Background/Purpose: Fatigue is one of the essential patient reported outcome almost all inflammatory rheumatic diseases. However, fatigue may be affected from multidimensional factors such as psychological (i.e. depression), physiologic (i.e. anemia) or both. In the clinical practice, active fatigue state may be proceed during remission according to other measures. Objective of this study was to assess frequency of active fatigue level at spondyloarthritis patients during ASAS partial remission.

Methods: Hacettepe University Rheumatology Biologic Registry (HUR-BIO) is a single center biological registry since 2005. HUR-BIO includes 933 ankylosing spondylitis (AS) and 143 axial spondyloarthritis (AxSpA) patients under anti-TNF drugs. After September 2012, we regularly collected outcome measures such as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BASDAI 2, 5 and 6. questions, Bath Ankylosing Spondylitis Functional Index (BASFI), CRP, 100mm visual analog scales (VAS) for patient global assessment (PtGA), fatigue and pain every 6 months. Assessment of SpondyloArthritis International Society (ASAS) partial remission was defined as less than 20/100 mm of BASFI, back pain, morning stiffness and PtGA. Active fatigue level was defined as more than 40/100 mm. 

Results: Overall, 716 patients (602 AS and 114 AxSpA) were assessed between September 2012 and January 2015 and 452 (63.1%) of patients were male. Mean age was 40.3±11.3 years old, mean disease duration was 8.9±7.1 years and mean symptom duration was 13.2±8.8 years. Initial biological drugs were etanercept 249 (34.8%), infliximab 208 (29.1%), adalimumab 197 (27.5%) and golimumab 62 (8.6%). Fatigue assessed at 1762 times from 716 patients over time. Active fatigue level detected at 663 of those 1762 (37.6%) visits. During this period, ASAS partial remission was detected 489 of 1697 assessment (28.8%). Active fatigue level found 30 of those 489 (6.1%) patients who were ASAS partial remission.  

Conclusion: In the routine practice, active fatigue level present at about 38% of spondyloarthritis patients despite biological treatment. Almost six percent of patients with ASAS partial remission were still active fatigue levels. Unfortunately, we did not evaluate possible causes of fatigue other than rheumatic diseases. Comprehensive psychologic and physiologic evaluation should be performed in these certain part of spondyloarthritis patients. Physicians should be keep in mind that fatigue may be continue otherwise clinical remission.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fatigue-may-be-independently-active-at-a-certain-part-of-spondyloarthritis-patients-hur-bio-real-life-results/