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  1. Rocío Violeta Gamboa Cárdenas1,
  2. Manuel F. Ugarte-Gil2,
  3. Cristina Reategui Sokolova3,
  4. Luz Hipólito4,
  5. Mariela Medina3,
  6. Claudia Elera-Fitzcarrald5,
  7. Victor Pimentel Quiroz3,
  8. Paola Alejandra Zeña Huancas3,
  9. Francisco Zevallos3,
  10. Samira Garcia-Hirsh3,
  11. Luciana Gil3,
  12. Zoila Rodriguez Bellido3,
  13. Cesar Pastor Asurza3,
  14. Risto Perich Campos3
  1. 1Hospital nacional Guillermo Almenara es Salud, Rheumatology, Lima, Peru
  2. 2Universidad Científica del Sur, Rheumatology, Lima, Peru
  3. 3Hospital Nacional Guillermo Almenara Essalud, Rheumatology, Lima, Peru
  4. 4Hospital Emergencias Grau EsSalud, Rheumatology, Lima, Peru
  5. 5Universidad Científica del Sur, Rheumatology, Lima, Peru


Background Chronic fatigue negatively impacts on quality of life in Rheumatoid Arthritis (RA) patients (1,2), does not allow optimal clinical results, being an negative predictor for clinical remission (3,4).

Objectives The objective was to determine whether disease activity correlates with increased fatigue in the follow-up of a RA patients.

Methods Prospective study of the RA-Almenara cohort (criteria ACR87/ACR-EULAR2010). Patients were included with at least two evaluations (half-yearly). Patients with fibromyalgia, major depression and/or anxious depressive disorder, chronic neuropathic pain or active systemic manifestations (including interstitial lung disease) were excluded. Disease activity was evaluated with SDAI (Simple Disease Activity Index) and fatigue with FACIT questionnaire (Functional Assessment of Chronic Illness Therapy-fatigue). A generalized estimation equation model was used to determine the association between SDAI and FACIT, at each visit according with two models of analyses. Model 1 considered SDAI value as a linear variable; Model 2 considered each category of SDAI (high, moderate and low) activity, using remission as reference. Multivariable analyses were adjusted by possible confounders: gender, age at diagnosis, instruction, socio-economic level (Graffar), disease duration, tobacco, ACPA level, disability (MDHAQ), use of conventional (c) and biologic(b) DMARDs and corticosteroids (current use, past or non-use).

Results Four hundred and twenty patients were included, 372 (88.6%) women, age at diagnosis was 44.1 (13.2) years, disease duration 17.7 (11.6) years. At the baseline 4.2% 13.6%, 41.0% and 41.2% were in remission, low, moderate and high activity respectively; 40% were using corticosteroids, 256 (61%) cDMARDs and 25 (6%) bDMARDs. Basal SDAI was 23.7 (20.4) and FACIT 17.2 (8.8). We analyzed 1233 follow up visits [2.2 (1.2) visits per patient]. Multivariablee analysis: In model 1 were associated with FACIT: SDAI [B: -0.03 (IC95%: - 0.06- -0.01;p=0.013] and MHAQ [B: -9.55 (IC95%: - 10.55- -0.54), p = <0.001]. In model 2, were associated with FACIT: the categories high [B: -4.92 (IC95%: -6.87 – -2.7); p <0.001], moderate [B: -3.75 (IC95% : -5.70- -1.89), p <0.001] and low [B: -2.22 (95% CI: - 4.05- -0.39); p = 0.018] disease activity by SDAI, in addition with MHAQ [B: -9.11 (IC95%: - 10.11- -8.11), p <0.001] and tobacco use [B: -3.37 (95% CI: - 6.56- -0.18, p = 0.039)]

Conclusions Higher disease activity correlates with worse fatigue scores, at each follow-up visits of patients with RA

Reference [1] Balsamo. Isr. Med. Assoc. J. 2014, 16, 57–60. 2. Alomari. Sci. World J. 2012:580863. doi: 10.1100/2012/580863. 3. Roodenrijs. Ann Rheum Dis. 2018 Sep 7. pii: annrheumdis-2018-213687. 4 Uhlig. J Rheumatol. 2016;43(4):716–23

Disclosure of Interests None declared

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