Katie L Druce1, Gareth T Jones1, Gary J Macfarlane1, Suzanne M M Verstappen1, Neil Basu2. 1. From the Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen, Aberdeen; Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.K.L. Druce, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.T. Jones, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.J. Macfarlane, MBChB, MD (Hons), PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; S.M. Verstappen, PhD, Arthritis Research UK Epidemiology Unit, University of Manchester; N. Basu, MBChB, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen. 2. From the Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen, Aberdeen; Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.K.L. Druce, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.T. Jones, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.J. Macfarlane, MBChB, MD (Hons), PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; S.M. Verstappen, PhD, Arthritis Research UK Epidemiology Unit, University of Manchester; N. Basu, MBChB, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen. epidemiology@abdn.ac.uk.
Abstract
OBJECTIVE: Fatigue is common and burdensome in rheumatoid arthritis (RA). Despite RA fatigue progression varying significantly between individuals in practice, existing longitudinal analyses only examine symptom advancement on a population level. This study aimed to determine fatigue trajectories at an individual level and to characterize those patients with the poorest prognosis, with a view to enabling earlier interventions. METHODS: Patients with RA reporting clinically relevant baseline fatigue (≥ 20 mm on a 0-100 mm visual analog scale) were identified from a longterm inflammatory polyarthritis cohort (the Norfolk Arthritis Register). Fatigue changes from baseline to 1- and 4-year followups were calculated, and sex-stratified group-based trajectory modeling (GBTM) determined trajectories of the symptom between which baseline characteristics were compared. RESULTS: Among 338 patients, only minimal average changes were observed between recruitment to 1 year (6.0 mm, SD 26.9) and 4 years (5.5 mm, SD 29.3). This was despite 45.6% and 40.7% of participants reporting clinically significant improvements (≥ 10 mm) at these respective followups. GBTM revealed varied trajectories of fatigue, which for both sexes consisted of Improved (men, n = 48 and women, n = 81) or persistent Moderate-high paths (n = 54, n = 105), and further included a persistent High trajectory in women (n = 50). Participants who followed persistent trajectories were best distinguished from improvers by patient-reported rather than demographic or clinical variables. CONCLUSION: Among patients with RA presenting with clinically relevant fatigue, distinct longitudinal symptom trajectories were identified on an individual level despite nominal average changes in fatigue on a group level. It is possible to identify and characterize subgroups of participants who report persistent fatigue and should therefore be targeted to receive future fatigue-alleviating interventions.
OBJECTIVE:Fatigue is common and burdensome in rheumatoid arthritis (RA). Despite RA fatigue progression varying significantly between individuals in practice, existing longitudinal analyses only examine symptom advancement on a population level. This study aimed to determine fatigue trajectories at an individual level and to characterize those patients with the poorest prognosis, with a view to enabling earlier interventions. METHODS:Patients with RA reporting clinically relevant baseline fatigue (≥ 20 mm on a 0-100 mm visual analog scale) were identified from a longterm inflammatory polyarthritis cohort (the Norfolk Arthritis Register). Fatigue changes from baseline to 1- and 4-year followups were calculated, and sex-stratified group-based trajectory modeling (GBTM) determined trajectories of the symptom between which baseline characteristics were compared. RESULTS: Among 338 patients, only minimal average changes were observed between recruitment to 1 year (6.0 mm, SD 26.9) and 4 years (5.5 mm, SD 29.3). This was despite 45.6% and 40.7% of participants reporting clinically significant improvements (≥ 10 mm) at these respective followups. GBTM revealed varied trajectories of fatigue, which for both sexes consisted of Improved (men, n = 48 and women, n = 81) or persistent Moderate-high paths (n = 54, n = 105), and further included a persistent High trajectory in women (n = 50). Participants who followed persistent trajectories were best distinguished from improvers by patient-reported rather than demographic or clinical variables. CONCLUSION: Among patients with RA presenting with clinically relevant fatigue, distinct longitudinal symptom trajectories were identified on an individual level despite nominal average changes in fatigue on a group level. It is possible to identify and characterize subgroups of participants who report persistent fatigue and should therefore be targeted to receive future fatigue-alleviating interventions.
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