Fatigue in patients with early rheumatoid arthritis undergoing treat-to-target therapy: predictors and response to treatment

Holten, Karen; Sundlisater, Nina Paulshus; Lillegraven, Siri; Sexton, Joseph; Nordberg, L.B.; Moholt, Ellen; Hammer, Hilde Berner; Uhlig, Till; Kvien, Tore K; Haavardsholm, Espen A.; Aga, Anna‐Birgitte

doi:10.1136/annrheumdis-2021-220750

Cited by 13 publications

(7 citation statements)

References 49 publications

(58 reference statements)

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“…Strikingly though, a higher baseline swollen joint count predicted lower long-term fatigue. These findings add to the recent results of the ARCTIC trial (Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen), in which more swollen joints and higher ultrasound inflammation at baseline were associated with less fatigue at year 2, while a predisposing effect was seen for PGA 50. Together, the results of both trials could indicate that RA-related fatigue is a composite of inflammation-driven fatigue and fatigue with a stronger psychosocial background.…”

Section: Discussionsupporting

confidence: 57%

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

et al. 2022

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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 (Care in early RA) and its 3-year extension. Fatigue was measured on Visual Analogue Scale, Multidimensional Fatigue Inventory and Short Form-36 (SF-36) vitality. Longitudinal fatigue trajectories were identified with multivariate growth mixture modelling. Early predictors of fatigue and the association of fatigue and its trajectories with disease activity and clinical/psychosocial outcomes were studied with linear mixed models and multilevel mediation.ResultsWe included 356 and 244 patients in the 2-year and 5-year analyses, respectively. Four fatigue trajectories were identified: rapid, gradual, transient improvement and early deterioration, including 10%, 14%, 56% and 20% of patients. Worse pain, mental health and emotional functioning were seen in the early deterioration group. Higher pain, patient global assessment (PGA) and disability (Health Assessment Questionnaire), lower SF-36 mental components, and fewer swollen joints at baseline predicted higher fatigue over 5 years, while early disease remission strongly improved 5-year fatigue. The association between Simple Disease Activity Index and fatigue was mediated by PGA, pain, mental health and sleep quality.ConclusionsAlthough fatigue evolves dynamically over time in early RA, most patients do not achieve sustained fatigue improvement despite intensive disease-modifying antirheumatic drug therapy. Higher 5-year fatigue levels were seen in patients with more perceived disease impact and fewer swollen joints at baseline. Conversely, early inflammatory disease control strongly improved long-term fatigue, pointing towards an early window of opportunity to prevent persistent fatigue.

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Section: Discussionsupporting

confidence: 57%

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

et al. 2022

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“…Singh et al (2014), reported that fatigue scores are significantly and positively associated with the DAS28, CDIA, TJC, SJC, PGA, and EGA [ 73 ]. Holten et al (2021) found that a high number of RA patients suffer from fatigue (69%) and that this high prevalence decreased during treatment in association with PGA and SJC [ 74 ]. Many people with RA (up to 43%) show a somatization comorbidity phenotype (the PS symptoms measured in our study) and the response to treatment may be reduced in this group of patients [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

Pathway Phenotypes Underpinning Depression, Anxiety, and Chronic Fatigue Symptoms Due to Acute Rheumatoid Arthritis: A Precision Nomothetic Psychiatry Analysis

