Fatigue and Work Disability In Psoriatic Arthritis

Jessica Walsh¹, Molly McFadden², Gerald G. Krueger³, Allen D. Sawitzke¹ and Daniel O. Clegg⁴, ¹Rheumatology, University of Utah, Salt Lake City, UT, ²Internal Medicine-Division of Epidemiology, University of Utah, SLC, UT, ³Dermatology, University of Utah, Salt Lake City, UT, ⁴Rheumatology, George Wahlen VA Medical Center/University of Utah, Salt Lake City, UT

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: fatigue and psoriatic arthritis, Work Disability

Session Information

Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment: Psoriatic Arthritis: Clinical Aspects and Treatment I

Session Type: Abstract Submissions (ACR)

Background/Purpose: Fatigue and work disability (WD) are common in people with psoriatic arthritis (PsA). Pain and discomfort from PsA contribute to fatigue by impairing sleep quality. Inflammatory mediators implicated in the pathogenesis of PsA may also impact fatigue with direct effects on the central nervous system. It is unclear if fatigue contributes to WD, independently of musculoskeletal and cutaneous disease activity in people with PsA. The purpose of this study was to explore the relationships between fatigue, WD, and PsA activity. Methods: Phenotype data were collected from participants in the Utah Psoriasis Initiative Arthritis registry between January 2010 and May 2013. WD was measured with the Work Limitations Questionnaire (WLQ). Two variables were used to assess fatigue, including question 1 from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI #1), “How would you describe the overall level of fatigue/tiredness you have experienced?” and question 1 from the Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL #1) “I feel tired whatever I do.” PsA activity was assessed with tender joint count (TJC), swollen joint count (SJC), dactylitis count, enthesitis count, inflammatory back pain (IBP), and the product of a cutaneous physician global assessment (PGA) and body surface area (BSA) (PGAxBSA). Depressed mood was measured with PsAQoL question 4 (PsAQoL #4) “I feel there is no enjoyment in my life.” Chi square, Fisher’s exact test, t-test, and Wilcoxon rank sum statistics were used to compare demographics and disease characteristics. ANCOVA analyses were used to determine the adjusted mean WLQ scores for PsQOL #1 and BASDAI #1. Results: Evaluations were completed with 107 participants. 54 (50.5%) were classified as having fatigue according to PsAQoL #1, and 64 (60.0%) were classified as high fatigue by BASDAI #1. TJC, SJC, enthesitis count, IBP, and depressed mood were highest or most frequent in fatigued participants (Table 1). After adjustments for PsA activity and depressed mood, WLQ work productivity loss was associated with fatigue, as measure by PsAQoL #1 (p=0.02) and BASDAI #1 (p= 0.002) (Table 1). Conclusion: WD was associated with fatigue, and the associations were not entirely explained by the musculoskeletal, cutaneous, or psychiatric manifestations of PsA. Additional research is required to characterize the relationship between fatigue and WD in people with PsA.

Disclosure:

J. Walsh,
None;

M. McFadden,
None;

G. G. Krueger,
None;

A. D. Sawitzke,
None;

D. O. Clegg,
None.

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