Fatigue In Rheumatoid Arthritis Research Articles

Efficacy of pharmacological interventions: a systematic review informing the 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases

ObjectiveTo identify the best evidence on the efficacy of pharmacological interventions in reducing fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and to summarise their safety in the...

MITIG.RA: study protocol of a tailored psychological intervention for managing fatigue in rheumatoid arthritis randomized controlled trial

BackgroundDespite remarkable medical advances in the treatment of rheumatoid arthritis (RA), a subset of patients fails to achieve complete clinical remission, as the Patient Global Assessment (PGA) of disease activity remains above 1, even after the inflammatory process is brought under control. This so-called state of ‘PGA-near-remission’ negatively impacts individuals’ functioning and potentiates inadequate care. Fatigue is a distressing and disabling symptom frequently reported by patients in PGA-near-remission, and its management remains challenging. While classic cognitive-behavioural interventions show some benefits in managing fatigue, there is potential for improvement. Recently, contextual-cognitive behavioural therapies (CCBT), like mindfulness, acceptance, and compassion-based interventions, have shown promising results in fatigue-associated disorders and their determinants. This study primarily aims to examine the efficacy of the Compassion and Mindfulness Intervention for RA (MITIG.RA), a novel intervention combining different components of CCBT, compared to treatment-as-usual (TAU) in the management of RA-associated fatigue. Secondary aims involve exploring whether MITIG.RA produces changes in the perceived impact of disease, satisfaction with disease status, levels of depression, and emotion-regulation skills.MethodsThis is a single center, two-arm parallel randomized controlled trial. Patients will be screened for eligibility and willingness to participate and will be assessed and randomized to the experimental (MITIG.RA + TAU) or control condition (TAU) using computer randomization. MITIG.RA will be delivered by a certified psychologist and comprises eight sessions of 2 h, followed by two booster sessions. Outcomes will be assessed through validated self-report measures, including fatigue (primary outcome), perceived impact of disease, depressive symptoms, mindfulness, self-compassion, safety, and satisfaction (secondary outcomes). Assessment will take place at baseline, post-intervention, before the first and second booster sessions (weeks 12 and 20, respectively), and at 32 and 44 weeks after the interventions’ beginning.DiscussionWe expect MITIG.RA to be effective in reducing levels of RA-associated fatigue. Secondarily, we hypothesize that the experimental group will show improvements in the overall perceived impact of disease, emotional distress, and emotion regulation skills. Our findings will contribute to determine the benefits of combining CCBT approaches for managing fatigue and associated distress in RA.Trial registrationClinicalTrials.gov NCT05389189. Registered on May 25, 2022.

A cross-sectional study of multidimensional fatigue in biologic-treated rheumatoid arthritis: which variables play a role?

Purpose Despite efficient biological disease-modifying antirheumatic drugs (bDMARDs) Rheumatoid Arthritis (RA) patients still suffer from high fatigue. This study aims to further our knowledge by assessing severity levels of the various fatigue dimensions and their associations with pain, sleep quality, and psychological well-being in bDMARDs treated RA patients. Material and Methods The sample consisted of 146 RA patients (84.9% females; mean age 56.6 ± 13.6 years), who completed the MFI-20, SF-36, PSQI, GAD-7 and PHQ-9. Correlation analyses and multiple linear regressions were used to analyse the data. Results General fatigue was the highest reported type of fatigue, followed by physical fatigue dimensions. In the final regression model, pain and disability were significantly associated with physical fatigue (p ≤ 0.001, p ≤ 0.05, respectively) and reduced activity (p ≤ 0.01, p ≤ 0.05, respectively). Anxiety was significantly associated with mental fatigue (p ≤ 0.05) and reduced motivation (p ≤ 0.01). Regression analyses showed no significant associations between depression, sleep quality, and fatigue in any of the final models. Conclusions Our findings indicate that effectively addressing fatigue in RA patients requires an individualized approach. This approach should acknowledge the varying degrees of fatigue across different fatigue dimensions (physical or mental), while also taking into account the patient’s mental health problems, pain levels, and disability levels.

