Fatigue In Rheumatic Diseases Research Articles

Is there a role for novel supplements in the management of fatigue in rheumatic diseases?

Fatigue is a common symptom of rheumatic diseases and frequently persists even when patients are in a near-remission state. In seeking options to manage troublesome symptoms such as fatigue, complementary...

Treatment strategy for fatigue in rheumatic diseases in view of the 2023 EULAR recommendations

Fatigue is a persistent and debilitating feeling of tiredness that limits the ability to perform daily activities and is a common and difficult-to-treat condition in patients with rheumatic diseases (RD). Fatigue is a major challenge for the physician. However, methods to treat it have not yet been developed, as fatigue is usually considered an insignificant background condition. This article provides an overview of the 2023 EULAR recommendations, which outline the guiding principles and strategy for the management of fatigue in patients with RD. The EULAR recommendations are based on an understanding of fatigue as a complex condition that requires an individualized approach in choosing the correction methods. It is important that the assessment of fatigue becomes part of the routine practice of rheumatologists and other physicians. Patient education recommendations emphasize the importance of an individualized approach tailored to the needs of the individual, including optimizing physical activity and psychoeducational interventions.

Potential Mechanism of Fatigue Induction and Its Management by JAK Inhibitors in Inflammatory Rheumatic Diseases.

It is well known that fatigue is a highly disabling symptom commonly observed in inflammatory rheumatic diseases (IRDs). Fatigue is strongly associated with a poor quality of life and seems to be an independent predictor of job loss and disability in patients with different rheumatic diseases. Although the pathogenesis of fatigue remains unclear, indirect data suggest the cooperation of the immune system, the central and autonomic nervous system, and the neuroendocrine system in the induction and sustainment of fatigue in chronic diseases. Fatigue does not correspond with disease activity and its mechanism in IRDs. It is suggested that it may change over time and vary between individuals. Abnormal production of pro-inflammatory cytokines such as interleukin-6 (IL-6), interferons (IFNs), granulocyte-macrophage colony-stimulating factor (GM-CSF), TNF, IL-15, IL-17 play a role in both IRDs and subsequent fatigue development. Some of these cytokines such as IL-6, IFNs, GM-CSF, and common gamma-chain cytokines (IL-15, IL-2, and IL-7) activate the Janus Kinases (JAKs) family of intracellular tyrosine kinases. Therapy blocking JAKs (JAK inhibitors - JAKi) has been recently proven to be an effective approach for IRDs treatment, more efficient in pain reduction than anti-TNF. Therefore, the administration of JAKi to IRDs patients experiencing fatigue may find rational implications as a therapeutic modulator not only of disease inflammatory symptoms but also fatigue with its components like pain and neuropsychiatric features as well. In this review, we demonstrate the latest information on the mechanisms of fatigue in rheumatic diseases and the potential effect of JAKi on fatigue reduction.

Impact of fatigue on rheumatic diseases.

Fatigue is a common, disabling, and difficult-to-manage problem in rheumatic diseases. The concept of fatigue is difficult to define. No clear and widely accepted definition of fatigue is available. The symptoms of fatigue are defined as an overwhelming, debilitating, and sustained sense of exhaustion that decreases the ability to function and carry out daily activities. Prevalence estimates of fatigue within musculoskeletal diseases vary considerably (35%-82%). In this review, we present data about the role of fatigue for the patients' quality of life, tools for diagnosing fatigue, factors contributing to fatigue like disease activity and psychological factors, and some experimental studies to verify the biological background of fatigue. Management of fatigue including pharmacological and non-pharmacological treatment is also part of this publication. Overall data are scarce for fatigue in rheumatic diseases, and further studies are warranted to identify the role of biological mechanism such as inflammation, hormonal changes, and autonomic nervous system in the pathogenesis of fatigue.

