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Fatigue burden and patient attribution across remission states in inflammatory bowel disease: a longitudinal cohort
Arun Swaminath1, Jakob Saidman1, Jeremy Polman1
1Division of Gastroenterology, Lenox Hill Hospital, New York, NY 10025, United States.
Background And Aims:
Fatigue is common in inflammatory bowel disease (IBD), but prior work has largely focused on symptomatic disease activity rather than progressively objective remission states. We evaluated the relationship between fatigue and hierarchical remission depth, repeated changes in remission status, and patients' attribution of fatigue to IBD.
Methods:
Adults with confirmed IBD completed PROMIS Fatigue surveys at 2 tertiary-care centers. PROMIS Fatigue was analyzed continuously and as clinically significant fatigue (T-score ≥55). Remission was classified hierarchically as no remission, physician-global-assessment (PGA)-defined clinical remission, endoscopic remission, or histologic remission. Visit-level repeated measures were analyzed using a linear mixed-effects model. First-visit logistic regression evaluated clinically significant fatigue after adjustment for anxiety, depression, anemia, and IBD subtype; corticosteroid exposure was added in a sensitivity model. Attribution analyses included only explicit Yes or No responses.
Results:
We surveyed 481 patients, contributing 900 surveys. PGA-defined clinical, endoscopic, and histologic remission remained associated with lower mean PROMIS Fatigue T-scores than no remission (adjusted differences -3.68, -3.45, and -3.27 points; all P ≤ .001). No remission remained associated with clinically significant fatigue after adjustment for anxiety, depression, anemia, IBD subtype (OR 2.75, 95% CI, 1.83-4.14), and for corticosteroid exposure (OR 2.34, 95% CI, 1.52-3.58). Attribution of fatigue to IBD differed by remission status (P < .000000001). Findings remained significant when objective remission was restricted to colonoscopy within 180 days of PROMIS completion (adjusted OR 2.23, 95% CI, 1.42-3.49).
Conclusion:
Remission was associated with lower fatigue burden, and patients in objective remission were less likely to attribute fatigue to IBD. These observational findings support assessing inflammatory disease control early in the evaluation of fatigue while also evaluating sleep, mood, anemia, pain, medications, and other non-inflammatory contributors.