Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: In rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) patients, fatigue has been mainly related to disease activity. Current management of rheumatic inflammatory diseases aims for low disease activity as the desirable target. However, many arthritic patients with such a therapeutic response still report severe fatigue with negative consequences on their quality of life. The main objective of our study was to investigate the potential mechanisms of this fatigue by exploring factors associated with fatigue in low-activity RA and axSpA patients.
Methods: Arthritic patients with low disease activity (DAS28<3.2 for RA or BASDAI<4/10 and ASDAS<2.1 for axSpA) were enrolled in a monocentric observational and cross-sectional study. All patients were treated with a bDMARD associated or not with conventional synthetic (cs)DMARD. All patients were successively enrolled in this study. Demographic, clinical and biological patient characteristics were recorded. Fatigue was assessed by a validated self-questionnaire FACIT-F and by VAS for fatigue. Anxiety and depression were estimated by HAD scores. Physical activity was assessed by a validated score IPAQ-SF. Sleep quality was assessed using the PSQI score. Function disability was evaluated with HAQ. Function disability was evaluated with HAQ.
Results: One hundred patients were included in the study with 55 RA (86% female) and 45 axSpA (68% men), with a mean disease duration of 11.9 ± 7.9 years. Furthermore, higher levels of physical activity together with lower functional disabilities were observed in axSpA patients compared to RA patients (Table 1). Notably, fatigue level was similar in RA and axSpA patients.
After the univariate statistical analysis, 7 parameters were statistically correlated with FACIT-F in our whole population: age, gender, sleep quality (PSQI and number of nighttime awakenings), anxiety (HAD anxiety), depression (HAD depression), and functional disability (HAQ). Four parameters remained positively associated with fatigue in the multiple linear regression: age, sleep quality (PSQI), depression (HAD depression), and functional disability (HAQ). Similar results were obtained when adding arthritic disease type (either RA or axSpA) in the multivariate analysis. Further analyses using ANCOVA test identified higher association between handicap and fatigue in axSpA patients than in RA patients. Fatigue level increased with higher handicap (p<0.001) and this trend was stronger in axSpA patients (p<0.05). Fatigue also increased with higher depression (p<0.001), with higher age (p<0.05), and sleep quality (p<0.05), but the strength of these associations was similar in both RA and axSpA patients.
Conclusion: Our study suggests the importance of advance care of depression, sleep quality, and functional deficit in patients with low-activity RA or axSpA in order to improve their state of fatigue and consequently to increase their quality of life.
To cite this abstract in AMA style:Nizeica V, Normand M, Denarie D, Pallot Prades B, Collet P, Amouzougan A, Locrelle H, Thomas T, Marotte H. Depression, Bad Sleep Quality, and Functional Deficit Are Independently Associated with Persistent Fatigue in Arthritic Patients with Low Disease Activity Under Biological Dmards [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/depression-bad-sleep-quality-and-functional-deficit-are-independently-associated-with-persistent-fatigue-in-arthritic-patients-with-low-disease-activity-under-biological-dmards/. Accessed September 19, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/depression-bad-sleep-quality-and-functional-deficit-are-independently-associated-with-persistent-fatigue-in-arthritic-patients-with-low-disease-activity-under-biological-dmards/