Role of Sleep Disturbance, Depression, Obesity, and Physical Inactivity in Fatigue in Rheumatoid Arthritis

Abstract

Background/Purpose: Fatigue is a major concern for individuals with rheumatoid arthritis (RA). However, in order to treat fatigue adequately, its sources need to be identified. Methods: Data were collected during a single home visit (n=158). All participants had physician-diagnosed RA. Assessments were made of self-reported sleep quality, depression, physical activity, RA disease activity, muscle strength, functional limitations, and body composition. Information was collected on demographics, medications, and smoking. The Fatigue Severity Index (FSI; average fatigue over the past 7 days) was used as the primary outcome. Analyses were first conducted to evaluate bivariate relationships with fatigue. Correlations among risk factors were examined. Multivariate analyses identified independent predictors of fatigue. Results: Mean age (±SD) was 59 (±11), mean disease duration was 21 (±13) years, and 85% were female. Mean FSI rating was 3.8 (±2.0; range 0–10). In multivariate analyses, self-reported disease activity, poor sleep, depression, and obesity were independently associated with fatigue. Physical inactivity was correlated with poor sleep, depression, and obesity. Mediation analyses indicated that physical activity had an indirect association with fatigue, mediated by poor sleep, depression, and obesity. Conclusion: This cross-sectional study suggests that fatigue may not be solely a result of RA disease activity, but may result from a constellation of factors, including RA disease activity or pain, but also inactivity, depression, obesity, and poor sleep. Results suggest new avenues for interventions to improve fatigue in individuals with RA, such as increasing physical activity or addressing depression or obesity.

Association of Improvement in Pain With Therapeutic Response as Determined by Individual Improvement Criteria in Patients With Rheumatoid Arthritis

“…Our study suggests that fatigue is not well represented in physician‐based evaluations, such as the DAS28 or MDGA, but is an important component of a patient's self‐perceived well‐being as indicated by its correlation with PGA scores. A recent study found that the fatigue experienced by patients with RA is associated with RA disease activity, poor sleep quality, depression, and obesity 25; accordingly, improvements in disease activity alone may not be sufficient to decrease a patient's overall fatigue. Of the 3 PROs we evaluated, fatigue was the least likely to improve.…”

Frailty and reduced physical function go hand in hand in adults with rheumatoid arthritis: a US observational cohort study

“…RA predisposes individuals to many of the factors that comprise the Fried definition of frailty, including sarcopenia, fatigue, and low activity [7–11]. However, the prevalence of frailty among individuals with RA has not been examined.…”

Physical activity interventions for fatigue in rheumatoid arthritis: a systematic review

“…Physical inactivity has been significantly associated with RA fatigue, and its effects appear to be mediated by a range of non-RA-specific variables that are important predictors of fatigue, for example, poor sleep quality, depressive symptoms and obesity 13 .…”

“…Regular participation in PA might reduce the impact of RA fatigue by moderating these associated risk factors 13 .…”

“…work, health, support networks) might influence a person's fatigue experience 12 . Recent multivariate analyses demonstrated that higher disease activity, poor sleep, depression and obesity are independent predictors of RA fatigue 13 .…”