A biopsychosocial network model of fatigue in rheumatoid arthritis: a systematic review

Abstract

Fatigue in RA is prevalent, intrusive and disabling. We propose a network model of fatigue encompassing multiple and mutually interacting biological, psychological and social factors. Guided by this model, we reviewed the literature to offer a comprehensive overview of factors that have been associated with fatigue in RA. Six categories of variables were found: physical functioning, psychological functioning, medical status, comorbidities and symptoms, biographical variables and miscellaneous variables. We then systematically reviewed associations between fatigue and factors commonly addressed by rheumatology health professionals. Correlations of fatigue with physical disability, poor mental well-being, pain, sleep disturbance and depression and anxiety were ∼0.50. Mostly these correlations remained significant in multivariate analyses, suggesting partly independent influences on fatigue and differences between individuals. These findings indicate the importance of research into individual-specific networks of biopsychosocial factors that maintain fatigue and tailored interventions that target the influencing factors most relevant to that person.

Support for a non-therapist assisted, Internet-based cognitive-behavioral therapy (iCBT) intervention for mental health in rheumatoid arthritis patients

“…Approximately 20–40% of RA patients meet criteria for major depressive disorder ( Margaretten et al, 2011 ; Matcham et al, 2013 ), 25–70% of RA patients present with an anxiety disorder ( El-Miedany and El Rasheed, 2002 ; Matcham et al, 2018 ), and the vast majority exhibit symptoms of both ( Covic et al, 2012 ). Research has consistently supported adverse outcomes in terms of both disease severity ( Kojima et al, 2009 ) and activity ( Edwards et al, 2011 ) for co-occurring depression and RA, and more recent literature confirms comorbid anxiety is also associated with worsened pain ( Jamshidi et al, 2016 ), fatigue ( Geenen and Dures, 2019 ), functional impairment ( Soósová et al, 2017 ), and quality of life ( Beşirli et al, 2020 ). Yet while interest rises in the use of pharmacotherapy in RA ( Vallerand et al, 2019 ), investment in psychological approaches remains limited ( Fiest et al, 2017 ).…”

The benefits of Qigong exercise for symptoms of fatigue

“…In fact, there appears to be a consistent overlap between fatigue, pain, depression, and anxiety. [ 24 , 25 ] Our focus is not on making the presence of fatigue sufficiently distinctive from other symptoms, rather, preventing it from a vicious circle of mutual influence.…”

Fatigue in inflammatory arthritis

“…The concept of complex factors influencing fatigue is supported by a recent systematic review in which the authors proposed a network model, encompassing multiple and mutually interacting biological, psychological and social factors. 37 Findings from the systematic review indicated correlations of fatigue with physical disability, poor mental well-being, pain, sleep disturbance, depression and anxiety. For the most part, these correlations remained significant in multivariate analyses, suggesting partly independent influences on fatigue and differences between individuals.…”

“…The results are equivocal, although there is growing consensus that psychosocial variables are influential. 37 In a study examining the physical and psychosocial correlates of fatigue in RA, the authors found that those with severe fatigue scored worse on all the psychosocial items that were measured, compared to those without severe fatigue. This included pain severity, role functioning, depressive mood, selfefficacy, worry, helplessness and non-restorative sleep.…”

“…This is important because even though the mechanisms are not fully understood, there is evidence that the associations of fatigue with factors that are amenable to behaviour change are moderate to high. 37…”