The Effect of Fatigue on Rheumatoid Arthritis Patients

Varying prevalence of fatigue from RA has been reported due to differences in definitions and measures.

Measuring fatigue in rheumatoid arthritis (RA) and optimizing its treatment is becoming an increasingly important part of care, according to findings from 3 studies presented at the European League Against Rheumatism Annual Congress (EULAR 2015) meeting held in Rome earlier this year.

The teams of researchers aimed to measure the effect of chronic fatigue of RA patients and understand how it is managed. This is especially important because varying prevalence of fatigue have been reported due to differences in definitions and measures.

One major study in particular reported 42% of RA patients have fatigue, though other studies have reported fatigue in adult RA patients at 80% prevalence or higher.

The 3 studies separately determined:

• First, patients with RA who have chronic fatigue are not well managed by health care professionals. More than three quarters (79%) of patients reported their fatigue had never been measured. A press release noted that these recommendations for validating fatigue in RA include measurements to improve patient outcomes.
• Secondly, guidelines are in development phases to validate clinically significant fatigue in RA patients.
• Finally, transient changes in fatigue are likely not linked to transient changes seen in RA disease activity — and the statement noted this was contrary to the original hypothesis. The authors believed this indicated that treatments developed for disease remission would likely not affect fatigue treatments in RA patients.

“One of the most important findings was that chronic fatigue in RA patients is not being well managed by health care professionals: 66% of respondents had never or rarely been asked about it, and 79% said their fatigue had never been measured,” explained Ailsa Bosworth of the National Rheumatoid Arthritis Society, Maidenhead, United Kingdom, in the statement regarding the first conclusion.

Bosworth continued by adding that by improving the management of fatigue linked to RA, validated fatigue measurements would be an essential component to the revision of the current guidelines.

Regarding the third study, lead investigator Rinie Geenen of the Department of Clinical and Health Psychology University Medical Center in Utrecht, Netherlands, explained that the treatment directed as RA disease remission would not treat fatigue because the mechanisms are separate.

The lead researchers from the second study added in their Chronic Related Fatigue interview was completed by 291 women with systemic sclerosis and 278 women successfully treated for breast cancer. In that study, the researchers were able to identify fatigue among sclerosis patients.

“This lack of association between fatigue and objective disease activity markers in patients with RA is counterintuitive since patients and doctors consider fatigue an indicator of underlying disease activity,” Professor Geenen explained.