Obesity Is a Robust Predictor of Persistent High Fatigue at 1 Year in Women and Men with Early Rheumatoid Arthritis

Susan J. Bartlett¹, Orit Schieir ², Marie-France Valois ³, Janet Pope ⁴, Louis Bessette ⁵, Carol Hitchon ⁶, Carter Thorne ⁷, Diane Tin ⁸, Glen Hazlewood ⁹, Gilles Boire ¹⁰, Edward Keystone ¹¹, Vivian Bykerk ¹² and Canadian Early Arthritis Cohort (CATCH) Investigators ¹³, ¹McGill University, Montreal, QC, Canada, ²University of Toronto, Montreal, Canada, ³McGill University, Montreal, Canada, ⁴Western University, London, ON, Canada, ⁵Laval University, Quebec City, QC, Canada, ⁶University of Manitoba, Winnipeg, Canada, ⁷Southlake Regional Health Centre, Newmarket, ON, Canada, ⁸Southlake Regional Health Centre, Newmarket, Canada, ⁹University of Calgary, Calgary, Canada, ¹⁰Sherbrooke University, Sherbrooke, QC, Canada, ¹¹Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada, ¹²Hospital for Special Surgery, New York City, NY, ¹³Canadian Early Arthritis Cohort (CATCH) Study, Toronto, Canada

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Early Rheumatoid Arthritis, Fatigue, psychosocial factors, sex bias and health outcome

Session Information

Date: Sunday, November 10, 2019

Title: RA – Diagnosis, Manifestations, & Outcomes Poster I: Risk Factors, Predictors, & Prognosis

Session Type: Poster Session (Sunday)

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

Background/Purpose: While treat-to-target strategies can dramatically reduce inflammation in RA, persistently high levels of fatigue are present in many patients and represent an important unmet need. Proposed underlying causes include RA disease activity, cognitive/emotional/behavioral factors (CEB), and personal (health) factors. We identified risk factors for persistent high fatigue at 12 months in women and men with ERA receiving guideline-based treatment.

Methods: Data were from patients enrolled in the Canadian Early Arthritis Cohort (CATCH) between 01-2007 and 03-2017 who met 1987 or 2010 ACR/EULAR RA criteria, had active disease treated with DMARDS, and had complete data on DAS28, BMI, and fatigue severity (0-10) over 12-months. Persistent high fatigue was defined as fatigue ≥ 4 at baseline with < 20% improvement by 12 months. Multivariable logistic regression was used to identify RA disease, CEB, and personal / health factors associated with persistent high fatigue in women and men.

Results: Patients (N=1002) were mostly white (81%), female (71%), with a mean (SD) age of 54 (15), symptom duration of 6 (3) months, and BMI of 28.0 (6.1); 32% were obese (BMI≥30). Women were generally younger, better educated, seropositive, and had greater disability, fatigue, depressive symptoms, and major stress in the year prior to diagnosis (p< .05). 21% of women and 19% of men reported persistent high fatigue throughout the first year (p=.13). Mean fatigue was significantly higher (p< .005) in women at all time points (Figure).

In multivariable regression that included all variables, predictors of persistent high fatigue in women were obesity (OR 1.7; 95% CI 1.1, 2.6), initial steroid use (OR 1.7; 95% CI 1.1, 2.7), seronegativity (OR 0.6; 95% CI 0.4, 1.0) and poor sleep (OR 1.1; 95% CI 1.0, 1.2). In men, obesity was the only significant predictor and was associated with a 2.4 times higher odds (95% CI 1.1, 5.1) of persistent fatigue at 1 yr. Other sociodemographic and RA characteristics, CEB and personal/health factors were not associated with persistent high fatigue in either sex in multivariable models.

Conclusion: Obesity is common in ERA and an important contributor to persistent high fatigue in both women and men. In obese RA patients on guideline-based treatment, lifestyle interventions targeting weight loss may play an important role and strategies to improve mood and manage stress may help reduce persistent high fatigue that does not improve with RA treatment.

