Background Fatigue is an important domain in the assessment of disease impact but has rarely been evaluated consistently after initiation of treatment in Rheumatoid Arthritis (RA) patients. Due tothe known efficacy of TNF inhibitors in the treatment of RA, their effect still remains controversial when specifically applied to the treatment of fatigue.
Objectives To examine the efficacy of anti-TNF treatment on fatigue that is an important systemic symptom in patients with rheumatoid arthritis and to evaluate the relationship between fatigue with depression and sleep disturbance and disease activity.
Methods In this study 39 active RA patients were included. Fatigue was evaluated using the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). The 28 joint disease activity score (DAS28) was calculated. Pain was assessed using a visual analog scale (VAS). Sleep quality was assessed by Pittsburg Sleep Quality Index (PSQI), and functional disability by Health Assessment Questionnaire (HAQ), and depression by Beck Depression Inventory (BDI) at baseline and third month of anti-TNF treatment.
Results The mean age of patients was 50.7±10.7years. The mean disease duraton at enrollment was 115.9±100.4months. At baseline, the mean total score of MFSI-SF was 28.7±18.At 3th month, fatigue score fell to 10.4±18.1 (p<0.001).
The initial clinical measures showed that MFSI-SFscores were significantly correlated with disease activity measures, including DAS28 and VAS pain and also HAQ, and tender joint count (p=0.007, p=0.01; p<0.001, p=0.011, respectively) MAF-SI also showed a significant correlation with PSQIand BDI (p=0.034, p=0.001 respectively).
In the multivariate linear regression analysis, BDI was the most powerful predictor of fatigue (β=1.142, p<0.001, 95% CI 0.654-1.630), whereas HAQ was also a significant predictor of fatigue. The stepwise hierarchical regression analysis showed that two variables (BDI and HAQ) explained 65% of the variation in fatigue with the MAF-SI scale as the dependent variable.
Conclusions Fatigue was experienced by almost 90% of patients with RA. Fatigue significantly associated with disease activity. The depression and functional disability were the strongest predictors of fatigue. Our results showed that fatigue decreased significantly when active RA was treated with anti-TNF.
Minnock P, Kirwan J, Bresnihan B. Fatigue is a reliable, sensitive and unique outcome measure in rheumatoid arthritis. Rheumatology 2009;48:1533-36.
Yount S, Sorensen MV, Cella D N et al. Adalimumab plus methotrexate or standart therapy is more effective than methotrexate or standar therapies alone in the treatment of fatigue in patients with active, inadequately treated RA. Clin Exp Rheumatol 2007;25(6):838-46.
Pollard LC, Choy EH, Gonzalez J et al. Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology 2006;45:885-889.
Disclosure of Interest None Declared
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