THU0480-HPR Which factors are related to fatigue in rheumatoid arthritis?

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...

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...

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...

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...

BackgroundFemale patients generally have higher scores than males on most items on self-report questionnaires, including MDHAQ/RAPID3 (multi-dimensional health assessment questionnaire/routine assessment of patient index data)1. MDHAQ/RAPID3 was validated in patients...

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.

BackgroundDeficiency of vitamin D has been reported in patients with many types of rheumatic diseases.ObjectivesWe aimed to determine the association between serum 25-hydroxyvitamin D (25-OHD) deficiency and global assessment of...

BackgroundPatients with rheumatoid arthritis (RA) can develop sicca symptoms which may be related to secondary Sjögren's syndrome (sSS).ObjectivesTo assess the prevalence and clinical characteristics of sSS in RA patients.MethodsIn this...

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)...

BackgroundFatigue is an important clinical manifestation reported by patients with Rheumatoid Arthritis (RA). The assessment of fatigue in RA is usually conducted using subjective questionnaires, including emotional and socials aspects1....

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),...

BackgroundFatigue is highly prevalent, disabling, and remains under-reported and undertreated in rheumatoid arthritis (RA). PROMIS measures were developed to assess common symptoms and impacts of health domains relevant to chronic...

BackgroundThe functional burden of disease in patients affected by Rheumatoid arthritis (RA), mainly caused by pain and swelling of joints, is often worsened by extra-articular manifestations, among which asthenia remains...

Introduction: Rheumatoid arthritis (RA) is a common autoimmune illness that manifests mostly as chronic, symmetric, and progressive polyarthritis with a global frequency of 0.3–1.0%. RA is a disease that affects people all over the world. In India, the prevalence is estimated to be 0.7%, with around 10 million persons suffering from RA. Most people with rheumatoid arthritis experience fatigue on most days, with over 70% experiencing symptoms similar to chronic fatigue syndrome. Patients rate fatigue as a top priority and believe this unmanageable symptom is ignored by clinicians; a systematic review shows the biological agents for RA inflammation have only a small effect on fatigue. Fatigue predicts and reduces the quality of life, and it is as difficult to cope with as pain. Physicians have traditionally concentrated on the inflammatory aspects of the illness (e.g., synovitis), whereas RA patients have prioritized pain, exhaustion, sleep difficulties, and other quality-of-life issues. Aims and Objectives: The basic aim of the study was to access the incidence of fatigue in rheumatoid arthritis and evaluate its impact on the quality of life in these patients using the MAF scale (multidimensional assessment of fatigue) after prior permission for the first time in an Asian population. Results: A total of 140 subjects and 100 controls were included in the study. Age was closely matched between the study subjects and controls. Among study subjects with the disease, 94 (67%) had a disease duration ≤ 5 years, 26 (19%) had a disease duration between 6–10 years, 10 (7%) had a duration of 11–15 years and 10 (7%) had >10 years disease duration. Among the sample, 31 (25%) study subjects had a DAS score ≤ 4.0, 63 (50%) study subjects had a DAS score (disease activity score) between 4.01 and 6.0, and in the remaining 31 (25%) study subjects, the DAS score was >6.0. The mean DAS score among study subjects was 4.96, and the study subjects had a mean activity of daily living (ADL) score of 11.64; controls had a mean score of 2.42 with a statistically significant p-value. The global fatigue index was higher in study subjects, with a mean of 33.16 in contrast with a mean of 14.41 in the controls with a significant p-value. Conclusion: Our study fatigue was a persistent problem, despite treatment. The median level of fatigue experienced by study subjects with RA was high. Therefore, as persistent fatigue is associated with functional loss, fatigue in RA remains an ‘unmet need’ and continues to be ignored by clinicians.