Table 1 ACR Predictors by Sex FINAL

Figure Mean fatigue by sex ACR2019

Table 2 ACR Predictors by Sex Final

Disclosure: S. Bartlett, Abbie, 2, Abbvie, 2, 5, Bayer, 5, International Society of QOL Research, 6, Janssen, 5, 8, Lilly, 5, Merck, 5, 8, Novartis, 5, 8, Pfizer, 5, Pfizer Inc, 8, PROMIS International, 6, UCB, 5, 8; O. Schieir, None; M. Valois, None; J. Pope, AbbVie, 5, Abbvie, 5, Actelion, 5, Actellion, 5, Amgen, 2, 5, AstraZeneca, 2, Astra-Zeneca, 2, Bayer, 2, 5, BMS, 2, 5, Eicos Sciences, 5, Eli Lilly & Company, 5, Eli Lilly and Company, 5, EMERALD, 5, Emerald, 5, Genzyme, 5, Janssen, 5, Lilly, 5, Merck, 2, 5, Novartis, 5, Pfizer, 2, 5, Roche, 2, 5, Sandoz, 5, Sanofi, 5, Seattle Genetics, 2, UCB, 2, 5, 8; L. Bessette, AbbVie, 2, 5, 8, Abbvie, 2, 5, 8, Amgen, 2, 5, 8, Amgen, BMS, Janssen, Roche, UCB Pharma, AbbVie Inc, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., 2, 5, 8, BMS, 2, 5, 8, Bristol-Myers Squibb, 2, 5, 8, Bristol-Myers-Squibb, 2, 5, 8, Celgene, 2, 5, 8, Eli Lilly, 2, 5, 8, Eli Lilly and Company, 2, 5, 8, Janssen, 2, 5, 8, Lilly, 2, 5, 8, Merck, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Pfizer Inc, 2, 5, Roche, 2, 5, 8, Sanofi, 2, 5, 8, UCB, 2, 5, 8, UCB Pharma, 2, 5; C. Hitchon, Pfizer, 2, UCB, 2, UCB Canada, 2; C. Thorne, Abbvie, 2, 5, Amgen, 2, 5, CaREBiodam, 2, Celgene, 2, 5, Centocor, 5, Janssen, 5, Lilly, 5, Medexus/Medac, 5, 8, Merck, 5, Novartis, 2, 5, Pfizer, 2, 5, Sandoz, 5, Sanofi, 5; D. Tin, None; G. Hazlewood, None; G. Boire, Abbvie, 2, Amgen, 2, 5, BMS, 2, 5, 8, Bristol-Myers Squibb, 2, 5, 8, Celgene, 5, Eli Lilly, 2, 5, Lilly, 2, 5, Merck, 2, 8, Novartis, 2, Pfizer, 2, 5, 8; E. Keystone, Abbvie, 2, 5, 8, Amgen, 2, 5, 8, AstraZeneca, 5, Astra-Zeneca, 5, Biotest, 5, BMS, 2, 5, 8, Celltrion, 5, Crescendo, 5, Crescendo Bioscience, 5, F. Hoffmann-La Roche Inc, 2, 5, 8, Genentech, 5, Genentech Inc., 5, Genzyme, 5, Gilead, 2, 5, Gilead Sciences, Inc., 5, Janssen, 2, 5, 8, Lilly, 2, 5, 8, Merck, 5, 8, Pfizer, 2, 5, 8, Pfizer Pharmaceuticals, 2, 5, 8, Roche, 2, 5, 8, Sandoz, 5, Sanofi, 2, 5, 8, Sanofi-Aventis, 2, 8, UCB, 5, 8; V. Bykerk, AbbVie, 5, Amgen, 1, 2, 3, 5, 8, Brainstorm Therapeutics, 1, 2, 3, 5, 8, Bristol-Myers Squibb, 5, Genentech, 5, Gilead, 5, NIH, 2, Pfizer, 1, 2, 3, 5, 8, Regeneron, 5, Regeneron Pharmaceuticals, Inc, 5, Sanofi, 5, Sanofi/Genzyme-Regeneron, 5, Sanofi-Genzyme/Regeneron, 1, 2, 3, 5, 8, Scipher, 1, 2, 3, 5, 8, The Cedar Hill Foundation, 9, UCB, 1, 2, 3, 5, 8, UCB Pharma, 5; C. (CATCH) Investigators, Amgen, 2, Pfizer Canada, 2, AbbVie Corporation, 2, Medexus Inc., 2, Eli Lilly Canada, 2, Merck Canada, 2, Sandoz Canada Biopharmaceuticals, 2.

To cite this abstract in AMA style:

Bartlett S, Schieir O, Valois M, Pope J, Bessette L, Hitchon C, Thorne C, Tin D, Hazlewood G, Boire G, Keystone E, Bykerk V, (CATCH) Investigators C. Obesity Is a Robust Predictor of Persistent High Fatigue at 1 Year in Women and Men with Early Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/obesity-is-a-robust-predictor-of-persistent-high-fatigue-at-1-year-in-women-and-men-with-early-rheumatoid-arthritis/. Accessed .

« Back to 2019 ACR/ARP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/obesity-is-a-robust-predictor-of-persistent-high-fatigue-at-1-year-in-women-and-men-with-early-rheumatoid-arthritis/