Rheumatoid arthritis presenting with mono- or oligo-arthritis and high VAS remains most fatigued during 5-years follow-up.

The severity of fatigue in rheumatoid arthritis (RA) has hardly improved in recent decades, leaving a large unmet need. Fortunately, not all RA-patients suffer from persistent fatigue, but the subgroup of patients who suffer the most is insufficiently recognizable at diagnosis. As disease activity is partly coupled to fatigue, Disease-Activity-Score (DAS)-components may associate with the course of fatigue. We aimed to identify the RA-patients who remain fatigued by studying DAS-components at diagnosis in relation to the course of fatigue over a 5-year follow-up period in two independent early RA-cohorts. 1560 consecutive RA-patients included in the Leiden Early Arthritis Cohort and 415 RA-patients included in the tREACH-Cohort were studied. Swollen joint count, tender joint count, ESR and Patient Global Assessment (Visual Analogue Scale(VAS),0-100 mm) were studied in relation to fatigue(VAS, 0-100mm) during 5-years using linear mixed models. Higher TJC and PGA at diagnosis were associated with a more severe course of fatigue. The SJC, in contrast, showed an inverse association; patients with mono- or oligo-arthritis at diagnosis remained more fatigued. The combination of aforementioned characteristics revealed that patients presenting with a mono- or oligo-arthritis and PGA ≥ 50 remained the most fatigued over time(+20mm vs polyarthritis with PGA < 50), whilst the DAS-course over time was not different. This subgroup comprised 14% of the early RA-population. Data from the tREACH-cohort showed similar findings. RA-patients who remain the most fatigued are characterized by mono- or oligo-arthritis and high PGA(VAS ≥ 50) at diagnosis. This understanding may enable early-intervention with non-pharmacological approaches in dedicated patient groups.

Efficacy of non-pharmacological interventions: a systematic review informing the 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases

ObjectiveTo identify the best evidence on the efficacy of non-pharmacological interventions in reducing fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and to summarise their safety in the...

Fatigue in patients with rheumatic and musculoskeletal diseases: a scoping review on definitions, measurement instruments, determinants, consequences and interventions

ObjectivesTo scope published reviews addressing fatigue in rheumatoid arthritis (RA), spondyloarthritis, osteoarthritis and fibromyalgia in areas relevant for clinical practice: (1) definition, (2) measurement instruments and diagnosis, (3) determinants, (4)...

Validación de la escala FACIT-fatiga en una muestra de población hispanohablante con artritis reumatoide

IntroductionFatigue is a frequent symptom in patients with rheumatoid arthritis (RA). The Functional Assessment of Chronic illnesses Therapy-Fatigue (FACIT-F) is an instrument that assesses self-reported fatigue and was validated for measuring fatigue in RA. ObjectiveThe aim of this study was to validate the FACIT-F for use in Spanish-speaking RA patients. Materials and methodsCross-sectional, multicentre study. We included patients (n = 192) with RA diagnosis from two hospitals. Exploratory and confirmatory analyses were conducted. Construct validity and internal consistency were evaluated. ResultsFACIT-F showed high internal consistency (alpha = .87, omega = .93). Analysis of the main components showed a single factor, which explained 62% of the variance. The confirmatory factor analysis showed a satisfactory fit of the model. We found a correlation between FACIT–F, VAS fatigue (-.72 P < .001), and BRAF-MDQ (-.81 P < .001). ConclusionFACIT-F is a valid instrument with a high internal consistency for measuring fatigue in clinical practice and research in Spanish-speaking patients with RA.

