Background/Purpose:  Some view fatigue as resulting from disease activity, while others see it as a natural consequence of the pain, disability, and the emotional burden of living with RA. We explored how RA symptoms and impacts contribute to fatigue.

Methods:  Participants had MD-diagnosed RA, were receiving care at an academic arthritis clinic, and were enrolled in an observational study. All completed PROMIS measures of fatigue, mood (depression, anxiety), and symptoms/impacts (physical function [PF], sleep disturbance, pain interference, and participation in social roles and activities). Clinical RA indicators and self reports of exercise frequency we also obtained. Pearson correlation and multiple regression models were used to evaluate associations among variables.

Results:  Data are from the baseline visit of 177 RA patients who were mostly female (82%) and white (83%) with a mean (SD) age of 56 (13) years; 24% had ≤ high school, 29% had RA ≤ 5 years with 13% ≤ 2 years, and 22% were disabled. Mean CDAI was 7.9 (7.8). Most were in CDAI remission (n=56; 32%) or LDA (n=67; 38%); 39 (22%) were in MDA, and 14 (8%) in HDA. As compared to the general US population, patients with active RA had higher disability, fatigue, and pain; only those with HDA had elevated mood, sleep disturbance and impaired participation (Table 1). Fatigue was moderately-strongly and directly associated with pain, sleep, depression, and anxiety (r’s .45-.67), inversely to PF and participation (r=-.61 and -.64, respectively), weakly and directly with swollen joints (r=.27) and weakly and inversely with regular exercise (r=-.24)(p’s <.001). Age and RA duration were not associated with fatigue (p’s .967 and .677, respectively). VIF estimates among remaining variable ranged from 1.1–3.3. In multiple regression, pain, physical function, and anxiety were significant predictors of fatigue [F (7,157) = 28.60, p<.001, r²=.54](Table 2).

Conclusion:  In RA, fatigue is common and increases with disease activity. Pain, disability, and anxiety contributed to fatigue, whereas depression and sleep disturbance did not. Overall, anxiety was within the normal range for most (72%) except those with the high disease activity. Our data suggest that beyond pain and disability, in 28% of people with RA, anxiety may also contribute to fatigue. Stress management coaching may offer opportunities to help reduce fatigue in people whose RA is otherwise well controlled. PCORI IP2-PI0000737 and SC14-1402-10818.

Table 2. Predictors of fatigue in people with rheumatoid arthritis

Std. beta = standardized estimate. *F (7,157) = 28.60, p=.000, adjusted r²=.541.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pain-physical-function-and-worry-but-not-depression-and-poor-sleep-lead-to-greater-fatigue-in-ra/