Pos0485 fatigue Using Patient-Reported Outcomes Measurement Information System (Promis) and Its Relationship With Disease Activity in Rheumatoid Arthritis: A Prospective Study From India

Abstract

BackgroundFatigue in rheumatoid arthritis (RA) is common, overwhelming and plays a key role in patients’ perception of the disease and strongly influences global assessment [1]. While fatigue in RA has no internationally accepted definition, it is multidimensional and has an inconsistent association with disease activity in different populations with very few studies from India [2, 3].ObjectivesTo determine the relationship between fatigue as measured by Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue raw score with disease activity in patients with RA. To determine the predictors of fatigue in patients with RA.MethodsA longitudinal study was conducted from January 2021 to December 2022 after Ethics Committee approval in patients with RA enrolled at our rheumatology clinic providing care to >450 patients with RA, in a tertiary care hospital. Fatigue (PROMIS Fatigue-short form 7a), patient assessment of global disease activity (PtGA), Disease Activity Score (DAS28), and Clinical Disease Activity Index (CDAI) were measured. Serum samples for interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) were collected and stored at -800C. Relationship of fatigue was examined with age, hemoglobin, serum vitamin D3, TNF-α, and IL-6 using Spearman correlation coefficient. A Receiver Operating Characteristic (ROC) curve was constructed to determine the optimal PROMIS cut-off for defining PtGA >2. Binary logistic regression analysis was used to assess predictors fatigue.ResultsOne hundred and fifty-four patients were enrolled, of whom 133 (86.3%) were females, 103 were reassessed at 6 months (85.4% females). All were on conventional disease-modifying antirheumatic drugs. Patients in remission using DAS28 were 9.7% (n = 15) and 52.4% (n = 54) and remission/low disease activity (LDA) based on CDAI <10 were 13.6% (n = 21) and 68.9% (n = 71) at enrolment and 6 months respectively. There was a significant reduction in median PROMIS at 6 months from 19(11) to 16(7) (p<0.0001). PROMIS was significantly lower in those with remission/LDA based on CDAI (p<0.0001) and DAS28 remission at enrolment and 6 months (p = 0.012 and 0.015 respectively). PROMIS >11 had 93.8% sensitivity and 78.6% specificity to predict PtGA >2 (AUC 0.92, 95% CI 0.81 - 1.00, P <0.0001) (Figure 1). PROMIS >11 was present in 89% at enrolment and 82.5% at 6 months. Age, hemoglobin, serum vitamin D3, TNF-α, and IL-6 had no correlation with fatigue. DAS28, CDAI, sleep (Pittsburgh Sleep Quality Index - PSQI), and depression (Patient Health Questionnaire - PHQ-9) were significant predictors of PROMIS >11 (Table 1).ConclusionFatigue is a significant problem in RA. A PROMIS score of 11 may be an acceptable cut-off for our population. Though fatigue improved with the treat-to-target approach, further studies are needed to determine if it is meaningful for patients. Along with disease activity, addressing sleep and depression is important in managing fatigue.Table 1.Predictors of fatigue (n= 154)PredictorsOdds ratio (95% CI)P valuePSQI2.31(1.45 - 3.69)<0.0001PHQ-94.38 (2.16 - 8.89)<0.0001CDAI1.26 (1.13 - 1.39)<0.0001DAS282.87 (1.72 - 4.79)<0.0001References[1]Beaumont JL, Davis ES, Curtis JR, Cella D, Yun H. Meaningful Change Thresholds for Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue and Pain Interference Scores in Patients With Rheumatoid Arthritis. J Rheumatol. 2021 Aug 1;48(8):1239–42.[2]Singh H, Arya S, Talapatra P, Lather K, Mathur R, Singhania A, et al. Assessment of fatigue in rheumatoid arthritis (by Functional Assessment of Chronic Illness Therapy-Fatigue score) and its relation to disease activity and anemia. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis. 2014 Mar;20(2):87–90.[3]Versteeg GA, ten Klooster PM, van de Laar MAFJ. Fatigue is associated with disease activity in some, but not all, patients living with rheumatoid arthritis: disentangling “between-person” and “within-person” associations. BMC Rheumatol. 2022 Jan 7;6:3.Disclosure of InterestsNone Declared.