Smesam

Qazmooz

Khayoon

et al. 2022

JPM

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Rheumatoid arthritis (RA) is a chronic inflammatory and autoimmune disorder which affects the joints in the wrists, fingers, and knees. RA is often associated with depressive and anxiety symptoms as well as chronic fatigue syndrome (CFS)-like symptoms. This paper examines the association between depressive symptoms (measured with the Beck Depression Inventory, BDI), anxiety (Hamilton Anxiety Rating Scale, HAMA), CFS-like (Fibro-fatigue Scale) symptoms and immune–inflammatory, autoimmune, and endogenous opioid system (EOS) markers, and lactosylcer-amide (CD17) in RA. The serum biomarkers were assayed in 118 RA and 50 healthy controls. Results were analyzed using the new precision nomothetic psychiatry approach. We found significant correlations between the BDI, FF, and HAMA scores and severity of RA, as assessed with the DAS28-4, clinical and disease activity indices, the number of tender and swollen joints, and patient and evaluator global assessment scores. Partial least squares analysis showed that 69.7% of the variance in this common core underpinning psychopathology and RA symptoms was explained by immune–inflammatory pathways, rheumatoid factor, anti-citrullinated protein antibodies, CD17, and mu-opioid receptor levels. We constructed a new endophenotype class comprising patients with very high immune–inflammatory markers, CD17, RA, affective and CF-like symptoms, and tobacco use disorder. We extracted a reliable and replicable latent vector (pathway phenotype) from immune data, psychopathology, and RA-severity scales. Depression, anxiety, and CFS-like symptoms due to RA are manifestations of the phenome of RA and are mediated by the effects of the same immune–inflammatory, autoimmune, and other pathways that underpin the pathophysiology of RA.

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“…Fatigue is one of the symptoms of rheumatoid arthritis. It is noted in more than 70 percent of patients [ 6 ]. Although it is a subjective symptom that also depends on many factors unrelated to the disease, it has a significant impact on the patient’s well-being and functioning, and is associated.…”

Section: Introductionmentioning

confidence: 99%

Work Ability and Quality of Life in Patients with Rheumatoid Arthritis

Tański¹,

Dudek

Adamowski

2022

IJERPH

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Background. Reduced work participation has social implications (sickness absence, economic impact) and consequences for the individual patient (impoverishment, depression, limited social interaction). As patients with rheumatoid arthritis (RA) are more likely to experience job loss and/or at-work productivity loss and are at higher risk of sickness absence and, ultimately, permanent work productivity, consideration should be given to the association between work productivity or partial work capacity and quality of life (QoL). The aim of the study was to assess the relationship between QoL and the risk of work disability, as well as to estimate the risk of a future event and identify factors affecting the risk of work disability in RA inpatients. Material and methods. This cross-sectional study included 142 inpatients (65 male) aged 47 (38–58) years, who met the established criteria for a diagnosis of RA and treatment with biologic drugs. Only standardized tools were used to examine the patients: WHOQOL-BREF, MFIS and AS-WIS. Results. An analysis of the QoL scores on the WHOQOL-BREF demonstrated that the patients’ QoL was lowest in the physical health domain and highest in the social relationships domain. The median WHOQOL-BREF total score in the group studied was 62.8, which indicates a moderate QoL. The median total score for the risk of work disability (AS-WIS) was 10.1, which indicates that the level of risk of work disability in the patients was higher than the average level reported in the literature. A multivariate analysis showed that the following were significant independent determinants of a higher risk of work disability: low QoL in the WHOQOL-BREF physical health (β = 0.961; p = 0.029) and psychological health (β = 1.752; p = 0.002) domains, being in a relationship (β = 0.043; p = 0.005) and the use of opioids for pain (β = 3.054; p = 0.012). Conclusions. RA patients presented with moderate QoL, moderate fatigue (MFIS) and high risk of disability (AS-WIS). There is an association between a high risk of work disability and lower QoL, especially in the physical and psychological health domains. The lower the QoL in those domains, the higher the risk of work disability. The identification of factors increasing the risk of work disability will help in planning tailored interventions to improve at-work productivity loss and thus prevent work disability.

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Fatigue in patients with early rheumatoid arthritis undergoing treat-to-target therapy: predictors and response to treatment

Cited by 13 publications

References 49 publications

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

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

Pathway Phenotypes Underpinning Depression, Anxiety, and Chronic Fatigue Symptoms Due to Acute Rheumatoid Arthritis: A Precision Nomothetic Psychiatry Analysis

Work Ability and Quality of Life in Patients with Rheumatoid Arthritis

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