Background/Purpose: Fatigue is a multifactorial and persistent symptom reported by patients with rheumatoid arthritis (RA). It is considered as frequent as pain. It would be of value to identify potential predictive factors of fatigue that could influence on its evolution.

Methods: The Etude et Suivi des polyarthrites Indifferenciees Récentes (ESPOIR) is a multicenter French cohort of patients with early arthritis. We selected patients fulfilling the 2010 ACR/EULAR criteria for RA during the first year of follow-up. We recorded fatigue (SF vitality score <=40), persistent fatigue (SF vitality score <=40 at the end of the study and at least in 50% of visits in the 5 years follow up) and disease variables at baseline and every 6 months up to 5 years. The association between fatigue/persistent fatigue and disease characteristics were evaluated by bivariate logistic regression models / tests. A multivariate logistic regression model was used to determine independent predictors of fatigue at baseline and persistent fatigue at 5 years of follow-up. Moreover, to analyse the association between the course of fatigue and disease characteristics over the time, baseline variables associated with fatigue at the multivariate analysis were analysed by a repeated measures logistic regression model at various time points (M12, M24, M36, M48 and M60).

Results:

We included 677 patients (73.4% women, mean ± SD age 48.6 ± 12 years); 46.5%, 28% and 22% of patients presented fatigue at baseline, 6 months and 5 years of follow up respectively. At baseline, fatigue was independently and significantly associated with single patients (OR = 2.5 95% CI [1.42-3.33] p <0.001), abnormal BMI (OR = 1.1 95% CI [1.01 – 1.10] p = 0.007), higher DAS28 (OR = 1.3 95% CI [1.08-1.60] p = 0.006), higher severity of morning stiffness (scored 0-10) (OR = 1.0 95% CI [1.00-1.01] p = 0.012), higher HAQ (OR = 2.4 95% CI [1.70-3.44] p <0.001), negativity of FR (OR = 1.5 95% CI [1.09-2.29] p = 0.016) and history of depression or anxiety (OR = 6.1 95% CI [3.90-9.83] p<0.001).

The most important predictors of fatigue over 5 years were disability (p<0.001) and depression/anxiety (p<0.001).

A 14.9% of patients presented persistent fatigue. Its independent predictors at 5 years of follow-up were HAQ (OR = 0.5 95% CI [1.66-3.73] p<0.001), history of depression/anxiety (OR = 3.6 95% CI [1.48-8.82] p = 0.005), >3 comorbidity (OR = 2.1 95% CI [1.18- 3.66] p = 0.010), dry syndrome (OR = 2.3 95% CI [1.39- 4.17] p = 0.002), and anti CCP negativity (OR = 1.96 95% CI [1.1-3.44] p = 0.021).

Conclusion: Fatigue was a frequent symptom in this cohort of early RA patient; its presence decreased at 6 months and remained stable over time. Baseline fatigue and persistent fatigue were both predicted by functional impairment and history of depression or anxiety. Disease activity measured by DAS28 was strongly associated to fatigue at baseline but it was not a predictor of persistent fatigue.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-fatigue-and-persistent-fatigue-in-early-rheumatoid-arthritis-a-longitudinal-observational-study/