Background Fatigue is a frequent symptom among patients with rheumatoid arthritis (RA) and contributes to decreased quality of life in these patients .There are various questionnaires to assess fatigue in rheumatic diseases among them the vitality scale from SF-36 .
Objectives To assess the effect of one year of biologic therapy on fatigue of RA patients and correlate it with other parameters of the disease like laboratory and clinical activity, function and the quality of life.
Methods 1029 patients from the Czech Registry of patients with RA (ATTRA), who had been treated with first line biological therapy for a minimum of 1 year, were analyzed. Following parameters were assessed at the start of biological therapy and 12 months after:
Fatigue was assessed using the ninth item from SF-36, question: “Did you feel tired during past 4 weeks?”
Humoral activity according to ESR and CRP, clinical activity was assessed by No. of tender and swollen joints and by patient's disease activity assessment (VAS100mm) and DAS28-CRP, function by HAQ and quality of life by EuroQOL and further items of SF-36 (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health).
Improvement, disease activity, function and quality of life after 12 month of biological therapy was assessed by counts (percentages) and median (interquartile range) when describing categorical and continuous variables respectively.
Significance of improvement after 12 months and significance of association between fatigue improvement and improvement in other parameters of disease was assessed using p-value of Wilcoxon Signed Ranks Test and Kruskal-Wallis H Test, respectively.
Results 1.After 12 months there is a significant improvement of fatigue as well as parameters of activity, function and quality of life (p<0,001 for all).
2.As to the correlation of the change in fatigue with the change of parameters of activity, function and the quality of life, the differences between patients in whom the fatigue improved were stronger as compared with patients in whom fatigue worsened, or remained stable.
3.The improvement of fatigue correlates most strongly with those parameters assessed by pats.,DAS28-CRP,CRPand ESR, less significantly (but still significantly) with tender joint count-p=0,02 and surprisingly not with swollen joint count.
Conclusions One year biological therapy of RA leads to significant improvement not only of clinical parameters of the disease, but also to significant improvement of fatigue. The improvement of fatigue strongly correlates with the improvement of clinical and humoral activity, function and quality of life. Absence of correlation with the No. of swollen joint is no clear and requires further clarification.
Suurmeijer TP, Walz M, MoumT, et al. Quality of life profiles in the first years of rheumatoid arthritis. Arthritis Rheum 2001;45:111-21.
Ware JE Jr, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36). Conceptual framework and item selection. Med Care 19925;30:473-83
Acknowledgements Aknowledgment: Supported by the Research program of the Ministry of health of Czech Republic: IGA MZ CR: No. 000 000 23728
Disclosure of Interest None declared