Background Fatigue is a major symptom in patients with inflammatory rheumatic diseases (IRD) that often severely affects quality of life and participation. While improved treatment strategies have reduced radiologic progression, fatigue often persists [1].

Objectives To explore the frequency of fatigue and its relationship to physician- and other patient-reported outcomes in patients with IRD.

Methods In 2020, 7637 patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA) or systemic lupus erythematosus (SLE) reported fatigue in the National Database of the German Collaborative Arthritis Centres [2]. Fatigue, pain, physician (PhGl) and patient global (PtGl) disease activity, PtGl health status (all on numeric rating scales, 0-10) were categorized into three groups (mild (0-3), moderate (4-6), severe [7-10]. Depressive symptoms assessed by WHO-5 well-being (0-100) were categorized to no (>50), mild (29-50) and moderate to severe (<29). The frequency and severity of fatigue was compared in terms of the rheumatic diseases, age, sex, disease duration and sociodemographics. Violin plots show the relationship between fatigue and the other outcomes.

Results A total of 4900 patients (84%) reported fatigue. Higher mean values were observed in patients with axSpA (4.3) compared to PsA (3.9), RA (3.8) and SLE (3.7) (table 1). Female and elderly patients, singles, and patients with little education years reported more fatigue. No difference in fatigue severity was found between patients with initial diagnosis and those with long-term disease. More fatigue was related to a poorer global health status, higher PhGl and PtGl disease activity, higher levels of pain, and more severe depressive symptoms (figure 1). Patients with concomitant fibromyalgia or depression reported worse fatigue compared to those with no or other comorbidities.

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Figure 1.

Relationship between fatigue and pain, global health, disease activity and depressive symptoms

Conclusion Fatigue is a frequent symptom across various inflammatory rheumatic diseases. A strong relationship to global health, disease activity, pain and depressive symptoms needs to be considered in the (individual) therapeutic management of the diseases that relies on a shared decision making.

References [1]PMID 26509063,

[2]PMID: 35793877

Acknowledgements We thank all participating rheumatologists and patients for their valuable contributions.

The NDB is supported by the Association of Regional Cooperative Rheumatology Centres, the German Society for Rheumatology and joint contributions to the Rheumatological Training Academy and the DRFZ by the following members of the Working Group of Corporate Members of the German Society for Rheumatology: AbbVie, AstraZeneca, BMS, GALAPAGOS, GSK, Lilly, Medac, MSD, Pfizer, Sanofi-Aventis and UCB.

Disclosure of Interests Christina Duesing Speakers bureau: Novartis, GSK, medac, Consultant of: GSK, Katja Thiele: None declared, Katinka Albrecht: None declared, Siegfried Wassenberg: None declared, Johanna Callhoff Speakers bureau: Janssen Cilag GmbH, Jutta Richter: None declared.