265 Targetingpain and fatigue in rheumatic diseases: results from the tired of being tiredprogramme

265 Targetingpain and fatigue in rheumatic diseases: results from the tired of being tiredprogramme

Impact of Fatigue in Rheumatic Diseases in the Work Environment: A Qualitative Study.

Fatigue is a symptom of arthritis that causes difficulty at work. An improved understanding of this symptom could assist its management in the work environment. The aim of this study was to explore people with rheumatic diseases’ experiences of fatigue in work. A qualitative descriptive design was used with semi-structured interviews and a constant comparative method of data analysis. There were 18 participants, the majority of them female with Rheumatoid Arthritis (RA) and working full-time. Three themes were identified: “Impact of fatigue on work performance” with cognition, mood and physical abilities being the main difficulties reported. In the second theme “Disclosure at Work” participants discussed disclosing their disease to employers but reported a lack of understanding of fatigue from colleagues. The final theme “work-based fatigue management strategies” included cognitive strategies and energy management techniques, which were mainly self-taught. In this study, fatigue was reported to impact on many areas of work performance with limited understanding from colleagues and employers. Interventions from health professionals to assist with development of work-related self-management skills are required to assist with symptom management in the work place. Such interventions should include education to employers and colleagues on the nature of fatigue in Rheumatic diseases.

Fatigue in Egyptian patients with rheumatic diseases: a qualitative study.

ObjectivesFatigue is frequent in rheumatic diseases. Fatigue expression and consequences may be modified by cultural differences. Our objective was to increase the understanding of the fatigue experience and characteristics among Egyptian, Muslim patients with rheumatic diseases.MethodsProspective monocentric qualitative study based on conventional qualitative content analysis, inductive reasoning, grounded theory. Egyptian patients with rheumatoid arthritis (RA), fibromyalgia or axial spondyloarthritis (AxSpA) were asked about fatigue, its patterns, consequences and self-management.ResultsOf the 60 patients interviewed, 20 patients had each disease (RA, fibromyalgia and AxSpA); median ages ranged from 34 to 40 years. Patients were mainly male (N = 40, 66 %), had 3 to 7 years (mean) of disease duration and had moderate disease activity. Some aspects of the patients’ experience of fatigue may be specific to the Egyptian and Muslim culture such as the description of fatigue as a physical more than a mental impact of the disease, the response to the effect of fatigue on sexual function and the gender specific (women more than men) limitation of social activities due to fatigue which was more obvious in our study than other previous studies. Other aspects of patients’ experience of fatigue like overlap between the patients’ perception of fatigue and pain and coping strategies were similar to the findings in previous studies.ConclusionThis study gives insights regarding fatigue in rheumatic diseases in an Arabic and Muslim culture. Similarities and differences with previous studies were noted and should be taken into account when assessing these patients.

The prevalence of severe fatigue in rheumatic diseases: an international study.

Fatigue is a common, disabling, and difficult-to-manage problem in rheumatic diseases. Prevalence estimates of fatigue within rheumatic diseases vary considerably. Data on the prevalence of severe fatigue across multiple rheumatic diseases using a similar instrument is missing. Our aim was to provide an overview of the prevalence of severe fatigue across a broad range of rheumatic diseases and to examine its association with clinical and demographic variables. Online questionnaires were filled out by an international sample of 6120 patients (88 % female, mean age 47) encompassing 30 different rheumatic diseases. Fatigue was measured with the RAND(SF)-36 Vitality scale. A score of ≤35 was taken as representing severe fatigue (90 % sensitivity and 81 % specificity for chronic fatigue syndrome). Severe fatigue was present in 41 to 57 % of patients with a single inflammatory rheumatic disease such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, Sjögren’s syndrome, psoriatic arthritis, and scleroderma. Severe fatigue was least prevalent in patients with osteoarthritis (35 %) and most prevalent in patients with fibromyalgia (82 %). In logistic regression analysis, severe fatigue was associated with having fibromyalgia, having multiple rheumatic diseases without fibromyalgia, younger age, lower education, and language (French: highest prevalence; Dutch: lowest prevalence). In conclusion, one out of every two patients with a rheumatic disease is severely fatigued. As severe fatigue is detrimental to the patient, the near environment, and society at large, unraveling the underlying mechanisms of fatigue and developing optimal treatment should be top priorities in rheumatologic research and practice.

