A biopsychosocial network model of fatigue in rheumatoid arthritis: a systematic review, 2019, Geenen and Dures

Andy

Andy

Retired committee member
Fatigue in RA is prevalent, intrusive and disabling. We propose a network model of fatigue encompassing multiple and mutually interacting biological, psychological and social factors.

Guided by this model, we reviewed the literature to offer a comprehensive overview of factors that have been associated with fatigue in RA.

Six categories of variables were found: physical functioning, psychological functioning, medical status, comorbidities and symptoms, biographical variables and miscellaneous variables. We then systematically reviewed associations between fatigue and factors commonly addressed by rheumatology health professionals.

Correlations of fatigue with physical disability, poor mental well-being, pain, sleep disturbance and depression and anxiety were ∼0.50. Mostly these correlations remained significant in multivariate analyses, suggesting partly independent influences on fatigue and differences between individuals.

These findings indicate the importance of research into individual-specific networks of biopsychosocial factors that maintain fatigue and tailored interventions that target the influencing factors most relevant to that person.
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Open access, https://academic.oup.com/rheumatology/article/58/Supplement_5/v10/5611823
 
Trish said:
Interesting to see on the same day we have this thread:
Fatigue in inflammatory rheumatic disorders: pathophysiological mechanisms, 2019, Korte and Straub
where fatigue is attributed to cytokines etc, ie biological factors.
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I think they are both part of some sort of special issue on fatigue in rheumatic disease.

The whole thing looks like psychosociorheumatoimmunobabble.
The interesting question is why what was a lively scientific speciality (rheumatology) in the 1990s became a stagnant pool of recycled drivel.
 
What are the stated benefits of redefining fatigue as meaning many different things? Has anyone ever bothered justifying that? Fatigue has both a common meaning and a medical meaning, the distinction mostly being down to a severity scale. What is the point in giving a unique concept multiple varied interpretations? I don't even understand the point of this old-style natural philosophy of just discussing various bits that have no evidence and reaching conclusions that the thing that interests them should be funded and studied.

BPS folks remind me of people who crash a potluck, bring nothing, are rude and generally occupy the whole atmosphere by talking loudly among themselves. Nobody invited them or even wants there but they still come in and bring something nobody wants or asked for but at the end of the party their conclusions is they should come back next time.
These findings indicate the importance of research into individual-specific networks of biopsychosocial factors that maintain fatigue and tailored interventions that target the influencing factors most relevant to that person.
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Except they don't. It's science 101 that correlation does not mean causation. They admit all they have is correlations. This is just their personal opinion and has nothing to do with the data they analyzed.
 
Andy said:
Open access, https://academic.oup.com/rheumatology/article/58/Supplement_5/v10/5611823
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As someone who is significantly disabled by autoimmune conditions (previously misdiagnosed with ME/CFS & Fibromyalgia) my experience has been that in my case there is no correlation whatsoever between my fatigue and my mood, emotional state, personal problems, etc. Over the past 6 years I have been thru all sorts of trials and tribulations in my life (poverty being a constant one). The only thing that finally improved my level of fatigue is appropriate diagnosis and pharmaceutical treatment. Now that I've experienced improvement and have a new fatigue 'baseline' the only things so far that have the ability to significantly worsen my fatigue (temporarily) have been sun exposure, viruses, and seasonal changes (my baseline fatigue worsens in the fall/winter months).

Before my AI diagnosis I wondered all the time if somehow I was psychologically adding to (or even manufacturing) my fatigue in some way or if my living situation or financial stress was. After the past 2 years of appropriate medical treatment I now feel incredibly confident that this is absolutely NOT the case.

I think that when your fatigue improves significantly it becomes much more clear what 'fatigue' is, in the physical sense. With improvement comes more clarity of what you were/are experiencing. Improvement has given me the ability to better understand what it was I was experiencing these past years. When I was in the midst of it, things felt muddled and confusing. I am now able to sense the 'borders' that separate my different symptoms (if that makes sense, hard to explain). I never could do that before.

I think this is probably true for many medical issues people experience. Before we become ill or maimed we don't really have a reason to closely pay attention to our body and how it feels all the time. Once that switch is flipped from healthy to sick/injured, over time it becomes difficult to remember what 'normal' felt like. So when you do experience significant improvement you gain much greater perspective. A perspective that was unavailable to me before I experienced improvement. As the saying goes..... hindsight is 20/20.

Am I making sense here? I hope so.
 
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