Session Information
Date: Monday, November 14, 2016
Title: Rheumatoid Arthritis – Clinical Aspects - Poster II: Co-morbidities and Complications
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
The mechanisms of fatigue in rheumatoid arthritis (RA) are still unclear and the effect of antirheumatic drugs on fatigue not fully established. Objectives: To analyse in a large cohort of RA the factors associated with fatigue focusing on social aspects, comorbidities and treatment intake.Methods:
Cross sectional analyses were performed on RA patients from the French cohort study of comorbidities COMEDRA (1). Fatigue was assessed as a quantitative variable (RAID3 0-10 numeric scale) or by class (acceptable <3; moderate 3-4; severe ≥5 out of 10). Relationship with demographic, social, disease characteristics, treatments, comorbidities, physical activity, quality of life was investigated in univariate analyses (Table) and multivariate polynomial regression (Figure).Results:
962 patients were analysed (age 57.7 ± 11.1 years, disease duration 11.1 years [6.2-19.1], mean DAS28 3.1 ± 1.3), 763 (79 %) were female. The mean fatigue score was 3.8± 2.7. Severe fatigue was more frequent in women, in patients not working, with less physical activity and more obesity. Fatigue was correlated with disease duration (p=0.05), all disease activity index (p<0.001), pain (p<0.001), mHAQ (p<0.001), sleep (p<0.001) and emotional well-being (p<0.001). Among comorbidities, hypertension, chronic obstructive pulmonary disease (COPD), fracture history and RA-related surgery were associated with fatigue. Multimorbidity assessed by the weighted multimorbidity index (MMI.weight) (2) was independently associated with severe fatigue as well as current treatment with NSAID or biotherapy. Methotrexate use and the type of biologic did not impact fatigue score.Conclusion:
Beyond the expected association of fatigue with female gender and disease activity, less physical activity, comorbidities and multimorbidity, treatments could contribute to the persistent fatigue noted in RA. Fatigue was associated with steroids, NSAIDs, biotherapies but not with methotrexate and did not depend of the type of biotherapy. 1. Dougados M et al. Ann Rheum Dis. 2015;74(9):1725-33 2. Radner H et al. Seminars in Arthritis and Rheumatism 2015;45 : 167–173|
RAID3 (0-10) Beta [95% CI] |
RAID3 by class, RR [95% CI] Moderate vs acceptable Severe vs acceptable | |
| Female gender n=763 | 1.03 [0.6;1.45] *** | 1.16 [0.78;1.70] 2.07 [1.43;3.01] *** |
| Low educational level n=680 | 0.38 [0.01;0.76] * | 0.95 [0.66;1.36] 1.33 [0.94;1.80] |
| Not working n=628 | 0.38 [0.02;0.74] * | 1.10 [0.78;1.56] 1.43 [1.05;1.94] * |
| Low physical activity n=353 | 0.69 [0.33;1.05] *** | 1.80[1.26;2.55] *** 1.71 [1.25;2.34]*** |
| BMI 25-30 n=276 ≥30 n=155 | 0.16 [-0.24;0.55] 1.20 [0.72;1.68] *** | 1.20 [0.83;1.75] 1.13 [0.81;1.59] 1.32 [0.78;2.23] 2.39 [1.56;3.67] *** |
| DAS28 2.6-3.2 >3.2 | 1.30 [0.86;1.74] *** 2.50 [2.15;2.84] *** | 2.20 [1.39;3.48] *** 3.13 [2.04;4.81] *** 3.89 [2.58;5.87] *** 9.35 [6.41;13.64] *** |
| Hypertension n=281 | 0.67 [0.29;1.05] *** | 1.19 [0.82;1.75] 1.75 [1.26;2.42] *** |
| COPD n=63 | 0.72 [0.02;1.41] * | 1.53 [0.73;3.20] 2.10 [1.12;3.93] * |
| Fracture history n=296 | 0.44 [0.06;0.81] * | 1.42 [0.99;2.04] 1.38 [0.99;1.90] |
| RA-related surgery n=287 | 0.40 [0.02;0.78] * | 0.99 [0.68;1.45] 1.27 [0.92;1.75] |
| Current NSAIDs n=249 | 0.75 [0.36;1.14] *** | 1.70 [1.14;2.52] ** 1.96 [1.39;2.77] *** |
| Current steroids n=364 | 0.75 [0.40;1.1] *** | 1.49 [1.05;2.11] ** 1.72 [1.27;2.33] *** |
| Biotherapy alone or in combination n=672 | 0.46 [0.07;0.84] * | 0.96 [0.67;1.38] 1.45 [1.04;2.01] ** |
***p<0.001; **p< 0.01; *p< 0.05. 
Disclosure: A. Tournadre, None; B. Pereira, None; L. Gossec, None; M. Soubrier, None; M. Dougados, AbbVie, Eli Lilly, Merck, Novartis, Pfizer, UCB Pharma, 2,AbbVie, Eli Lilly, Merck, Novartis, Pfizer, UCB Pharma, 5.
To cite this abstract in AMA style:
Tournadre A, Pereira B, Gossec L, Soubrier M, Dougados M. The Association of Fatigue, Comorbidities and Anti Rheumatic Drugs in Rheumatoid Arthritis: Results from French Cohort Study of Comorbidities [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-association-of-fatigue-comorbidities-and-anti-rheumatic-drugs-in-rheumatoid-arthritis-results-from-french-cohort-study-of-comorbidities/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-of-fatigue-comorbidities-and-anti-rheumatic-drugs-in-rheumatoid-arthritis-results-from-french-cohort-study-of-comorbidities/