Can the Cancer-related Fatigue Case-definition Criteria Be Applied to Chronic Medical Illness? A Comparison between Breast Cancer and Systemic Sclerosis.

Fatigue is a crucial determinant of quality of life across rheumatic diseases, but the lack of agreed-upon standards for identifying clinically significant fatigue hinders research and clinical management. Case definition criteria for cancer-related fatigue were proposed for inclusion in the International Classification of Diseases. The objective was to evaluate whether the cancer-related fatigue case definition performed equivalently in women with breast cancer and systemic sclerosis (SSc) and could be used to identify patients with chronic illness-related fatigue. The cancer-related fatigue interview (case definition criteria met if ≥ 5 of 9 fatigue-related symptoms present with functional impairment) was completed by 291 women with SSc and 278 women successfully treated for breast cancer. Differential item functioning was assessed with the multiple indicator multiple cause model. Items 3 (concentration) and 10 (short-term memory) were endorsed significantly less often by women with SSc compared with cancer, controlling for responses on other items. Omitting these 2 items from the case definition and requiring 4 out of the 7 remaining symptoms resulted in a similar overall prevalence of cancer-related fatigue in the cancer sample compared with the original criteria (37.4% vs 37.8%, respectively), with 97.5% of patients diagnosed identically with both definitions. Prevalence of chronic illness-related fatigue was 36.1% in SSc using 4 of 7 symptoms. The cancer-related fatigue criteria can be used equivalently to identify patients with chronic illness-related fatigue when 2 cognitive fatigue symptoms are omitted. Harmonized definitions and measurement of clinically significant fatigue will advance research and clinical management of fatigue in rheumatic diseases and other conditions.

Effects of exercise on physical limitations and fatigue in rheumatic diseases.

Physical activity covers not just sports but also simple everyday movements such as housework, walking and playing. Regular exercise has a great importance in maintaining good health, indeed inactivity is a risk factor for different chronic diseases. Physical exercise can play a crucial role in the treatment of rheumatic diseases, optimizing both physical and mental health, enhancing energy, decreasing fatigue and improving sleep. An exercise program for patients with rheumatic diseases aims to preserve or restore a range of motion of the affected joints, to increase muscle strength and endurance, and to improve mood and decrease health risks associated with a sedentary lifestyle. In this editorial I describe the benefits of the exercise on physical limitations and fatigue in rheumatic diseases that seem to have a short and long-term effectiveness. A literature review was conducted on PubMed, Scopus and Google Scholar using appropriate keywords based on the present editorial.

FRI0215 Fatigue in Egyptian Patients with Rheumatic Diseases; A Difficult Concept but A Major Impact: A Qualitative Study

BackgroundPatients with rheumatic diseases commonly experience fatigue and this fatigue has a substantial impact on patients' self-care activities and overall quality of life. Fatigue levels and the expression of fatigue...

FRI0071 Effect of Biological Therapy on Fatigue in Patients with Rheumatoid Arthritis

BackgroundFatigue is a frequent symptom among patients with rheumatoid arthritis (RA) and contributes to decreased quality of life in these patients [1].There are various questionnaires to assess fatigue in rheumatic...

