The Relationship Between Fatigue and Disease Activity as Determined by Different Indices in Patients with Psoriatic Arthritis (PsA)

Mehmet Tuncay Duruoz¹, Halise Hande Gezer ², Kemal Nas ³, Erkan Kilic ⁴, Betul Sargin ⁵, Sevtap Acer Kasman ¹, Hakan Alkan ⁶, Nilay Sahin ⁷, Gizem Cengiz ⁸, Nihan Cuzdan ⁹, Ilknur Albayrak Gezer ¹⁰, Dilek Keskin ¹¹, Cevriye Mulkoglu ¹², Hatice Resorlu ¹³, Şebnem Ataman ¹⁴, Ajda Bal ¹⁵, Okan Kucukakkas ¹⁶, Ozan Volkan Yurdakul ¹⁶, Meltem Alkan Melikoglu ¹⁷, Yildiray Aydin ³, Fikriye Figen Ayhan ¹⁸, Hatice Bodur ¹⁹, Mustafa Calis ⁸, Erhan Capkin ²⁰, Gul Devrimsel ²¹, Kevser Gök ²², Sami Hizmetli ²³, Ayhan Kamanli ³, Yasar Keskin ¹⁶, Hilal Kocabas ²⁴, Oznur Kutluk ²⁵, Nesrin Sen ²⁶, Omer Faruk Sendur ²⁷, Ibrahim Tekeoglu ³, Sena Tolu ²⁸, Murat Toprak ²⁹ and Tiraje Tuncer ²⁵, ¹Marmara University School of Medicine, PMR Department, Rheumatology Division, İstanbul, Turkey, ²Marmara University School of Medicine, PMR Department, Rheumatology Division, İstanbul, Istanbul, Turkey, ³Sakarya University School of Medicine, PMR Department, Rheumatology and Immunology Division, Sakarya, Turkey, ⁴Afyonkarahisar State Hospital, Afyonkarahisar, Turkey, ⁵Adnan Menderes University School of Medicine, PMR Department, Rheumatology Division, Aydın, Turkey, ⁶Pamukkale University School of Medicine, PMR Department, Rheumatology Division, Denizli, Turkey, ⁷Balıkesir University School of Medicine, PMR Department, Balıkesir, Turkey, ⁸Erciyes University School of Medicine, PMR Department, Rheumatology Division, Kayseri, Turkey, ⁹Şanlıurfa Training and Research Hospital, Rheumatology Clinic, Şanlıurfa, Turkey, ¹⁰Selçuk University School of Medicine, PMR Department, Konya, Turkey, ¹¹Kırıkkale University School of Medicine, PMR Department, Kırıkkale, Turkey, ¹²Ankara Training and Research Hospital, PMR Clinic, Ankara, Turkey, ¹³Çanakkale Onsekiz Mart University School of Medicine, PMR Department, Çanakkale, Turkey, ¹⁴Ankara University School of Medicine, Physical Medicine and Rehabilitation, Rheumatology Department, Ankara, Ankara, Turkey, ¹⁵Dışkapı Yıldırım Beyazıt Training and Research Hospital, PMR Clinic, Ankara, Turkey, ¹⁶Bezmialem Vakıf University School of Medicine, PMR Department, İstanbul, Turkey, ¹⁷Atatürk University School of Medicine, PMR Department, Rheumatology Division, Erzurum, Turkey, ¹⁸Uşak University School of Health Sciences, PMR Department, Uşak, Turkey, ¹⁹Yıldırım Beyazıt University School of Medicine, PMR Department, Ankara, Turkey, ²⁰Karadeniz Teknik University School of Medicine, PMR Department, Trabzon, Turkey, ²¹Recep Tayyip Erdoğan University School of Medicine, PMR Department, Riza, Turkey, ²²Numune Training and Research Hospital, Rheumatology Clinic, Ankara, Turkey, ²³Cumhuriyet University School of Medicine, PMR Department, Rheumatology Division, Sivas, Turkey, ²⁴Necmettin Erbakan University Meram School of Medicine, PMR Department, Rheumatology Division, Konya, Turkey, ²⁵Akdeniz University School of Medicine, PMR Department, Rheumatology Division, Antalya, Turkey, ²⁶Kartal Dr. Lütfi Kırdar Training and Research Hospital, Rheumatology Clinic, İstanbul, Turkey, ²⁷Adnan Menderes University School of Medicine, PMR Department, Aydın, Turkey, ²⁸Medipol University School of Medicine, PMR Department, İstanbul, Turkey, ²⁹Yüzüncü Yıl University School of Medicine, PMR Department, Van, Turkey

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Disease Activity and patient outcomes, Fatigue, Psoriatic arthritis

Session Information

Date: Tuesday, November 12, 2019

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster III: Psoriatic Arthritis, Clinical Features

Session Type: Poster Session (Tuesday)

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

Background/Purpose: Fatigue is a substantial problem in patients with psoriatic arthritis (PsA) that needs to be considered in the core set of domains. This study aimed to evaluate the relationship between fatigue and disease activity levels as determined by various scales in patients with PsA.

