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  1. M. Garrido-Cumbrera1,
  2. V. Navarro-Compán2,
  3. L. Christen3,
  4. C. Bundy4,
  5. R. Mahapatra5,
  6. S. Makri6,
  7. C. J. Delgado-Domínguez1,
  8. J. Correa-Fernández1,
  9. S. Sanz-Gómez1,
  10. D. Poddubnyy7
  11. on behalf of IMAS working group
  1. 1Universidad de Sevilla, Health & Territory Research (HTR), Seville, Spain
  2. 2Hospital Universitario La Paz, IdiPaz, Madrid, Spain
  3. 3Novartis Pharma AG, Patient Engagement, Basel, Switzerland
  4. 4Cardiff University, School of Healthcare Sciences, Cardiff, United Kingdom
  5. 5Axial Spondyloarthritis International Federation (ASIF), Patient Advocacy, London, United Kingdom
  6. 6Cyprus League Against Rheumatism (CYPLAR), Patient Advocacy, Nicosia, Cyprus
  7. 7Charité - Universitätsmedizin Berlin, Rheumatology Department, Berlin, Germany


Background: Fatigue/tiredness is an essential aspect of disease for patients with axial spondyloarthritis (axSpA). However, little is known about its prevalence and associated factors.

Objectives: The aim is to assess the prevalence of fatigue and associated factors in a large sample of patients with axSpA patients from 13 European countries.

Methods: Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries were analyzed.

The presence of fatigue/tiredness was evaluated using the Visual Analogue Scale from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI): “How would you describe the overall level of fatigue/tiredness you have experienced? (0-10)”. Risk of poor mental health was assessed using the 12-Item General Health Questionnaire (GHQ-12; 0-12).

Possible associated factors included: Socio-demographic and disease characteristics, disease activity and function and mental health disorders.

The Mann-Whitney test was used to compare the means of variables of two categories vs. the numerical variables, the χ2 test was used to compare the distribution between the categorical variables. Binary logistic regression and multiple linear regression were used to identify possible predictors.

Results: A total of 2,846 axSpA patients participated in the EMAS survey: mean age was 43.9 years, 61.3% female, 48.1% had a university degree, 67.9% were married and 71.3% were HLA-B27 positive. Fatigue/tiredness was associated with younger age (6.4±2.3 vs 5.5±2.4), being female (6.6±2.2 vs 5.7±2.4), lower educational level (6.9±2.4 vs 6.0±2.0) and separated or divorced persons (6.8±2.2 vs 6.2±2.3; all p<0.001). Those reporting work impact (6.8±2.1 vs 5.8±2.4), physically inactive (6.9±2.2 vs 6.1±2.3) or those with sleep disorders (7.0±2.0 vs 5.8±2.4), anxiety (7.0 ± 2.0 vs 5.9±2.4) or depression (7.2±1.9 vs 5.9±2.4; all p<0.001) also presented greater fatigue, as did those with higher morning stiffness (r=0.499) and functional limitation (r=0.257), and poorer mental health GHQ-12 (r=0.419). Finally, the variables independently associated with fatigue were female gender (B=0.427), being physical inactive (B=-0.395) and those with greater morning stiffness severity (B=0.349; see Table 1). In addition, those on temporary and permanent sick leave, along with the unemployed, presented greater fatigue (7.1, 6.8 and 7.1 respectively).

Table 1.

Linear regression analysis to predict presence of fatigue/tiredness (N = 2052)

Conclusion: Fatigue/tiredness was highly prevalent among axSpA European patients with female gender, engage in physical activity and those with greater morning stiffness severity most strongly associated, and the unemployed presenting greatest fatigue.

Acknowledgements: This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests: Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

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