The Comparability of English, French and Dutch Scores on the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F): An Assessment of Differential Item Functioning in Patients with Systemic Sclerosis

ObjectiveThe Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT-F) is commonly used to assess fatigue in rheumatic diseases, and has shown to discriminate better across levels of the fatigue spectrum than other commonly used measures. The aim of this study was to assess the cross-language measurement equivalence of the English, French, and Dutch versions of the FACIT-F in systemic sclerosis (SSc) patients.MethodsThe FACIT-F was completed by 871 English-speaking Canadian, 238 French-speaking Canadian and 230 Dutch SSc patients. Confirmatory factor analysis was used to assess the factor structure in the three samples. The Multiple-Indicator Multiple-Cause (MIMIC) model was utilized to assess differential item functioning (DIF), comparing English versus French and versus Dutch patient responses separately.ResultsA unidimensional factor model showed good fit in all samples. Comparing French versus English patients, statistically significant, but small-magnitude DIF was found for 3 of 13 items. French patients had 0.04 of a standard deviation (SD) lower latent fatigue scores than English patients and there was an increase of only 0.03 SD after accounting for DIF. For the Dutch versus English comparison, 4 items showed small, but statistically significant, DIF. Dutch patients had 0.20 SD lower latent fatigue scores than English patients. After correcting for DIF, there was a reduction of 0.16 SD in this difference.ConclusionsThere was statistically significant DIF in several items, but the overall effect on fatigue scores was minimal. English, French and Dutch versions of the FACIT-F can be reasonably treated as having equivalent scoring metrics.

Some Unresolved Issues for the Study of Fatigue: The Way Forward

This section of the supplement “Fatigue: A New Frontier” will discuss 3 issues that have significant import for elucidating mechanisms by which fatigue occurs and its evaluation and treatment. These issues are clearly not the only ones that are important for future research or clinical practice, but they are the most prevalent issues raised in the articles of this supplement. They present significant challenges in both research and clinical arenas and offer substantial research opportunity. There exists a body of published data that leave a number of unresolved key issues. These include: 1) What are our best metrics for measuring fatigue? 2) Do the constructs of peripheral and central fatigue advance our understanding of fatigue syndromes or create arbitrary limitations? 3) Will a better understanding of the interactions among immunoregulation and metabolic control of energy production and utilization (and performance and perception) help us derive a comprehensive approach to the management of fatigue? What are the Best Metrics for Measuring Fatigue? Many of the sections of this supplement address the need for valid and reliable instruments for measuring fatigue. The authors identify instruments that were specifically developed for use in some of the disease entities they discuss. For example, the Fatigue Severity Scale has been used to assess fatigue in rheumatic diseases and multiple sclerosis. Whereas in assessing cancer-related fatigue, other self-report instruments have been used, including the Functional Assessment of Cancer Therapy-Fatigue, Cancer Fatigue Scale, and Brief Fatigue Inventory, among others. Self-reports are necessary for assessing fatigue, but many suggest that they are not sufficient. The trend is toward using instruments that are coupled with objective findings. For example, in cancer-related fatigue and the neurological conditions, studies have included measures of neuromuscular fatigue. As discussed in this theme issue, there seems to be a shift in thinking about what is most important in measuring fatigue in the elderly. In particular, the concept of fatigability, which links fatigue with function and thereby assesses the impact fatigue may have on independence, has gained momentum as the measurement of choice. Fatigue measures in the affective/fatigue or pain/fatigue overlap syndromes, such as chronic fatigue syndrome and fibromyalgia (FM), remain reliant on self-reports of symptoms, mood, and behavior. Most authors contributing to this special issue indicate that one of the more significant problems facing clinicians and researchers studying and treating fatigue is reaching agreement on which measures to use for evaluation and treatment outcomes. There has not been consensus on whether fatigue measures should or must include objective measures, or whether they need to be disease specific. There does not seem to be consensus on what the essential components of a fatigue measure need be and whether this would be true for all or most chronic medical conditions, including those that may have significant psychoaffective and biopsychosocial components. This is an opportune time to promote a Consensus Conference designed to explore issues such as how to measure fatigue and what should be included in these measures. Such a conference would also introduce the use of theories and approaches to computer technologies such as item response theory and computerized-adapted training to help assure validity and efficiency in the choice of relevant metrics. One such approach, patient reported outcomes medical information system (PROMIS), has been instrumen