Fatigue and Physical Functioning in Patients with Giant Cell Arteritis

Gunnar Tomasson¹, John T. Farrar², David Cuthbertson³, Susan Ashdown⁴, Don Gebhart⁵, Georgia Lanier⁶, Nataliya Milman⁷, Jacqueline Peck⁴, Joanna C. Robson^8,9, Judy A. Shea¹⁰, Simon Carette¹¹, Gary S. Hoffman¹², Nader A. Khalidi^13,14, Curry L. Koening¹⁵, Carol A. Langford¹⁶, Carol A McAlear¹⁷, Paul A. Monach¹⁸, Larry W. Moreland¹⁹, Christian Pagnoux²⁰, Antoine G. Sreih²¹, Kenneth J. Warrington²², Steven R. Ytterberg²³ and Peter A. Merkel²⁴, ¹Dept of Public Health Sciences, University of Iceland, Reykjavik, IS, ²University of Pennsylvania, Philadelphia, PA, ³Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, ⁴Oxford, Oxford, United Kingdom, ⁵Columbus, Columbus, OH, ⁶NONE, Framingham, MA, ⁷University of Ottawa Department of Medicine, University of Ottawa Division of Rheumatology, Ottawa, ON, Canada, ⁸School of Clinical Sciences, University of Bristol, Bristol, United Kingdom, ⁹Faculty of Health and Applied Science, University of the West of England, Bristol, United Kingdom, ¹⁰Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, ¹¹Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, ¹²Rheumatology, Cleveland Clinic, Cleveland, OH, ¹³Rheumatology, McMaster University, Hamilton, ON, Canada, ¹⁴Division of Rheumatology, McMaster University, Hamilton, ON, Canada, ¹⁵Rheumatology, University of Utah, Salt Lake City, UT, ¹⁶Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, ¹⁷Penn Vasculitis Center, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, ¹⁸Rheumatology, Boston University School of Medicine, Boston, MA, ¹⁹Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, ²⁰Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, ²¹Rheumatology, The University of Pennsylvania, Philadelphia, PA, ²²Rheumatology, University of California Los Angeles, CA, USA Mayo, Rochester, MN, ²³Rheumatology, Mayo Clinic, Rochester, MN, ²⁴Division of Rheumatology, University of Pennsylvania, Philadelphia, PA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Fatigue, giant cell arteritis and physical function

Session Information

Date: Sunday, November 13, 2016

Title: Vasculitis - Poster I: Large Vessel Vasculitis and Polymyalgia Rheumatica

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Physical function is an established outcome measure for many rheumatic diseases and fatigue is a common disease manifestation across most, if not all, systemic inflammatory diseases. These two domains are often rated among the most important disease manifestations by patients. For giant cell arteritis (GCA), there exists limited data as to how the disease affects health-related quality of life, including fatigue and physical functioning.

Methods: Data from subjects with GCA participating in a multicenter longitudinal cohort from December 2014 to April 2016 were used. Fatigue and physical functioning were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) instruments administered through computer adaptive testing (CAT). PROMIS instruments are calibrated so that scores are normally distributed with a mean of 50 and standard deviation of 10 in the US population. Higher scores signify better physical functioning and increased fatigue. Active disease was defined as physician global assessment > 0. Scores were compared to age-stratified population norms and a one sample t-tests was done. To assess whether PROMIS measures discriminated between active disease and remission in GCA, a mixed linear model was constructed with a random intercept introduced for each study subject.

Results: Data from 194 subjects that came for 435 study visits were used. The mean age of the participants was 73.7 (sd 7.9) years and 135 (70%) were women. At baseline 167 patients with GCA were in disease remission but nonetheless had substantially reduced physical functioning and increased fatigue compared to age-stratified population norms (Table). Thirteen patients had a total of 25 visits with active disease. Active disease was associated with a higher score of fatigue by 5.69 points (95% CI: 2.65; 8.73) and lower score of physical functioning by -1.76 points (95%CI: 4.14; 0.61).

Conclusion: Patients with GCA have substantially increased fatigue and reduced physical functioning compared to age-stratified population norms. PROMIS measures for fatigue and physical functioning can discriminate between active disease and remission in GCA. These results highlight the benefit of combining patient-reported outcomes with physician-reported assessments in the evaluation of patients with GCA. Table. Age-stratified scores for PROMIS instruments among patients with GCA during remission

	Patients with GCA	Population Norms	P-value
Fatigue
45-54	—	51.6
55-64	54.6	49.7	0.04
65-74	52.9	48.1	0.001
≥75	53.8	48.0	<0.001
Physical functioning
45-54	—	49.0
55-64	42.4	47.5	0.03
65-74	42.6	47.2	<0.001
≥75	39.6	45.2	<0.001

PROMIS = Patient Reported Outcome Measurement Information System; GCA = giant cell arteritis

Disclosure: G. Tomasson, None; J. T. Farrar, None; D. Cuthbertson, None; S. Ashdown, None; D. Gebhart, None; G. Lanier, None; N. Milman, None; J. Peck, None; J. C. Robson, None; J. A. Shea, None; S. Carette, Genentech and Biogen IDEC Inc., 2,GlaxoSmithKline, 2; G. S. Hoffman, None; N. A. Khalidi, Roche Pharmaceuticals, 2,Bristol-Myers Squibb, 2; C. L. Koening, None; C. A. Langford, Genentech and Biogen IDEC Inc., 2,GlaxoSmithKline, 2,Bristol-Myers Squibb, 2; C. A. McAlear, None; P. A. Monach, Genentech and Biogen IDEC Inc., 2,Bristol-Myers Squibb, 2,MedScape, 5,GlaxoSmithKline, 2,Vasculitis Foundation Board of Directors, 6,Editorial Board of Arthritis and Rheumatology, 6; L. W. Moreland, Genentech and Biogen IDEC Inc., 2,Pfizer Inc, 2,questcor, 2,Roche Pharmaceuticals, 2,Bristol-Myers Squibb, 2,Pfizer Inc, 5,Boehringer Ingelheim, 5,Acerta, 5,CVS/Caremark, 5,Smith Kline Beecham, 5; C. Pagnoux, Chemocentryx, 5,Chemocentryx, 9,Roche Pharmaceuticals, 9,Roche Pharmaceuticals, 5,Sanofi-Aventis Pharmaceutical, 5,Hoffmann-La Roche, Inc., 8; A. G. Sreih, Alexion Pharmaceuticals, Inc., 1,Bristol-Myers Squibb, 2,Celgene, 2,Chemocentryx, 2,Roche Pharmaceuticals, 2,GlaxoSmithKline, 2,Kropp and Partners, 5; K. J. Warrington, None; S. R. Ytterberg, Sanofi-Aventis Pharmaceutical, 5; P. A. Merkel, Bristol Myers Squibb, 2,CaridianBCT, 2,Celgene, 2,Chemocentryx, 2,Genentech/Roche, 2,GlaxoSmithKline, 2,Kypha, 2,Bristol-Myers Squibb, 5,Chemocentryx, 5,Genentech/Roche, 5,GlaxoSmithKline, 5,PrinicipioBio, 5,Auven, 5,Proteon Therapeutics, 5.

To cite this abstract in AMA style:

Tomasson G, Farrar JT, Cuthbertson D, Ashdown S, Gebhart D, Lanier G, Milman N, Peck J, Robson JC, Shea JA, Carette S, Hoffman GS, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Sreih AG, Warrington KJ, Ytterberg SR, Merkel PA. Fatigue and Physical Functioning in Patients with Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/fatigue-and-physical-functioning-in-patients-with-giant-cell-arteritis/. Accessed .

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