Background/Purpose: Residual fatigue highlights an unmet prevalent1 need in rheumatoid arthritis (RA) patients despite achieving remission of disease activity according to activity indices (DAS28).We examine associated factors that may explain residual fatigue in RA patients according to two types of predefined clinical remission and compare them.

Methods: Patients with RA (EULAR/ACR, 2010), excluding chronic fatigue syndrome, were collected for 6 months from different Rheumatology Services throughout Catalonia (ARCat study group), fulfilling 3 questionnaires:1. MDHAQ: Function (FN, modified HAQ)(1-10), VAS_Pain (0-10), PGA (0-10), VAS_Fatigue (0-10, significant fatigue=VAS_Fatigue>5)2, Review of 60 symptoms (ROS60), self-assessment 48 joint count (sRADAI) and integrated indices: RAPID3 (0-30), FAST3_Pain, FAST3/FAST4_Fatigue, and MDS2.2. Global FACIT_Fatigue, for fatigue(0-64, indirect score).3. Global RAID, for the impact of the disease (0-10).They were studied according to 1. Remission by DAS28ESR< 2.6 (DAS28 REM) and 2. A defined “Inflammatory remission” by SJC=0 and CRP< 0.4mg/dL (=SJC/CRP REM).Sociodemgraphics variable, evolution of the disease, concomitant rheumatic diseases and comorbidities (depression, anemia, anxiety, hypothyroidism, and diabetes mellitus), and treatments (glucocorticoids, DMARDs, antidepressants) were analyzed. Patient outcomes from questionnaires (PROMs) and joint examinations (TJC28, SJC28), laboratory markers (RF, ACPA, ESR, and CRP), and disease activity composite indices (CDAI, SDAI, and DAS28CRP/ESR) were assessed.A univariate analysis of the different variables studied was performed on whether VAS_fatigue is >5 or not in these patients according to two described types of remission (SJC/CRP REM vs DAS28 REM).

Results: A total of 246 RA non-selected patients were recruited, 77,1% females, mean age of 61.3 ±10.5 years, 17.19 (20.39) years of disease, BMI of 26.5±5 kg/m2, and DAS28ESR=3.47 (1.37). Osteoarthritis (17.1%) and Sjögren Syndrome (11.4%) as concomitant rheumatic diseases, and glucocorticoids (37.4%), bDMARD (45%), Jak inhibitors (13.6%) and antidepressants (15%) treatments were the most frequent.SJC/CRP REM definition was observed in 102 patients; 28 of them (27.4%) experienced residual fatigue, and 92 patients met remission according to DAS28 REM, 18 (19.5%) reporting residual fatigue.In clinical disease activity, TJC and SJC, and the composite indices, PROMs scores, were significantly associated with residual fatigue even in both types of studied remission (Table). And SCJ/CRP REM patients showed a significantly higher prevalence of female sex, active smokers, and a history of depression and antidepressants, but not in DAS28 REM. However, antirheumatic DMARDb treatment was associated with fatigue in DAS28 REM (Table).

Conclusion: Clinical disease activity and PROMs scores factors are similar in explaining residual fatigue in both types of defined clinical remission. Moreover, in the group of patients without SJC and with normal CRP, we also must take into account: female sex, smoking, and history of depression.References: 1. Druce K, et al. Rheumatology 2016. 2. Tournadre, et al. Joint Bone Spine, 2019.

Table. Associated factors to residual fatigue in patients with remission by SJC/CRP compared with patients in remission by DAS28, only significant data (p < 0.05).

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-rheumatoid-arthritis-patients-have-residual-fatigue-without-swollen-joints-and-laboratory-inflammation-a-multicenter-study/