Methods: A total of 1134 patients (726 females, 408 males) diagnosed with PsA according to the CASPAR criteria were included (Turkish League Against Rheumatism (TLAR) Network multi-center study). Demographic features and clinical conditions of the patients were recorded. The following parameters were assessed: Maastricht Ankylosing Spondylitis Enthesis Score (MASES), Psoriasis Area and Severity Index (PASI), VAS fatigue (0-10 points: 0 – < 2 absent or mild, 2 – < 5 moderate, and 5 – 10 severe fatigue), Hospital Anxiety and Depression Scale (HAD), Fibromyalgia Rapid Screening Tool (FIRST). Disease activity was evaluated using the scores of DAS28, DAPSA, BASDAI, minimal disease activity (MDA), and very low disease activity (VLDA). The Spearman correlation coefficient was used for correlations. The Mann-Whitney U and chi-squared tests were used for between-group comparisons. A P value of less than 0.05 was considered to be statistically significant.

Results: The mean age of the patients was 46.9 (SD:12.1) years, and the median disease duration was four years (range 0-44 years). The mean fatigue score was 4.9 (SD:2.8), being absent or mild, moderate, and severe fatigue in 14.8%, 24.9%, and 60% of the patients, respectively. The mean of women’s fatigue VAS was 5.4 (SD:2.7) while the men’s fatigue VAS mean was 4.01 (SD:2.7) (p< 0.05). Fatigue has good correlation with VAS-pain (rho: 0.595), FIRST (rho: 0.513), anxiety (rho: 0.436), depression (rho: 0.388), MASES (rho: 0.297) and it has poor correlation with PASI (rho: 0.073). DAS28 and DAPSA remission, MDA, and VLDA rates were 24.3%, 2.6%, 13.6%, and 2.3%, respectively. The fatigue score was significantly lower in patients with DAS28 remission, DAPSA remission, MDA and VLDA (p< 0.05) and fatigue has a significant correlation with disease activity levels on DAS28 and DAPSA (p< 0.05) (Table 1). The DAS28, DAPSA, and BASDAI scores showed significant between-group differences across the three severity groups of fatigue, being the highest disease activity among patients with severe fatigue (p< 0.05). Significantly higher FIRST, anxiety and depression scores were noted in patients with DAS28 remission and fatigue compared with patients in remission but no fatigue (p< 0.05).

Conclusion: Fatigue is common and associated with disease activity, depression, anxiety, and fibromyalgia in PsA. Patients with remission, according to DAS28, DAPSA, and patients with MDA and VLDA have already mild to moderate fatigue.

Fatigue Table1

Disclosure: M. Duruoz, İbrahim etem, 8, Abdi İbrahim, 8, Abdi Ibrahim, 8, Abvie, 2, 8, AMGEN, 8, AMGEN, Novartis, ILKO, ONKO, İbrahim Ethem, Abdi İbrahim, 8, Ibrahim Ethem, 8, ILKO, 8, Novartis, 8, ONKO, 8; H. Gezer, None; K. Nas, None; E. Kilic, None; B. Sargin, None; S. Acer Kasman, None; H. Alkan, None; N. Sahin, None; G. Cengiz, None; N. Cuzdan, None; I. Albayrak Gezer, None; D. Keskin, None; C. Mulkoglu, None; H. Resorlu, None; �. Ataman, None; A. Bal, None; O. Kucukakkas, None; O. Yurdakul, None; M. Alkan Melikoglu, None; Y. Aydin, None; F. Ayhan, None; H. Bodur, None; M. Calis, None; E. Capkin, None; G. Devrimsel, None; K. Gök, None; S. Hizmetli, None; A. Kamanli, None; Y. Keskin, None; H. Kocabas, None; O. Kutluk, None; N. Sen, None; O. Sendur, None; I. Tekeoglu, None; S. Tolu, None; M. Toprak, None; T. Tuncer, None.

To cite this abstract in AMA style:

Duruoz M, Gezer H, Nas K, Kilic E, Sargin B, Acer Kasman S, Alkan H, Sahin N, Cengiz G, Cuzdan N, Albayrak Gezer I, Keskin D, Mulkoglu C, Resorlu H, Ataman �, Bal A, Kucukakkas O, Yurdakul O, Alkan Melikoglu M, Aydin Y, Ayhan F, Bodur H, Calis M, Capkin E, Devrimsel G, Gök K, Hizmetli S, Kamanli A, Keskin Y, Kocabas H, Kutluk O, Sen N, Sendur O, Tekeoglu I, Tolu S, Toprak M, Tuncer T. The Relationship Between Fatigue and Disease Activity as Determined by Different Indices in Patients with Psoriatic Arthritis (PsA) [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/the-relationship-between-fatigue-and-disease-activity-as-determined-by-different-indices-in-patients-with-psoriatic-arthritis-psa/. Accessed .

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