Unsupervised clustering to differentiate rheumatoid arthritis patients based on proteomic signatures

Objective Patients with rheumatoid arthritis (RA) have different presentations and prognoses. Cluster analysis based on proteomic signatures creates independent phenogroups of patients with different pathophysiological backgrounds. We aimed to identify distinct pathophysiological clusters of RA patients based on circulating proteomic biomarkers. Method This was a cohort study including 399 RA patients. Clustering was performed on 94 circulating proteins (92 CVDII Olink®, high-sensitivity troponin T, and C-reactive protein). Unsupervised clustering was performed using a partitioning cluster algorithm. Results The clustering algorithm identified two distinct clusters: cluster 1 (n = 223) and cluster 2 (n = 176). Compared with cluster 1, cluster 2 included older patients with a higher burden of comorbidities (cardiovascular and RA related), more erosive and longer RA duration, more dyspnoea and fatigue, walking a shorter distance in the Six-Minute Walk Test, with more severe diastolic dysfunction, and a 4.5-fold higher risk of death or hospitalization for cardiovascular reasons. Tumour necrosis factor (TNF) receptor superfamily-related pathways were mainly responsible for the model’s discriminative ability. Conclusion Using unsupervised cluster analysis based on proteomic phenotypes, we identified two clusters of RA patients with distinct biomarkers profiles, clinical characteristics, and different outcomes that could reflect different pathophysiological backgrounds. TNF receptor superfamily-related proteins may be used to distinguish subgroups.

Depression and Fatigue in Rheumatoid Arthritis- A Study in Southern India

Rheumatoid Arthritis is a chronic autoimmune condition in which the patient experiences pain, joint immobility which in some instance can also lead to disability, and thus difficulty in carrying out various activities of daily living. It is a natural consequence that patients may experience varying degrees of depressive symptoms and fatigue. Aim and Objectives: In our study, it is our objective to find out the prevalence of depression, its severity and its correlation with disease activity, pain and inflammatory markers like ESR. We also attempted to quantify the fatigue using the MAF scale by calculating the GFI (Global Fatigue Index) and its prevalence in remission vs non remission patients. Study design: The study is a cross-sectional observational study of consecutive patients with a diagnosis of RA as per EULAR 2020 criteria. The patients were interviewed using standard questionnaires MAF (multidimensional assessment of fatigue questionnaire) and PHQ9 (Patient Health Questionnaire 9). Tools used in the study: Fatigue was measured by using MAF (Multidimensional Assessment of Fatigue). Depression is measured using the PHQ9 questionnaire. Results: The population studied was found to have a prevalence of 33.5% depression. The patients’ mean age was 52.4510.53 years and disease duration 8.026.22 years. Their mean DAS28 was 2.961.1. The mean PHQ-9 score was 3.993.5., mild (26%), moderate (5.5%), moderately severe (1.5%) and severe (0.5%) degrees. Correlation of PHQ9 scores with DAS, VAS and ESR was done to see if there is a relation of depression to any of the clinical outcomes. It was found that depression had a positive correlation with disease activity score DAS 28 (coefficient of correlation 0.167, p = 0.018), VAS pain scores (coefficient = 0.361, p &lt; 0.001) as well as ESR (coefficient = 0.217, and p = 0.002). Fatigue was evaluated using the MAF which gave the Global Fatigue Index (GFI). The mean MAF score was 8.623.33. 78% of patients had fatigue in the level (0-10), 20.5% in the (10-20) level and 1.5% in the (20-30) level. Statistical test for comparison between groups using t test was found to be significant with p value 0.034. Conclusion: Our study on both depression and fatigue once again emphasises the need for rheumatologists especially in the Indian scenario to address them in their routine clinical practice. There should be regular screening for these conditions during the patient visits similar to other risk factors screening in RA.

