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Fatigue in rheumatoid arthritis; a persistent problem: a large longitudinal study.

Hanna W van Steenbergen1, Roula Tsonaka2, Tom W J Huizinga1

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RMD Open
|October 29, 2015
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Summary

Fatigue in rheumatoid arthritis (RA) remained stable over 8 years, with small effects from inflammation. Improved treatments did not reduce RA fatigue, highlighting it as an unmet need.

Keywords:
InflammationOutcomes researchPatient perspectiveRheumatoid Arthritis

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Area of Science:

  • Rheumatology
  • Clinical Immunology
  • Longitudinal Studies

Background:

  • Fatigue is a common and debilitating symptom in rheumatoid arthritis (RA).
  • The long-term trajectory of fatigue and its relationship with inflammation in RA are not well understood.
  • Understanding these factors is crucial for developing effective management strategies.

Purpose of the Study:

  • To investigate the 8-year course of fatigue in patients with rheumatoid arthritis (RA).
  • To examine the association between fatigue severity and markers of inflammation over time.
  • To assess the impact of evolving treatment strategies on fatigue levels in RA.

Main Methods:

  • A cohort of 626 RA patients from the Leiden Early Arthritis Clinic was followed for 8 years.
  • Fatigue severity (0-100 mm scale) and clinical variables were assessed annually.
  • Linear quantile mixed models were used to analyze serial measurements, accounting for different treatment strategies implemented over time.

Main Results:

  • Median fatigue severity was 45 mm at baseline and remained relatively stable throughout the 8-year follow-up.
  • Factors independently associated with higher fatigue included female gender, younger age, higher swollen and tender joint counts, and elevated C-reactive protein levels.
  • Despite improvements in treatment strategies leading to less radiographic progression, no significant effect on fatigue severity was observed.

Conclusions:

  • The association between inflammation and fatigue in RA is statistically significant but has small effect sizes, indicating the involvement of non-inflammatory pathways.
  • Current improved treatment strategies for RA did not lead to a reduction in fatigue severity.
  • Fatigue in RA continues to be a significant 'unmet need' requiring further research and novel therapeutic approaches.