Background Many patients diagnosed with AS or PsA experience chronic fatigue or low energy which can persist during treatment and affect health related quality of life (HRQOL) and the ability to work.
Objectives To assess self-reported fatigue in patients with AS and vitality in those with PsA, HRQOL and employment status.
Methods In this fatigue and HRQOL study of a cross-sectional survey from 5 European countries and the USA, physicians with 3–30 years' experience were eligible if treating patients with AS or PsA. Inclusion of patients was not restricted by treatment. Patients reported HRQOL (EQ-5D and SF-36), Work Productivity and Activity Impairment Questionnaire (WPAI) as well as other items. AS patients rated their fatigue using BASDAI (BASDAI-Fatigue). In PsA the SF-36 vitality domain (VT) was used to assess fatigue. Fatigue was classified in AS as non-severe (BASDAI-Fatigue <5) to severe (BASDAI-Fatigue ≥5). In PsA tertiles using SF-36 VT were applied to stratify fatigue: low (>65 to 100), moderate (45 to 65) high (0 to <45).
Results Results are presented from 910 patients with AS (613 EU/297 USA) and 1136 with PsA (762/374) who completed questionnaires.
Among AS patients who answered the BASDAI-Fatigue item, 42.0% [373/889] reported severe and 58.0% [516/889] non-severe fatigue. Tertiles of fatigue in PsA were defined based on responses from 1108 patients, who answered the SF-36 VT as: 33.6% [372/1108] low, 35.4% [392/1108] moderate and 31.0% [344/1108] high fatigue.
AS patients reporting severe fatigue had significantly worse HRQOL than those with non-severe fatigue: EQ-5D utility (0.64 vs 0.89); SF-36 physical component summary (PCS) (52.7 vs 82.3); mental component summary (MCS) (54.4 vs 75.9) scores. All SF-36 domains were also significantly lower (all p <0.0001).
PsA patients with high fatigue reported significantly worse HRQOL than those with low or moderate fatigue: EQ-5D (0.60 vs 0.93 and 0.81 respectively); SF-36 PCS (49.7 vs 90.2 vs. 74.1); SF-36 MCS (48.4 vs 84.4 vs. 67.3). All SF-36 domains were significantly worse, omitting VT as this was used for PsA fatigue classification. (all p <0.0001)
Patients with AS reporting severe fatigue had significantly greater overall work impairment due to their disease than those with non-severe fatigue (WPAI (mean): 41.7% vs 13.7%; p <0.0001). Similar significant associations were evident with PsA patients with high, low, moderate fatigue: 43.1% vs 8.9% and 20.0% respectively (p <0.0001).
Among 156 AS patients reporting additional information on retirement or unemployment, 98 had severe and 58 non-severe fatigue. Those with severe fatigue had significantly higher rates of retirement or unemployment due to AS (49.0% vs. 22.4%; p=0.0012).
Conclusions This large analysis of patient-reported data shows that fatigue is common in AS and PsA with a substantial number reporting high/severe fatigue. Fatigue significantly affects HRQOL, social functioning, work productivity and therefore impacts patients' daily life as well as societal costs.
Disclosure of Interest P. Conaghan Speakers bureau: Abbvie, Janssen, Lilly, Novartis, Pfizer and Roche, A. Deodhar Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Janssen, Novartis, Pfizer and UCB, Consultant for: AbbVie, Amgen, Boehringer Ingelheim, Janssen, Novartis, Pfizer and UCB, V. Strand Consultant for: Abbvie, Amgen Corporation, AstraZeneca, BMS, Celgene, Celltrion, CORRONA, Genentech/Roche, GlaxoSmithKline, Janssen, Jazz Pharmaceuticals, Lilly, Novartis, Pfizer, Regeneron, Sandoz, Sanofi and UCB, R. Alten Grant/research support from: Novartis, Speakers bureau: Novartis, E. Sullivan Consultant for: Novartis, S. Blackburn Consultant for: Novartis, H. Tian Employee of: Novartis, K. Gandhi Shareholder of: Novartis, Employee of: Novartis, S. Jugl Shareholder of: Novartis, Employee of: Novartis