Biologic and Nonbiologic Interventions for Fatigue in Rheumatoid Arthritis (2019). Calabrese.

Woolie

Woolie

Senior Member
Just in case you thought we were the only ones having to put up with this crap:
The importance of fatigue in RA is underscored by several studies that have concluded that patients may value a day without fatigue as much as a day without pain.

...when the disease is active and patients have a lot of inflammation and pain in their joints, they are less likely to exercise, and exercise is clearly inversely related to fatigability. The more you exercise, the less fatigued you are....patients with RA are more likely to have intercurrent mood disorders, including varying degrees of depression and anxiety. In addition to anhedonia and abulia, common symptoms of depression include pain and fatigability...

From the pharmacologic perspective, there is great interest in determining whether certain agents, such as interleukin-6 inhibitors, may have something more to offer patients with fatigue, and there are some supportive data to suggest that this may be true for some individuals. Clinically meaningful patient-reported benefits on fatigue have been observed in randomized clinical trials with both sarilumab and tocilizumab.

However, patients need more than just pharmacologic intervention. They need wellness interventions, whether this involves coaching on exercise, cognitive behavioral therapy, sleep therapy, and/or stress modification.
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The middle bit sounds promising to me. The rest is the usual BS. Although it doesn't explicitly mention negative illness beliefs, I think that's implicit in the suggestion of CBT.

I love how they think the fatigue might respond to "stress modification". Sounds like the tail is wagging the dog here :facepalm: Having fatigue that makes it overwhelmingly difficult to do your daily activities , and threatens your job or relationships - that's pretty darned stressful. Maybe treat the fatigue and that'll help a lot with the stress!

This short article is available in full here.
 
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Jonathan Edwards said:
How can my colleagues have become so mindblowingly ignorant?
Thirty years ago no US physician would have made themselves look such a fool.
What happened to the other six classes of drug that reduce fatigue?
What happened to the need for evidence?
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Its some sort of magazine-style "expert commentary", rather than an academic article (although I don't think that really excuses it).

It seems to me we all have a need to believe there is some magic out there that might fill the gaps in mainstream medicine. While its no longer considered appropriate in mainstream science to talk about spirits and humours or medicinal herbs, society allows us to talk about the psyche as much as we like, with little accountability. And it all sounds kind of hopeful and vaguely plausible.

A perfect replacement for those previous sources of BS!
 
Speaking as someone that experiences inflammatory fatigue, its utterly bizarre that anyone informed could think its remotely comparable, or influenced by, fatigue experienced from a lack of exercise.

For me inflammatory fatigue is like an episode of PEM turned up to 11, all at once and out of nowhere. Then when on biologics and stable, without flares, its largely a non-issue. Fundamentally different experiences.
 
Ryan31337 said:
Speaking as someone that experiences inflammatory fatigue, its utterly bizarre that anyone informed could think its remotely comparable, or influenced by, fatigue experienced from a lack of exercise.

For me inflammatory fatigue is like an episode of PEM turned up to 11, all at once and out of nowhere. Then when on biologics and stable, without flares, its largely a non-issue. Fundamentally different experiences.
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Interesting, @Ryan31337. May I ask what your diagnosis is - the one for which the biologics are prescribed? (fine not to say if you prefer not to)
 
Hi @Woolie,

Officially its Adalimumab prescribed for clinical non-radiographic axial spondyloarthritis.

Unofficially the Rheumatologist was convinced of some form of SpA but on the fence about specific type, with no definitive evidence (yet).

I appear to have elements of axial, peripheral, psoriatic and bowel - but all relatively mild and hard to pin down. The most recent significant flare was textbook inflammatory back pain with some post-inflammatory MRI signs (but not fully diagnostic), hence the clinical diagnosis.

