Fatigue Significantly Impacts Numerous Aspects of Life in Patients with RA, AxSpA, PsA

Inflammatory arthritis (IA) patients often experience fatigue; 41% to 51% of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) patients suffer from severe fatigue. Patients with these rheumatic diseases who are plagued by fatigue may suffer in several domains, including quality of life, work impairment, depression, and more, according to a new study.

“Fatigue is considered a multidimensional and complex phenomenon and is found to be associated with pain, sleep problems and low physical activity. Also, severe fatigue has been found to predict depression, low physical activity and quality of life, and more healthcare utilization,” the researchers wrote. “On the other hand, depression, reduced illness beliefs, psychological distress and low self-efficacy have been found to contribute to fatigue. There is limited literature on the correlation between disease-specific and socioeconomic factors.”

RA, PsA, and axSpA patients in Denmark were recruited at an outpatient rheumatology clinic and invited to fill out a survey including disease characteristics, socioeconomic factors, and patient-reported outcomes (PROs)—measured using the FACIT-Fatigue sub-scale, Work Productivity and Activity Impairment scale (WPAI), EuroQol (EQ-5D), Medical Outcomes Study Sleep Scale (MOS), Major Depression Inventory (MDI), and Health Assessment Questionnaire (HAQ).

Final analysis included 487 patients with RA (n=292; 60%), axSpA (n=110; 23%), and PsA (n=85; 17%). The mean age was 53.4 years, and most of the cohort was female (62%). The overall mean fatigue score was 34.4; when measured by disease, it was 34.9 in the RA group, 34.8 in the axSpA group, and 31.8 in the PsA group. The following factors were associated with fatigue:

• Female sex
• Being a more experienced patient
• 12-month history of changing medications
• Unemployment
• Less education
• Lower household income

Fatigue was correlated with all PROs, adversely impacting work, quality of life, sleep, depression, physical functioning, and pain. No significant associations were observed between type of IA, age, or current treatment and fatigue.

The study was published in PLOS ONE.

“People with IA report fatigue as a key issue that rheumatologists frequently overlook, and consequently patients often believe they should accept fatigue as a part of their condition. However, based on the complexity of fatigue as we identified, rheumatologists and other health professionals instead need not only to be aware of the impact of fatigue on the individual patient’s life, but also to focus their care specifically on the relationship of fatigue with other aspects of the patient’s everyday life,” the researchers wrote. They concluded that fatigue is not a single problem but “a symptom that broadly affects the lives of people with IA.”