A cross-sectional study of multidimensional fatigue in biologic-treated rheumatoid arthritis: which variables play a role?

Abstract

Purpose

Despite efficient biological disease-modifying antirheumatic drugs (bDMARDs) Rheumatoid Arthritis (RA) patients still suffer from high fatigue. This study aims to further our knowledge by assessing severity levels of the various fatigue dimensions and their associations with pain, sleep quality, and psychological well-being in bDMARDs treated RA patients.

Material and Methods

The sample consisted of 146 RA patients (84.9% females; mean age 56.6 ± 13.6 years), who completed the MFI-20, SF-36, PSQI, GAD-7 and PHQ-9. Correlation analyses and multiple linear regressions were used to analyse the data.

Results

General fatigue was the highest reported type of fatigue, followed by physical fatigue dimensions. In the final regression model, pain and disability were significantly associated with physical fatigue (p ≤ 0.001, p ≤ 0.05, respectively) and reduced activity (p ≤ 0.01, p ≤ 0.05, respectively). Anxiety was significantly associated with mental fatigue (p ≤ 0.05) and reduced motivation (p ≤ 0.01). Regression analyses showed no significant associations between depression, sleep quality, and fatigue in any of the final models.

Conclusions

Our findings indicate that effectively addressing fatigue in RA patients requires an individualized approach. This approach should acknowledge the varying degrees of fatigue across different fatigue dimensions (physical or mental), while also taking into account the patient’s mental health problems, pain levels, and disability levels.

Implications for Rehabilitation

• despite the high prevalence of fatigue in rheumatoid arthritis (RA), the patients reported that 79% of healthcare professionals do not assess fatigue during visits; therefore, a measure of fatigue should be a part of routine medical examinations

• rehabilitation professionals should evaluate multidimensional fatigue, which seems to be more informative than a single measure of severity

• development and use of an effective individual non-pharmacological management program, based on an understanding of the variables associated with multidimensional fatigue may help in improving the quality of life of patients with RA

Keywords:

• Rheumatoid arthritis
• fatigue
• pain
• sleep quality
• anxiety
• depression

Acknowledgements

The authors would like to thank the patients with RA from the Rheumatology outpatient department in Kosice who participated in this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Slovak Research and Development Agency under contract APVV-22-0587.