Multimorbidity and Fatigue in Rheumatoid Arthritis: A Cross-Sectional Study of a Population-Based Cohort

Abstract

Introduction: The objective was to evaluate the relationships between multimorbidity and overall fatigue as well as fatigue subdomains in patients with rheumatoid arthritis (RA). Methods: A cross-sectional study of a population-based cohort of patients with RA was performed. Fatigue was assessed using the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ). Patients' medical records were reviewed for 25 chronic comorbidities prior to the BRAF-MDQ. Linear and logistic regression models were used to estimate the differences in BRAF-MDQ total and subdomain (physical, living, cognitive, and emotional) scores associated with multimorbidity, adjusting for age, sex, disease duration, obesity, smoking, C-reactive protein, and RA autoantibodies. Higher BRAF-MDQ scores indicate greater fatigue severity. Results: The cohort included 192 patients, median age 62 years, and median RA duration 13 years. Multimorbidity was common with 93 (48%) having C 2 comorbidities, and 27 (14%) having C 4 comorbidities. The median BRAF-MDQ total score was 9 (interquartile range 3-18), with higher scores indicating greater fatigue. Patients with C 4 comorbidities had higher total BRAF-MDQ scores (median 16.5, interquartile range: 6.8-24.8) than patients with \ 4 comorbidities (7.5, 2.8-16.0; p = 0.014). Each additional comorbidity was associated with a 2.33 (95% confidence interval [CI] 1.10-3.56) unit increase in total BRAF-MDQ score (p \ 0.001), and the presence of C 4 comorbidities was associated with a 9.33 (95% CI 3.92-14.7) unit increase in total BRAF-MDQ score. Multimorbidity was significantly associated with all four fatigue subdomains in adjusted models. Conclusions: Multimorbidity is associated with increased fatigue in patients with RA. The findings suggest that interventions targeting multimorbidity could help alleviate treatmentrefractory fatigue in patients with RA and other rheumatic diseases.

Fatigue in rheumatoid arthritis patients: The status, independent risk factors, and consistency of multiple scales

“…Previous studies have explored fatigue conditions and some fatigue-related risk factors (including disease-related, personal, social, and seasonal factors) in RA patients. [9][10][11][12][13][14] For example, one recent study shows that fatigue occurrence is 62%; meanwhile, education level and disease activity are related to fatigue score in RA patients. 9 Simultaneously, another study indicates that some factors are associated with fatigue in RA patients, such as age, disease duration, functional disability, quality of life, and so on.…”

“…12 Moreover, some previous studies also exhibit that sleep disorders and comorbidities (such as hypertension, hypothyroidism, and deficiency anemias) are linked with fatigue in RA patients. 13,14 However, the gap of the above studies is that the vast majority of these studies use a single scale for fatigue evaluation in RA patients. More importantly, few studies verify the consistency among different scales for fatigue evaluation in RA patients.…”

“…Previous studies have explored fatigue conditions and some fatigue‐related risk factors (including disease‐related, personal, social, and seasonal factors) in RA patients 9–14 . For example, one recent study shows that fatigue occurrence is 62%; meanwhile, education level and disease activity are related to fatigue score in RA patients 9 .…”

“…One study illustrates that RA patients experience greater fatigue during the winter 12 . Moreover, some previous studies also exhibit that sleep disorders and comorbidities (such as hypertension, hypothyroidism, and deficiency anemias) are linked with fatigue in RA patients 13,14 . However, the gap of the above studies is that the vast majority of these studies use a single scale for fatigue evaluation in RA patients.…”

Recurring Fatigue After Biologic Administration: Patient-Reported Data from the Dutch Biologic Monitor

“…It is well known that various factors may contribute to experiencing fatigue in patients with IMIDs, such as the disease itself and behavioural and psychological factors [3][4][5][6][7]. Multimorbidity, pain, depression and disability have been associated with fatigue in rheumatic diseases [3,4,[8][9][10]. Anti-tumour necrosis factor (TNF) treatment as well as other biologic treatment have demonstrated improvements in fatigue in patients with rheumatoid arthritis and other IMIDs [11][12][13][14][15][16][17].…”