Autonomous motivation to reduce sedentary behaviour is associated with less sedentary time and improved health outcomes in rheumatoid arthritis: a longitudinal study

BackgroundThis longitudinal study investigated whether changes in autonomous and controlled motivation to reduce sedentary behaviour were associated with variability in sedentary, standing and stepping time and, in turn, disease activity, systemic inflammation, pain and fatigue in rheumatoid arthritis (RA).MethodsPeople with RA undertook assessments at baseline (T1, n = 104) and 6 months follow-up (T2, n = 54) to determine autonomous and controlled motivation to reduce sedentary behaviour (Behavioural Regulation in Exercise Questionnaire-2), free-living sedentary, standing and stepping time (7 days activPAL3μ wear), Disease Activity Score-28 (DAS-28), systemic inflammation (c-reactive protein [CRP]), pain (McGill Pain Questionnaire) and fatigue (Multidimensional Assessment of Fatigue Scale). N = 52 participants provided complete data at T1 and T2. Statistical analyses: In a series of models (A and B), path analyses examined sequential associations between autonomous and controlled motivation to reduce sedentary behaviour with activPAL3μ-assessed behaviours and, in turn, RA outcomes.ResultsModels demonstrated good fit to the data. Model A (sedentary and stepping time): autonomous motivation was significantly negatively associated with sedentary time and significantly positively related to stepping time. In turn, sedentary time was significantly positively associated with CRP and pain. Stepping time was not significantly associated with any health outcomes. Model B (standing time): autonomous motivation was significantly positively associated with standing time. In turn, standing time was significantly negatively related to CRP, pain and fatigue.ConclusionsAutonomous motivation to reduce sedentary behaviour is associated with sedentary and standing time in RA which may, in turn, hold implications for health outcomes.

Effects of yoga on depressive symptoms, anxiety, sleep quality, and mood in patients with rheumatic diseases: Systematic review and meta-analysis.

To investigate the effects of yoga on depressive symptoms, anxiety, sleep quality, and mood of patients with rheumatic diseases through a systematic literature review with meta-analysis. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and the Cochrane recommendations and risk of bias tool. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Studies were selected using the PICOS (participants, intervention, comparison, outcome, and study) strategy. Searches were carried out until March 2022 and performed in Web of Science, PubMed, SportDiscus, Scopus, Cochrane, and EBSCO databases. Data were extracted to identify the differences between yoga and control and exercise groups and effect sizes. In total, 27 studies were included for qualitative analysis and 18 for meta-analysis. The studies found investigated yoga in patients with osteoarthritis, fibromyalgia, rheumatoid arthritis, and chronic fatigue syndrome. Regarding the risk of bias, the majority of studies showed a high risk or uncertain risk of bias in several criteria. Regarding the meta-analysis, yoga was favored to decrease depressive symptoms (standard mean difference [SMD]:-0.88; 95% confidence interval [CI]:-1.42; -0.34), anxiety (SMD: -0.51; 95% CI=-0.81 to -0.20), and improve sleep qualitySMD =-0.96; 95% CI=-1.36 to -0.56). No differences were found between yoga and other exercise modalities in depression (p < .01). Yoga is effective in improving depression, anxiety, and sleep quality of patients with rheumatic diseases. However, research in this field still needs further studies, because of methodological issues in the studies and a reduced number of studies conducted on each rheumatic disease and on the effects of yoga on each variable.

The Assessment of Fatigue in Rheumatoid Arthritis Patients and Its Impact on Their Quality of Life.

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.

Brief intervention to reduce fatigue impact in patients with inflammatory arthritis: design and outcomes of a single-arm feasibility study

ObjectivesPatients with inflammatory arthritis report that fatigue is challenging to manage. We developed a manualised, one-to-one, cognitive–behavioural intervention, delivered by rheumatology health professionals (RHPs). The Fatigue - Reducing its Effects...

Assessment of Correlation of Fatigue in Patients of Rheumatoid Arthritis using Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire Score with Disease Activity – An Indian Experience

