Melissa Holdren1, Orit Schieir2, Susan J Bartlett3, Louis Bessette4, Gilles Boire5, Glen Hazlewood6, Carol A Hitchon7, Edward Keystone8, Diane Tin9, Carter Thorne9, Vivian P Bykerk10, Janet E Pope11. 1. University of Western Ontario, London, Ontario, Canada. 2. University of Toronto, Toronto, Ontario, Canada. 3. McGill University, Montreal, Quebec, Canada. 4. CHU de Québec-Université Laval, Laval, Quebec, Canada. 5. Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec, Canada. 6. University of Calgary, Calgary, Alberta, Canada. 7. University of Manitoba, Winnipeg, Manitoba, Canada. 8. Mount Sinai Hospital, Toronto, Ontario, Canada. 9. Southlake Regional Health Centre, Newmarket, Ontario, Canada. 10. Mount Sinai Hospital, Toronto, Ontario, Canada, and Hospital for Special Surgery and Weill Cornell Medicine, New York, New York. 11. University of Western Ontario and St. Joseph's Health Care London, London, Ontario, Canada.
Abstract
OBJECTIVE: To examine the relationship between disease activity and fatigue over time in early rheumatoid arthritis (RA). METHODS: Data were from patients with early RA (duration of symptoms ≤12 months) enrolled in the Canadian Early Arthritis Cohort (CATCH). Patients rated their fatigue over the past week using an 11-point numerical rating scale (NRS) for up to 5 years of follow-up. Fatigue severity was classified as low (≤2), moderate (>2 but <5), or high (≥5). Differences in fatigue ratings in patients who achieved a low disease state (Disease Activity Score in 28 joints [DAS28] <3.2) and those who did not within 3-months of cohort entry were compared. RESULTS: Of 1,864 patients included, 88% met RA criteria, and 72% were women. The mean ± SD baseline DAS28 was 4.9 ± 1.5. Nineteen percent of the patients reported moderate baseline fatigue, and 59% reported severe baseline fatigue. Fatigue was correlated with pain and patient global ratings (r = 0.56-0.67, P < 0.001), and was weakly correlated with DAS28, tender joint count, swollen joint count, physician global assessment of disease activity, erythrocyte sedimentation rate, and C-reactive protein level. Patients who reported low fatigue by 3 months had significantly lower fatigue throughout follow-up compared to those who had moderate or high fatigue at 3 months (P < 0.001). Patients who achieved a DAS28 <3.2 within 3 months had significantly lower fatigue ratings (mean ± SD 2.7 ± 2.6) than those with a DAS28 >3.2 (4.6 ± 3.0) (P < 0.001), with improvements in fatigue that persisted through 5 years of follow-up. Maximal improvements in fatigue lagged behind remission by 6 months. CONCLUSION: Fatigue is common in early RA, and improvements may occur after remission. Early treatment response within 3-months was associated with short-term and long-term benefits in fatigue over time.
OBJECTIVE: To examine the relationship between disease activity and fatigue over time in early rheumatoid arthritis (RA). METHODS: Data were from patients with early RA (duration of symptoms ≤12 months) enrolled in the Canadian Early Arthritis Cohort (CATCH). Patients rated their fatigue over the past week using an 11-point numerical rating scale (NRS) for up to 5 years of follow-up. Fatigue severity was classified as low (≤2), moderate (>2 but <5), or high (≥5). Differences in fatigue ratings in patients who achieved a low disease state (Disease Activity Score in 28 joints [DAS28] <3.2) and those who did not within 3-months of cohort entry were compared. RESULTS: Of 1,864 patients included, 88% met RA criteria, and 72% were women. The mean ± SD baseline DAS28 was 4.9 ± 1.5. Nineteen percent of the patients reported moderate baseline fatigue, and 59% reported severe baseline fatigue. Fatigue was correlated with pain and patient global ratings (r = 0.56-0.67, P < 0.001), and was weakly correlated with DAS28, tender joint count, swollen joint count, physician global assessment of disease activity, erythrocyte sedimentation rate, and C-reactive protein level. Patients who reported low fatigue by 3 months had significantly lower fatigue throughout follow-up compared to those who had moderate or high fatigue at 3 months (P < 0.001). Patients who achieved a DAS28 <3.2 within 3 months had significantly lower fatigue ratings (mean ± SD 2.7 ± 2.6) than those with a DAS28 >3.2 (4.6 ± 3.0) (P < 0.001), with improvements in fatigue that persisted through 5 years of follow-up. Maximal improvements in fatigue lagged behind remission by 6 months. CONCLUSION:Fatigue is common in early RA, and improvements may occur after remission. Early treatment response within 3-months was associated with short-term and long-term benefits in fatigue over time.
Authors: Susan J Bartlett; Clifton O Bingham; Ronald van Vollenhoven; Christopher Murray; David Gruben; David A Gold; David Cella Journal: Arthritis Res Ther Date: 2022-04-05 Impact factor: 5.156
Authors: Karen Holten; Nina Paulshus Sundlisater; Siri Lillegraven; Joseph Sexton; Lena Bugge Nordberg; Ellen Moholt; Hilde Berner Hammer; Till Uhlig; Tore K Kvien; Espen A Haavardsholm; Anna-Birgitte Aga Journal: Ann Rheum Dis Date: 2021-08-13 Impact factor: 19.103