Background Fatigue in RA has a multi-causal pathway. It is recommended that it should be measured in all RA studies using a validated instrument. Fatigue in elderly patients could have a different perception than in younger patients, identifying the associated factors could be a key to the management of this complex symptom.
Objectives To compare fatigue and its associated factors in young and elderly patients with RA from two university hospitals.
Methods A cross-sectional analysis was performed in 167 RA patients diagnosed according to the 2010 ACR-EULAR criteria. Patients were divided into two groups based on age (≥60 and <60) for comparative purposes. Fatigue was assessed using 4 instruments: the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), the fatigue subscale of the Short-form 36 survey (fatigue-SF36), the Visual Analogic scale of fatigue (VASf) and the Functional Assessment of chronic illness Therapy Fatigue Scale (FACIT-F). To compare the mean of fatigue between groups we used a T-Test.
To determine in each group of patients (young and elderly patients) the relationship between the 4 subscales of fatigue (assessed by BRAF-MDQ) and the other variables (DAS28, CPR, ESR, hemoglobin, vitamin D, HAQ, RAID [Rheumatoid Arthritis Impact of Disease], SF36, Hospital Anxiety and depression Scale [HAD] and Brief Pain Inventory) a Spearman correlation was performed. A value of p < 0.05 was accepted as statistically significant.
Results A total of 167 patients were included, 81 (48.5%) young and 86 (51.5%) elderly patients. We found fatigue (using 4 instruments) has not significant differences in young and elderly patients (Table 1). In young and elderly patients, physical, living, cognitive and emotional fatigue were correlated to RAID, SF36, HAD and pain but they were not associated to CRP, ESR, hemoglobin and vitamin D. In young patients, all dimensions of fatigue were associated with DAS28. Furthermore, in elderly patients we found a relationship between physical (p-value 0.044) and living fatigue (p-value 0.012) with DAS28, nevertheless cognitive and emotional fatigue (p-value 0.078 and 0.079 respectively) were not related.
Conclusion In young and elderly patients, all dimensions of fatigue appear to be related with subjective but not with objective variables. In young patients, all dimensions of fatigue were associated with DAS28 but in elderly patients only physical and living fatigue were correlate to disease activity. These results could indicate that it is important to evaluate fatigue in a multidimensional perspective in elderly patients.
References Belza BL, Henke CJ, Yelin EH, Epstein WV, Gilliss CL. Correlates of fatigue in older adults with rheumatoid arthritis. Nurs Res. 1993 Mar-Apr;42(2):93-9.
Hewlett S, Dures E, Almeida C. Measures of fatigue: Bristol Rheumatoid Arthritis Fatigue MultiDimensional Questionnaire (BRAF MDQ), Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales (BRAF NRS) for severity, effect, and coping, Chalder Fatigue Questionnaire (CFQ), Checklist Individual Strength (CIS20R and CIS8R), Fatigue Severity Scale (FSS), Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F), Multi-Dimensional Assessment of Fatigue (MAF), Multi-Dimensional Fatigue Inventory (MFI), Pediatric Quality Of Life (PedsQL) Multi-Dimensional Fatigue Scale, Profile of Fatigue (ProF), Short Form 36 Vitality Subscale (SF36 VT), and Visual Analog Scales (VAS). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S263-86.
Disclosure of Interests None declared
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