Background: Fatigue affects 40%–80% patients of rheumatoid arthritis (RA), impairing their quality of life. Objectives: The aim of this study was to assess fatigue by means of Bristol RA Fatigue Multidimensional Questionnaire score (BRAF-MDQ) and correlate it with the disease activity of RA patients. One hundred RA patients (as per American College of rheumatology 1987 criteria) having no underlying other chronic disease were evaluated at baseline (M0), 1 month (M1), and 3 months (M3) for fatigue (using BRAF-MDQ) and disease activity Disease Activity Index 28 (DAS-28) and Clinical Disease Activity Index (CDAI). The correlation between fatigue score and disease activity score was evaluated. Results: Fatigue score (BRAF-MDQ) decreased from 19.28 ± 13.846 at baseline to 17.46 ± 13.56 at M1 and 13.27 ± 11.633 at M3, respectively (P < 0.001). Similarly, there was significant decrease in disease activity of DAS-28 from 4.439 ± 1.41 at baseline to 3.715 ± 1.655 at M1 and 3.668 ± 1.46 at M3; while CDAI reduced from 18.82 ± 14.314 at baseline to 14.16 ± 12.611 at M1 and 11.65 ± 11.769 at M3, respectively (P < 0.001). There was a positive significant correlation (P value < 0.001) between BRAF-MDQ score and DAS-28 score (r = 0.503; 0.687 and 0.680) and CDAI score (r = 0.642,0.728 and 0.732) at baseline, 1 month, and 3 months, respectively. Multivariate analysis showed that CDAI (M0) was a significant factor affecting BRAF-MOQ score at follow-up of 3 months (M3) with beta coefficient of 0.872, P < 0.0001. Conclusion: The results of the present study indicate that fatigue quantum is related to disease activity and should be evaluated at the time of diagnosis. BRAF-MDQ is a simple, yet effective patient reported outcome questionnaire which assessed the fatigue quantum. Routine assessment of fatigue through BRAF-MDQ along with assessment of disease activity will be a holistic approach in management of RA.

Longitudinal trajectories of fatigue in early RA: the role of inflammation, perceived disease impact and early treatment response

ObjectiveFatigue is common in rheumatoid arthritis (RA). We aimed to explore its longitudinal course, predictors and association with disease activity in early RA.MethodsData came from the 2-year treat-to-target trial CareRA...

The Sustained Physical Activity Role in Overcoming Fatigue in Patients with Rheumatoid Arthritis

Lack of knowledge about the causes of fatigue often leads to ignoring this symptom in rheumatoid arthritis (RA). The severity of fatigue in patients with RA can be significantly reduced by actively using non-pharmacological treatment strategies. Aim. To evaluate the effectiveness of aerobic exercise (walking) to reduce fatigue in RA patients during long-term follow-up. Material and methods. The study involved 102 patients with RA (women 100%; average age 54.38 ± 11.3 years; disease duration 9.5[5;15] years; DAS28-ESR activity 2.85[2.32;3.06] points; fatigue on the VAS scale ≥50), who completed the stage of sanatorium treatment in full (21 days) and provided data on aerobic physical activity (steps quantity per day) and fatigue scores on the British Rheumatoid Arthritis Fatigue Scale – Numerical Rating Scale (BRAF-NRS V2). RA patients were divided into two groups according to their level of physical activity: group I (n=53) with a sedentary lifestyle (less than 5–6 thousand steps/day) and group II (n=49) with a recommended (mobile) lifestyle (more than 7–8 thousand steps/day). Assessment of RA patients’ adherence to physical activity was carried out 2 months after return from the sanatorium, and the dynamics of BRAF-NRS fatigue indexes were recorded. Results and discussion. Seventy-six people (74.5%) agreed to participate in the final survey: 32 patients from a group I and 44 patients from a group II. Commitment to daily aerobic activity (more than 5,000 steps per day) was maintained by 34% of participants in the group I and 59% in the group II (p=0.033). The majority of respondents (51.3%) decreased the physical activity level and significantly reduced the time for aerobic exercise after returning from the sanatorium, citing a lack of incentives and time. 47% of the group I patients (15/32) felt able to devote more attention to physical activity, but only 25% confirmed a strong belief that they would dedicate at least 30 minutes to aerobic exercise 5 times a week over the next three months. In the group II, 48% of patients (p=0.044) reported maintaining or even increasing the corresponding physical activity level, confirming the effectiveness of individual physical activity programs formed during the sanatorium treatment and then integrated into daily life. Two months after returning from the sanatorium, group II patients showed lower fatigue scores on all BRAF-NRS scales: NRS-severity (p=0.04), NRS-effect (p=0.005), and NRS-overcoming (p=0.034). The analysis of variance revealed a decrease in the level of fatigue in the medium term (up to 2 months) regardless of the level of physical activity of the patients, but in RA patients committed to an active lifestyle and regular aerobic physical activity (group II), the positive changes were most pronounced (p&lt;0.001). Conclusion. The positive effect of aerobic exercise (walking) on reducing fatigue is significantly negated even in the med-term, if patients do not continue to lead an active lifestyle. After completion of the sanatorium stage of treatment (with selection of optimal dose and frequency of physical activity), RA patients should be further encouraged to do daily aerobic exercises and be supported to continue rehabilitation programs in the community in order to achieve a better effect in the long term.

