Fatigue and Factors Related to Fatigue in Rheumatoid Arthritis: A Systematic Review

Abstract

Objective. 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. Methods. 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. Results. 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 illnessrelated 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. Conclusion. 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.

Predictors of Fatigue in Rheumatoid Arthritis Patients in Remission or in a Low Disease Activity State

“…Being physically inactive may also increase fatigue. These findings are in line with a recent systematic review documenting that pain and physical function, in addition to depression, were the variables most strongly related to fatigue in RA patients (5). Previous studies have shown divergent results regarding the relationships between fatigue and disease activity measures (6,9).…”

“…In our study, lower ESR at baseline was a statistically significant predictor of a higher fatigue level at 6 months. This negative relationship between ESR and fatigue has also been found in previous studies, but results are divergent and this needs further investigation (5,10,11).…”

“…Nikolaus et al addressed the necessity of conducting prospective longitudinal studies with representative samples and multivariate analysis in the examination of fatigue, which was used in this study (5). The demographics were typical of patients with RA in remission or low disease activity, and similar results might be found in other studies.…”

The role of psychological factors in inflammatory rheumatic diseases: From burden to tailored treatment

“…Minor or daily stressors (for example, negative interpersonal events) are associated with more fatigue and pain, elevated immune activity, and disease exacerbations [2, 11,15,23,27,34,35]. However, less clear are the results regarding major stressors, such as the death of a loved one.…”

“…Good quality social support has shown to protect against psychological distress and increase in physical symptoms [2,8,23]. It has, however, also been shown that problematic, unwanted, or stressful relationships lead to increased distress, higher symptom levels, and increased inflammatory activity in rheumatic diseases, thus indicating that the quality of social support is particularly important [2, 11,23,34]. Regarding the social aspects within the healthcare context, a satisfactory relationship between the care provider and patient, which, for example, consists of mutual trust and active participation of the patient in treatment and decision making, has been shown to be an important predictor of high patient engagement and well-being in inflammatory rheumatic diseases.…”