bias was assessed using the Cochrane tool. A meta-analysis of fatigue outcomes was performed by calculating the standardized mean difference (SMD) using a random-effects model. Five RCTs were included. None of the trials selected patients with RA for having fatigue. Risk of bias was low in 3 RCTs and unclear in 2. Land-based aerobic exercise programs had a positive effect on fatigue in RA compared to no exercise at 12 weeks, SMD -0.31 (95% confidence interval [95% CI] -0.55, -0.06). At 24 weeks, the effect of aerobic land-based exercise was smaller and not statistically significant: SMD -0.15 (95% CI -0.33, 0.02). There is evidence with low risk of bias that an aerobic exercise program is effective in reducing fatigue among patients with RA, especially in the short term; however, effects are small. To substantiate the evidence, RCTs should be performed in patients with RA selected for having fatigue.

Psychological correlates of fatigue in rheumatoid arthritis: A systematic review

BackgroundFatigue in rheumatoid arthritis (RA) could be related to several factors.1 The disease process, as well as its consequences such as pain, mental health problems and activity limitations are contributed...

BackgroundPatients with chronic inflammatory rheumatism claim fatigue as a key symptom of their disease. The association between fatigue and inflammatory joint diseases such as rheumatoid arthritis (RA) or axial spondyloarthritis...