Background/Purpose: Fatigue is an important problem for many patients with rheumatic diseases. Fatigue is associated with disease severity, psychological distress, and a poorer quality of life in rheumatoid arthritis (RA) (1), but the extent to which the level of fatigue may contribute to disease activity is controversial. A fatigue 0-10 visual analog scale (VAS) is included on a multidimensional health assessment questionnaire (MDHAQ). We analyzed possible associations between fatigue and global estimates of disease activity according to the patient (PATGL) and the physician (DOCGL) in patients with different rheumatic diseases seen in routine care.

Methods: All patients seen in one academic clinical setting complete a 2-page MDHAQ in 5-10 minutes in the waiting area, prior to seeing the rheumatologist in the infrastructure of usual care. The MDHAQ includes physical function (FN) in 10 activities of daily living, three 0-10 visual analog scale (VAS) for pain (PN), PATGL, and fatigue (FT), and demographic data. Four activity categories were defined for PATGL and DOCGL: <1 for ‘inactive disease’, 1-3 for ‘low’, 3-6 for ‘moderate’, and >6 for ‘high’. Median values for fatigue and interquartile range (IQR) were compared in the 4 PATGL and DOCGL categories in 4 diagnostic groups: rheumatoid arthritis (RA), osteoarthritis (OA), systemic lupus erythematosus (SLE), and fibromyalgia (FM), using one-way analysis of variance; Kruskall-Wallis tests of significance were performed.

Results: The study included 612 consecutive patients, 173 with RA, 199 with OA, 146 with SLE and 94 with FM. Median fatigue scores were significantly higher in FM (7, IQR=5-8) p<0.001, but similar in RA (4, IQR=1-7), OA (5, IQR=2-7.5), and SLE (5, IQR=1.5-7.5). Fatigue scores were significantly higher according to disease activity categories in RA, OA and SLE patients for both PATGL and DOCGL, suggesting associations with diseases that are characterized by inflammatory or structural abnormalities (Table). By contrast, only PATGL, but not DOCGL, was associated significantly with fatigue, but a linear trend, as seen in RA, OA, and SLE, was not observed in patients with FM.

Conclusion: Fatigue scores are associated with severity of disease activity in conditions with inflammatory or structural abnormalities, such as RA, OA, and SLE, but do not appear to be similarly associated in myofascial pain syndromes. Fatigue may be due to different mechanisms in different rheumatic diseases. Fatigue is a relevant and important symptom, which may be assessed in the infrastructure of routine care as quantitative data on an MDHAQ, with no extra work for the doctor and minimal interference with clinic patient flow.

Reference: 1) Nikolaus S, et al. Arthritis Care Res (Hoboken) 2013; 65:1128-46.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-much-does-fatigue-contribute-to-the-physician-and-patient-global-estimates-in-different-rheumatic-diseases-analysis-from-routine-care-on-a-multidimensional-health-assessment-questionnaire-mdhaq/