Background Fatigue is common to all the rheumatic conditions, in varying degrees, and is a frequent, often severe problem that has major consequences on patients life.
Objectives To evaluate the fatigue in a group of patients with spondyloarthritis and possible associations with anemia, disease activity index and degree of pain with fatigue experienced by patients.
Methods Patient’s demographic data were collected. The Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT F), version 4- Portuguese translation available, was applied for fatigue measurement. Scores range from 0 to 160, with lower scores reflecting greater fatigue. Patients were grouped by predominant axial or peripheral involvement. Clinical measures were collected according to the predominant involvement (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) for the axial and Disease Activity Score in 28 joints- erythrocyte sedimentation rate (DAS28- ESR) for the peripheral). In all, global assessment (PGA) of disease activity, pain on a 0-100-mm visual analog scale (VAS) and laboratory findings were recorded. Correlation studies were performed with Spearman test.
Results A total of 51 patients were consecutively included, 32 (62.7%) were male and 19(37.3%) were female, with a mean age of 44.1±13.9 years (17 to 69) and a median disease duration of 137.6±110.1 months (7 to 445). The predominant involvement was axial in 28 (54.9%) patients and peripheral in 23 (45.1%). Nineteen (37.3%) patients were treated with biological therapies and 24 (47.1%) with classical disease-modifying anti-rheumatic drugs (DMARDs). Mean DAS28 was 2.41±1.26 (0.53 to 4.76) and BASDAI 2.78±2.43 (0 to 8.24), mean fatigue question in BASDAI of 3.03±2.98 (0 to 10) and mean BASFI was 3.31±2.89 (0 to 9.3). Mean of PGA and pain scores on a VAS was 31.51±25.44 and 32.57±29.1 respectively. FACIT-F scored from 61 to 158 (mean of 112.37±23.44). Mean FACIT-F was statistically significant lower in women than men (p<0.05) and the functional component of FACIT-F lower in patients with predominant peripheral involvement (p<0.05). Correlation with FACIT-F total score was strongest for BASFI (r= -0.710; p<0.01); BASDAI (r= -0.501; p<0.01); BASDAI-fatigue (r=-0.466; p<0.01), pain (r= -0.505; p<0.01), PGA (r=-0.455; p<0.01) and age (r=-0.404; p<0.01). DAS28, hemoglobin and ESR correlated with the physical component of the FACIT-F (r=-0.538; r=0.356; r=-0.382 with a p<0.05) but not with the total FACIT-F score. Fatigue levels were not significantly different between patients on biologic or other treatments.
Conclusions Fatigue is an important symptom in patients with inflammatory arthritis. FACIT-F is a psychometrically sound measure of the fatigue in different domains. The FACIT-F showed a good (negative) correlation with measures of pain, disease assessment and disease function, showing a trend to be lower in patients with higher activity. No association was found with therapy, disease duration, acute-phase reactants or anemia.
References Webster k, Cella D, Yost K. The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: properties, applications, and interpretation. Health and Quality of Life Outcomes 2003, 1:79
Disclosure of Interest None Declared
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