Background/Purpose: Fatigue is a common complaint in patients with rheumatoid arthritis (RA)¹. However, its impact on disease activity and clinical remission in patients with RA has not been explored thoroughly in daily clinical practice². The aim of this study was to investigate how fatigue is related to disease activity and clinical remission in patients with RA.

Methods: Among Japanese patients with RA in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort study in April 2015, fatigue was measured based on the checklist of individual strength (CIS) 8R (normal, CIS 8R≤26; heightened fatigue, 27≤CIS 8R≤34; severe fatigue, CIS 8R≥35). We performed a cross-sectional investigation of the association between fatigue severity and the 28-joint disease activity score (DAS28) and its components (swollen joint counts, tender joint counts, erythrocyte sedimentation rate and patient global assessment [PtGA]) with an ordered logistic regression analysis. We also analyzed the contribution of patient demographic and clinical factors to fatigue severity among the variables with significance in an ordered logistic regression analysis by analysis of variance (ANOVA).

Results: Among 5,679 RA patients (mean age, 61.4 years; female, 85.8%; mean DAS28 score, 2.62; mean CIS 8R, 28.3), fatigue severity was normal in 2,152 patients (37.9%, [mean age, 61.0 years; female, 82.0%]), heightened in 1,489 patients (26.2%, [mean age, 61.0 years; female, 86.7%]) and severe in 1,383 patients (24.4%, [mean age, 57.5 years; female, 90.4%]). The proportion of corticosteroid use (normal fatigue, 22.0%; heightened fatigue, 30.3%; and severe fatigue, 40.3%) and non-steroidal anti-inflammatory drug [NSAID] use (normal fatigue, 38.8%; heightened fatigue, 52.0%; and severe fatigue, 62.7%) was significantly higher with fatigue severity (P = 0.0010 and 0.0327, respectively). The DAS28 score was significantly associated with fatigue severity (mean DAS28 score: normal fatigue, 2.30; heightened fatigue, 2.63; and severe fatigue, 2.98; P = 0.0443). The DAS28 remission rate significantly decreased with fatigue severity (normal, 65.5%; heightened, 51.5%; and severe, 40.0%; P < 0.0001). Of the four components of the DAS28 score, only PtGA had a significant association with fatigue severity (mean PtGA [mm]: normal fatigue, 11.7; heightened fatigue, 24.7; and severe fatigue, 40.2; P < 0.0001). Among the six variables with significance in an ordered logistic regression analysis (gender, PtGA, pain, the Japanese version of the Health Assessment Questionnaire [J-HAQ] score, corticosteroid use and NSAID use), PtGA had the strongest contribution to fatigue severity (81.0%), followed by the J-HAQ score (9.4%), gender (3.2%) and NSAID use (3.1%).

Conclusion: Fatigue was strongly associated with PtGA and affected the evaluation of disease activity and clinical remission in patients with RA, suggesting that evaluating fatigue may be important for controlling disease activity in patients with RA in daily practice.

References: [1] Kirwan JR, et al. J Rheumatol. 2007;34:1171-3. [2] Felson DT, et al. Arthritis Rheum. 2011;63:573-86.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fatigue-is-strongly-associated-with-the-patient-global-assessment-and-may-affect-disease-severity-and-clinical-remission-in-patients-with-rheumatoid-arthritis-a-cross-sectional-study-from-iorra-a-la/