Background The primary goal of treatment for rheumatoid arthritis (RA) is to maximize health-related quality of life (HRQL) through symptom and damage control, and normalize function and participation in social and life activities. Although fatigue is recognized as one of the most debilitating symptoms of RA, little is known about how fatigue impacts participation.
Objectives We hypothesized that fatigue, along with pain, mood, disease activity, and disability would be associated with reduced participation.
Methods RA patients enrolled in an observational study at an academic center completed PROMIS measures assessing fatigue, physical function, mood (depression and anxiety), pain interference, sleep disturbance, and participation. RA clinical indicators were also collected at the visit. Variance inflation factors were examined to evaluate collinearity among variables. Covariates/confounders independently associated with participation included pain, mood (depression, anxiety), sleep, disease activity (CDAI), and physical function. Multiple regression models that did and did not include pain were compared using likelihood ratio tests with SPSS and R.
Results Participants were mostly female (82%) and white (83%) with mean (SD) age of 56 (13) years; 24% had ≤ high school, 29% had RA ≤5 years with 13% ≤2 years, and 22% were disabled. Mean CDAI was 7.9 (7.8). Most were in CDAI remission (n=56; 32%) or LDA (n=67; 38%); 39 (22%) were in MDA and 14 (8%) in HDA. Mean PROMIS fatigue was 53.9 (10.0); fatigue increased across CDAI levels from 46.2 (8.6) in remission to 64.0 (9.6). Only those with HDA had mean sleep, depression or anxiety scores >55 (i.e., above population norms).
In the full model, fatigue, depression, CDAI, and physical function were significant independent predictors of reduced participation in social roles and activities (F (2, 162) =29.75, p<.001, adjusted r2=.55). Contrary to our hypothesis, pain was not associated with participation in univariate or multivariate models.
Conclusions Our results suggest that in RA patients, high levels or fatigue are common; conversely, depression, anxiety, and sleep disturbance were elevated only in people with HDA. Disability and fatigue appear to have the greatest impact on participation in social roles and activities. RA treatments and interventions that attenuate fatigue and improve mood in people with active RA may improve their ability to participate in social and life situations restoring a sense of normalcy and improving HRQL.
Acknowledgements Funding: PCORI IP2-PI0000737 and SC14–1402–10818, CIHR 312205.
Disclosure of Interest None declared