Beyond Inflammation: Associations of Depression and Anxiety With Fatigue in Rheumatoid Arthritis

Background Fatigue is one of the most common and disabling symptoms in patients with rheumatoid arthritis (RA). Although often attributed to inflammatory disease activity, psychological factors such as depression and anxiety may also contribute significantly. This study aimed to evaluate the association between fatigue and depressive and anxiety symptoms in patients with RA and to determine whether these associations persist after adjustment for clinical and demographic variables. Methods In this cross-sectional secondary analysis, 90 patients with rheumatoid arthritis were included. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. Depressive and anxiety symptoms were measured using the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Disease activity was evaluated using the Disease Activity Score in 28 joints (DAS28). Associations were analyzed using Spearman's correlation, and multivariable linear regression models were used to identify independent predictors of fatigue. Results The median FACIT-F score was 37.0 (interquartile range (IQR): 27.0-45.0), although moderate-to-severe fatigue was present in 32 (35.6%) patients. Fatigue was moderately associated with disease activity (ρ = -0.38, p < 0.001) and strongly associated with depressive (ρ = -0.63, p < 0.001) and anxiety symptoms (ρ = -0.60, p < 0.001). In multivariable analysis, both depressive (β = -0.50, p = 0.008) and anxiety symptoms (β = -0.40, p = 0.002) remained independently associated with fatigue. Inclusion of psychological variables increased the explained variance in fatigue from 19.8% to 52.4% (ΔR² = 0.326). Conclusion Fatigue in rheumatoid arthritis appears to be associated not only with inflammatory disease activity but also with depressive and anxiety symptoms. These findings support a multidimensional biopsychosocial understanding of fatigue and indicate that psychological factors are important correlates of fatigue severity in rheumatoid arthritis.