Efficacy and Acceptability of Intermittent Aerobic Exercise on Polysomnography-Measured Sleep in People With Rheumatoid Arthritis With Self-Reported Sleep Disturbance: A Randomized Controlled Trial.

ObjectiveThis study's objective was to investigate the efficacy and acceptability of intermittent aerobic exercise training on sleep parameters, fatigue, pain, depressive symptoms, physical function, and cardiorespiratory fitness in people with rheumatoid arthritis (RA).MethodsThirty‐eight people with RA were assigned to intermittent aerobic exercise training (three sessions/week for 6 weeks; intervention group, n = 17) or usual care (control group, n = 21). The primary outcome was a change in polysomnography‐assessed sleep efficiency from baseline to the end of the intervention. Secondary outcomes were sleep quality (Pittsburgh Sleep Quality Index), fatigue (Bristol Rheumatoid Arthritis Fatigue Multi‐Dimensional Questionnaire), depression (Center for Epidemiological Studies‐Depression), and cardiorespiratory fitness (watt max test).ResultsNo between‐group differences were found in changes in polysomnography‐assessed sleep efficiency (0.04; 95% confidence interval [CI]: −0.02 to 0.09, P = 0.17). In the intervention group, sleep efficiency was improved significantly from baseline (0.84; 95% CI: 0.80‐0.88) compared with the end of the intervention (6 weeks) (0.88; 95% CI: 0.85‐0.92); however, there was no significant difference in the control group. Fatigue and depression measures were significantly lower in the intervention group than in the control group. Between‐group differences were overall fatigue (−16.1; 95% CI: −25.1 to −7.0, P = 0.001), physical fatigue (−5.0; 95% CI: −7.3 to −2.7, P = 0.0001), cognitive fatigue (−2.4; 95% CI: −4.2 to 0.6, P = 0.009), living with fatigue (−2.5; 95% CI: −4.5 to −0.5, P = 0.01), and depressive symptoms (−6.8; 95% CI: −12.4 to −1.1, P = 0.02).ConclusionThe intervention yielded no significantly better sleep efficiency compared with usual care. However, aspects of fatigue, including physical and cognitive fatigue, and depressive symptoms were significantly improved in the intervention group.

Fatigue is associated with disease activity in some, but not all, patients living with rheumatoid arthritis: disentangling \u201cbetween-person\u201d and \u201cwithin-person\u201d associations

