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Exploring Fatigue Trajectories in Early Symptomatic Knee and Hip Osteoarthritis: 6-year Results from the CHECK Study
Jadran Botterman1, Christina Bode2, Liseth Siemons1
1From the Department of Psychology, Health and Technology, University of Twente; Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente; Arthritis Center Twente, Enschede; Department of Rehabilitation Medicine and Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands.J. Botterman, MSc, Junior Researcher, Department of Psychology, Health and Technology, University of Twente; C. Bode, PhD, Assistant Professor, Department of Psychology, Health and Technology, University of Twente, and the Arthritis Center Twente; L. Siemons, PhD, Postdoctoral Researcher, Department of Psychology, Health and Technology, University of Twente, and the Arthritis Center Twente; M.A. van de Laar, MD, PhD, Rheumatologist, Full Professor, Department of Psychology, Health and Technology, University of Twente, and the Arthritis Center Twente, and the Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente; J. Dekker, PhD, Full Professor, Department of Rehabilitation Medicine and Department of Psychiatry, VU University Medical Center.
Objective:
To examine whether different groups of fatigue trajectories can be identified among patients with early symptomatic osteoarthritis (OA) of the knee or hip, to describe the level of fatigue severity within each of these fatigue groups, and to investigate the involvement of age, sex, use of medication, comorbidity, and OA severity in relation to group membership.
Methods:
Six years of followup data on fatigue (Medical Outcomes Study Short Form-36 Vitality scale) came from the Cohort Hip and Cohort Knee (CHECK) cohort. Growth mixture modeling was applied to identify distinct fatigue trajectories as well as to take into account the effects of the patient characteristics.
Results:
Three fatigue trajectories were identified: low fatigue, low-to-high fatigue, and high fatigue. Latter trajectories showed considerable overlap from years 2 to 6, but differed in some patient characteristics in comparison with each other and in comparison with the low fatigue group. Comorbidity, medication use, and sex were significantly associated with the identified trajectories. Women, individuals with a comorbid disease, and those who used medication were more likely to follow a high fatigue trajectory.
Conclusion:
These findings suggest heterogeneous development of fatigue in the early OA population associated with varying patient characteristics. Further, this study shows that a considerable number of patients with OA already experience elevated levels of fatigue at an early stage of OA. While these findings need to be replicated, the identification of these trajectories with differing patient characteristics may warrant tailored psychosocial interventions for patients with elevated levels of fatigue.
