Trajectories of Fatigue in Inflammatory Bowel Disease

Abstract

Background Fatigue is one of the most frequently reported symptoms by patients with inflammatory bowel disease (IBD), both during active disease phases as well as during clinical remission. This study addressed whether different trajectories of fatigue over time can be identified among patients with IBD. Subsequently, we compared the demographic and clinical characteristics between trajectories. Methods The current study included 849 patients with IBD diagnosed with either Crohn disease (CD; n = 511) or ulcerative colitis (UC; n = 338) who visited the University Medical Center in Groningen (the Netherlands) at least 3 times during a 9-year follow-up. We conducted latent class growth analyses to identify distinct trajectories. Results In all patients with IBD (and in the subgroup with CD), we found 5 trajectories for fatigue. In the UC subgroup, we found 4 fatigue trajectories. One trajectory present in both patients with CD (11.45%) and patients with UC (4.75%) was characterized by chronic elevated levels of fatigue across time. Women and parents were more prevalent in trajectories with higher fatigue severity. We also found significant associations among the fatigue trajectories with disease activity and psychological well-being. Conclusions The results clearly showed the existence of distinct fatigue paths over time in patients with IBD. Those reporting more chronic elevated levels of fatigue also reported greater disease activity and reduced well-being. Therefore, reducing disease activity may be important for the treatment of fatigue. In addition, given the significant association with well-being, it is possible that reducing fatigue may improve self-reported well-being.

Trajectories of health‐related quality of life and fatigue during vedolizumab therapy in inflammatory bowel disease

“…Fatigue had relatively high impact on perceived "Function" and "Well-being," which is congruent with QoL and fatigue being strong determinants for work productivity loss in IBD. [7][8][9]30 There was low correlations between variables related to disease activity and fatigue at baseline as well as during VDZ therapy. 4,6,8,30 Concordantly, we have previously proposed that fatigue may represent a systemic extraintestinal disease manifestation that is largely independent of disease activity, chronicity, or nutritional deficiencies.…”

“…[7][8][9]30 There was low correlations between variables related to disease activity and fatigue at baseline as well as during VDZ therapy. 4,6,8,30 Concordantly, we have previously proposed that fatigue may represent a systemic extraintestinal disease manifestation that is largely independent of disease activity, chronicity, or nutritional deficiencies. 3,6,31,32 Most QoL and fatigue measures rely on comprehensive and time-consuming questionnaires which can be challenging to incorporate into a routine clinical monitoring program.…”

Proteomic analyses do not reveal subclinical inflammation in fatigued patients with clinically quiescent inflammatory bowel disease

“…” (in Dutch: “ In hoeverre heeft u last gehad van vermoeidheid in de afgelopen 24 uur? ”) 8 Answers to this item were based upon a visual analogue 10-point Likert scale, ranging from a score of 1 (being not fatigued at all) to 10 (being severely fatigued) (Supplementary Fig. S4 ).…”

“…Previous studies have linked inflammatory disease activity to fatigue in various chronic diseases, including IBD, but also in cancer, rheumatic- and autoimmune diseases 3 , 7 . In patients with IBD, the severity of fatigue has been associated with higher disease activity as measured by clinical disease activity scores 8 , 9 . In contrast, other studies have demonstrated that fatigue is not dependent on disease activity, and that it may even increase in patients who are in remission 10 , 11 .…”

Effect of 5-Hydroxytryptophan on Fatigue in Quiescent Inflammatory Bowel Disease: A Randomized Controlled Trial

“…Only patients with quiescent IBD were included to avoid the wellknown influence of disease activity on IBD-related fatigue, for which the first step is optimizing IBD treatment. 38,39…”