Psychological correlates of fatigue in rheumatoid arthritis: A systematic review

Abstract

Fatigue is common and debilitating in Rheumatoid Arthritis (RA). A focus on the psychological variables associated with fatigue may help to identify targets for intervention which could enhance the treatment of fatigue in RA. The purpose of this review was to systematically identify psychological variables related to fatigue in RA, with the overall aim of suggesting evidence-based targets for fatigue intervention in RA. Twenty-nine studies met inclusion criteria and were included in the narrative synthesis. A wide range of psychological variables were addressed, spanning 6 categories: affect and common mental disorders; RArelated cognitions; non-RA-related cognitions; personality traits; stress and coping; and social support/interpersonal relationships. The most consistent relationship was found between mood and fatigue, with low mood frequently associated with increased fatigue. Some evidence also highlighted the relationship between RA-related cognitions (such as RA selfefficacy) and fatigue, and non-RA-cognitions (such as goal ownership) and fatigue. Limited evidence was found to support the relationship between stress and coping or personality traits and fatigue, although mixed evidence was found for the relationship between social support and fatigue. The results of this review suggest the interventions for fatigue in RA may benefit from a focus on mental health, and disease-related cognitions.

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.…”

“…Social factors include both the availability and quality of social support by significant others [34]. Good quality social support has shown to protect against psychological distress and increase in physical symptoms [2,8,23].…”

“…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.…”

The inflammatory perspective of depression in the context of chronic medical conditions

“…When considering the prevalence of depression using the self-assessment questionnaire Patient Health Questionnaire, version 9, it was 38.8% (95% CI 34.0%, 43.0%). Although the prevalence of depression disorder is higher in RA than in the general population, it is similar to other chronic and disability diseases [108][109][110][111]. Besides possible common endogenous ethiopathogenic pathways, potential causes for the development of depression in RA patients include more advanced age, severe forms of disease, pain, work disability.…”

Neuropsychiatric manifestations in rheumatoid arthritis

“…Prevalence is up to 40% when considering patients with mild and moderate symptoms [23][24][25][26]. Although the prevalence of depression is higher in RA than in the normal population (RR 2.06-95% IC, 1.73-2.44, p b 0.001), it is similar to other chronic and disability diseases [26][27][28][29]. Potential causes for depression in RA include more advanced age, severe forms of disease, pain, work disability [25,28,30].…”