Fatigue Broadly Impacts Patients With RA, Psoriatic Arthritis, Axial Spondyloarthritis

Fatigue is a common problem for patients with inflammatory arthritis, such as rheumatoid arthritis (RA), and a new study in PLOS ONE has highlighted the broad impact fatigue can have on patients with RA, psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA).

Danish researchers used a questionnaire-based cross-sectional survey to collect patient characteristics from patients in Denmark with RA, PsA, and axSpA.

“Fatigue is considered a multidimensional and complex phenomenon and is found to be associated with pain, sleep problems and low physical activity,” the authors explained. “Also, severe fatigue has been found to predict depression, low physical activity and quality of life, and more healthcare utilization. On the other hand, depression, reduced illness beliefs, psychological distress and low self-efficacy have been found to contribute to fatigue.”

Data was collected on 487 patients over a 6-month period from January 2017 to June 2017. The majority (60%) of patients had RA (n = 292), 23% had axSpA (n = 110), and 17% had PsA (n = 85).

Patients completed a questionnaire that asked about their disease history, type of household, education, employment, and household income. The researchers also used respondents’ medical journals to gather information about type of diagnosis, age, gender, treatment, treatment changes, and disease activity score. For the disease activity score, Disease Activity Score 28 (DAS28) was used for RA and PsA, Bath Ankylosing Spondylitis Disease Activity Index for axSpA, and Bath Ankylosing Spondylitis Functional Index for PsA and axSpA.

Fatigue did not differ significantly between the disease groups. The Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale has a range of 0 to 52, with higher scores indicating lower levels of fatigue. The FACIT-Fatigue score was 34.9 for RA, 31.8 for PsA, and 34.8 for axSpA. In comparison, the general population has a mean fatigue score of 44.0. While levels of fatigue were similar across the diseases, women, experienced patients, and patients who changed medication in the past 12 months all reported higher mean fatigue rate.

The socioeconomic characteristics that were correlated significantly with fatigue were education, employment, and income, with patients who had less education, were unemployed/retired, and had lower income showing a higher mean fatigue rate.

There was also a correlation between fatigue and work impairment, quality of life, pain, sleep problems, depression, and physical functioning.

The authors noted the limitations of their study included the fact that the cohort was slightly older and consisted of more women and the geographical scope was limited since the cohort was drawn from 2 clinics in the Capital Region of Denmark. They added that they cannot make conclusions concerning causality because they used a cross-sectional study.

“Fatigue cannot be seen as a single problem, but rather as a symptom that broadly affects the lives of people with [inflammatory arthritis],” the authors concluded.

Reference

Appel Esbensen B, Elkjær Stallknecht S, Elmegaard Madsen M, Hagelund L, Pilgaard T. Correlations of fatigue in Danish patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis. PLoS ONE. Published online August 3, 2020. doi:10.1371/journal.pone.0237117