BackgroundPrevious research has shown an unclear and inconsistent association between fatigue and disease activity in patients with rheumatoid arthritis (RA). The aim of this study was to explore differences in “between-person” and “within-person” associations between disease activity parameters and fatigue severity in patients with established RA.MethodsBaseline and 3-monthly follow-up data up to one-year were used from 531 patients with established RA randomized to stopping (versus continuing) tumor necrosis factor inhibitor treatment enrolled in a large pragmatic trial. Between- and within-patient associations between different indicators of disease activity (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], swollen and tender joint count [ SJC and TJC], visual analog scale general health [VAS-GH]) and patient-reported fatigue severity (Bristol RA Fatigue Numerical Rating Scale) were disaggregated and estimated using person-mean centering in combination with repeated measures linear mixed modelling.ResultsOverall, different indices of disease activity were weakly to moderately associated with fatigue severity over time (β’s from 0.121 for SJC to 0.352 for VAS-GH, all p’s < 0.0001). Objective markers of inflammation (CRP, ESR and SJC) were associated weakly with fatigue within patients over time (β’s: 0.104–0.142, p’s < 0.0001), but not between patients. The subjective TJC and VAS-GH were significantly associated with fatigue both within and between patients, but with substantially stronger associations at the between-patient level (β’s: 0.217–0.515, p’s < 0.0001). Within-person associations varied widely for individual patients for all components of disease activity.ConclusionAssociations between fatigue and disease activity vary largely for different patients and the pattern of between-person versus within-person associations appears different for objective versus subjective components of disease activity. The current findings explain the inconsistent results of previous research, illustrates the relevance of statistically distinguishing between different types of association in research on the relation between disease activity and fatigue and additionally suggest a need for a more personalized approach to fatigue in RA patients.Trial registration Netherlands trial register, Number NTR3112.

Aerobic exercise and fatigue indices in rheumatoid arthritis patients in the health resort care setting

To evaluate the effectiveness of aerobic exercise (walking) to reduce fatigue in RA patients in the health resort setting. The study involved 102 female patients with RA (age 54.38±11.3 years, body mass index 20-29 kg/m2, DAS28-ESR ≤3.2, with severe fatigue of VAS ≥50) who received 21 days of health resort treatment. The health-improving and therapeutic complex includes dosed physical activity, aerobic exercises (walking). Visual analog scale (VAS0-100) and Bristol Rheumatoid Arthritis Fatigue Scale-Numerical Rating Scale (BRAF-NRS V2) were used to assess fatigue, and the 50-meter walking test was used to evaluate the functional status of patients. A correlation between walking duration and the number of steps at a distance of 50 m (p<0.001) as well as between these indices and fatigue (p<0.001) was shown. A positive effect of a standard three-week medical rehabilitation program for patients with RA on fatigue NRS severity (p=0.003) and NRS effect (p=0.037), as well as on patients' functional status (reduced time spent on the 50-meter test, p=0.01) was demonstrated. When comparing groups of RA patients with low (group 1, <5000-6000 steps per day) and optimal (group 2, ≥7000-8000 steps per day) aerobic exercise, positive results were noted in the short term (at 3 weeks) (p<0.001). Aerobic exercise is a promising intervention for treating fatigue in rheumatoid arthritis patients. Medical rehabilitation in a resort setting is the best starting point to encourage performing regular physical activity, as well as the best way to develop exercise programs tailored to rheumatoid arthritis patients.

Measuring Fatigue in Rheumatoid Arthritis' Patients with the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ) and the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS): A Cross-Sectional Study

Fatigue is a common problem in Rheumatoid Arthritis (RA) and many factors are responsible for its etiology. The aim of this cross-sectional study was to investigate the current status of fatigue and to evaluate the factors related to fatigue by using the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ) and Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS) developed specifically for RA in patients with RA. 64 patients with RA were included in the study. The Disease Activity Score (DAS28-CRP) of 28 joints was used to assess disease activity, and the Health Assessment Questionnaire (HAQ) was used to assess functional status. In addition, BRAF-MDQ and BRAF-NRS scales were used to assess fatigue, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to screen for psychiatric symptoms. All correlations between BRAF-MDQ, BRAF-NRS scales and DAS28-CRP, BAI, BDI were statistically significant (p<0.05, each other). BRAF-MDQ, BRAF-NRS scales were found to be unrelated to age, seropositivity, and drugs used. Considering the effect of disease activity, HAQ, anxiety and depressive symptoms on the BRAF-MDQ total, it was associated only with BAI (p<0.001, 95% CI 0.593-1.768). In this study, we showed the contribution of anxiety and depressive symptoms to fatigue as well as disease activity. We consider that effective interventions focusing on these symptoms can improve fatigue and reduce the burden of chronic disease.