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Beyond Inflammation: Associations of Depression and Anxiety With Fatigue in Rheumatoid Arthritis
Nadina Kurtanović1, Maida Skokić2, Melika Salihović Jahić2
1Department of Physical Medicine and Rehabilitation, Health Institution Spa Gata Bihać, Bihać, BIH.
Cureus
|June 29, 2026
Summary
Fatigue in rheumatoid arthritis (RA) is linked to both disease activity and psychological factors like depression and anxiety. Addressing these mental health aspects is crucial for managing RA fatigue.
Area of Science:
- Rheumatology
- Psychiatry
- Clinical Psychology
Background:
- Fatigue is a prevalent and debilitating symptom in rheumatoid arthritis (RA).
- While inflammatory disease activity is a known contributor, psychological factors like depression and anxiety also significantly impact RA fatigue.
- Understanding the interplay between physical and psychological factors is essential for comprehensive RA management.
Purpose of the Study:
- To investigate the association between fatigue and symptoms of depression and anxiety in patients with rheumatoid arthritis (RA).
- To determine if these associations remain significant after controlling for clinical and demographic variables.
- To highlight the role of psychological factors in the multidimensional understanding of RA fatigue.
Main Methods:
- A cross-sectional secondary analysis of 90 rheumatoid arthritis (RA) patients.
- Fatigue assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale.
- Depressive symptoms measured by Beck Depression Inventory-II (BDI-II), anxiety symptoms by Beck Anxiety Inventory (BAI), and disease activity by DAS28.
Main Results:
- Fatigue showed moderate association with disease activity (ρ = -0.38) and strong associations with depressive (ρ = -0.63) and anxiety symptoms (ρ = -0.60).
- Multivariable analysis confirmed that both depressive and anxiety symptoms were independent predictors of fatigue severity (β = -0.50 and β = -0.40, respectively).
- Psychological variables significantly increased the variance explained in fatigue, from 19.8% to 52.4%.
Conclusions:
- Fatigue in rheumatoid arthritis (RA) is significantly associated with both inflammatory disease activity and psychological distress, including depression and anxiety.
- These findings support a biopsychosocial model for understanding fatigue in RA.
- Psychological interventions may be important adjuncts to disease-modifying treatments for improving fatigue in RA patients.
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