AB1455-HPR The experience of living with fatigue among people with rheumatoid arthritis – a qualitative meta-synthesis

Abstract

BackgroundPeople with Rheumatoid Arthritis (RA) experience fatigue as the most significant symptom of their illness. Despite a substantial body of knowledge about fatigue, there is a need for an overall comprehensive understanding of the experience of living with fatigue among people with RAObjectivesTo identify, appraise and synthesise qualitative studies on experiences of living with fatigue in people with RAMethodsWe conducted a qualitative meta-synthesis, inspired by Sandelowski and Barroso1. This included a systematic literature search conducted in February 2017, for studies published in the past 15 years, in the databases PubMed, Cinahl, Embase, SveMed, PsychInfo and Web of Science. To be included the studies had to include findings regarding the experience of adults with RA living with fatigue. The international Critical Appraisal Skills programme was used to assess the quality. The analysis and synthesis were inspired by Malterud’s systematic text condensation2 ResultsEight qualitative articles were included. The synthesis resulted in an overall theme ‘fatigue: the vicious cycle of an unpredictable symptom’. In addition, the analysis derived five subthemes, ‘being alone with fatigue‘, ‘necessary prioritising in everyday life’, ‘when time gets a different meaning’, ‘language as a tool for increased understanding’ and ‘strategies to manage fatigue’. Fatigue affects all areas of everyday life for people with RA. They strive to plan and prioritise, pace, relax and rest. In addition, they try to make use of a variety of words and language to help others understand that the RA-related fatigue they experience is not ‘normal’ fatigue. People with RA-related fatigue experience feeling alone with their symptom, but they develop their own strategies to manage fatigue in their everyday lifeConclusionsThe unpredictability of RA-related fatigue is dominant, pervasive and is experienced as a vicious cycle, which can be described in relation to its physical, cognitive, emotional, social and behavioural impact. Acknowledgement and support from health professionals can make a difference to people with RA-related fatigueReferences[1] Sandelowski, M & Barosso, J. 2007: Handbook for synthesizing qualitative research. New York, Springer.[2] Malterud, K. 2012: Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health, 40, 795–805Disclosure of InterestNone declared

Management of Fatigue in Rheumatoid Arthritis

“…Pain can lead to poor sleep, depressed mood and fatigue, all of which are connected. 6 18 28 31 32 Also, more than 10% of patients with RA have fibromyalgia 33 and 10% report depression in ERA. 26 Behavioural and psychological factors are more likely explanations of fatigue in RA and not disease activity.…”

Does the Course of Disease Influence the Development of Fatigue in Rheumatoid Arthritis Patients?

“…Like other authors, we did not find a significant effect of inflammation on the development of fatigue in RA patients. Similarly, also Van Hoogmoed et al (2010), andRepping-Wuts et al (2007) reported that pain, disability, depression, and low self-efficacy were associated with greater fatigue, but inflammatory indices were not correlated with fatigue severity. The fatigue in RA patients may be only partially related to disease activity, which may have accounted for poor agreement with respect to a fatigue domain within a flare questionnaire in RA (Pope, 2020).…”

“…Fatigue is often present even if RA activity is low. This can be due to common chronic pain in RA, which can lead to poor sleep, depressed mood, and fatigue (Katz, 2017;Bingham et al, 2019;Junghaenel et al, 2019;Primdahl et al, 2019;Silva et al, 2019). Also, 10% of RA patients report depression in early RA (Holdren et al, 2019).…”