Thankfully the biologic is helping a great deal with all of those issues. So now most of the time its back to managing 'just' dysautonomia/CFS :)
 
Ryan31337 said:
Speaking as someone that experiences inflammatory fatigue, its utterly bizarre that anyone informed could think its remotely comparable, or influenced by, fatigue experienced from a lack of exercise.

For me inflammatory fatigue is like an episode of PEM turned up to 11, all at once and out of nowhere. Then when on biologics and stable, without flares, its largely a non-issue. Fundamentally different experiences.
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I experience the same although I am on DMARDs not biologics for my autoimmune diseases. And exercise has never once improved my fatigue, it's the opposite, I have to be extremely careful to limit my physical activity or I will pay for it. The idea that exercise would decrease my fatigue is laughable to me.
 
Woolie said:
The middle bit sounds promising to me. The rest is the usual BS. Although it doesn't explicitly mention negative illness beliefs, I think that's implicit in the suggestion of CBT.
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I'd say this qualifies:
abulia: an absence of willpower or an inability to act decisively, as a symptom of mental illness
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And false attribution syndrome strikes again. As usual. There is no can't, only won't.
 
Woolie said:
Its some sort of magazine-style "expert commentary", rather than an academic article (although I don't think that really excuses it).
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It makes things even worse since it is presumably done as part of a money-making process.

What shocks me is that thirty years ago no US physician would have bullshitted like this. US medicine used to be rigorous when it came to putting out material. Admittedly in those days it was in textbooks or professional journals if not academic papers because there was little of the now pervasive net based junk. But even in the eighties I occasionally was asked to write something like this for a commercial sponsor and took it very seriously. I always felt humbled by how much more seriously Americans tended to take the need for evidence citation.

This is a dumbing down, not just the persistence of dumbness. It is. manifestation of a move away from anything intelligent or meaningful for the sake of cash. Maybe, just maybe, that might change if politics changes but I am not sure anyone has the necessary commitment.
 
Jonathan Edwards said:
It makes things even worse since it is presumably done as part of a money-making process.

What shocks me is that thirty years ago no US physician would have bullshitted like this. US medicine used to be rigorous when it came to putting out material. Admittedly in those days it was in textbooks or professional journals if not academic papers because there was little of the now pervasive net based junk. But even in the eighties I occasionally was asked to write something like this for a commercial sponsor and took it very seriously. I always felt humbled by how much more seriously Americans tended to take the need for evidence citation.

This is a dumbing down, not just the persistence of dumbness. It is. manifestation of a move away from anything intelligent or meaningful for the sake of cash. Maybe, just maybe, that might change if politics changes but I am not sure anyone has the necessary commitment.
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People tend to believe in books they purchase on Amazon, even though its content is not peer reviewed. Witch hunts like you would never believe. My father falls for this all the time, in the hope to cure his diabetes. (No carb, vegan, paleo, just cabbage soup). Patients still recommend all kinds of stuff to other patients, supplements, thyroid tests, expensive tests, diets... it is never ending.
 
The situation is worse than that. Due to their stunning success reducing fatigue in CFS (!) the BPS brigade, including some of our well known names, have made great inroads into the world of RA and MS, probably others I don't now about.

Rona Moss Morris is very friendly with the MS Association for instance.

Other diseases are getting dragged down into the mess they have made for us. I tried to explain about RMM to my MS centre and the way the PACE trial results were a fraud but you sound like a conspiracy theorist.

We live in times where exercise is seen as a universal panacea and their "evidence base" fits with preconceptions people already have since they are in newspapers and magazines all the time. The fact that research has now given them a scientific basis is easy to accept.
 
Actually @rvallee, its even worse than that. This is another complete arse-about-face argument:
... patients with RA are more likely to have intercurrent mood disorders, including varying degrees of depression and anxiety. In addition to anhedonia and abulia, common symptoms of depression include pain and fatigability...
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So people with RA have a lot of pain and fatigability, and probably also have "anhedonia" according to many self-report schemes (because they no longer get the pleasure out of some activities that they used to)... so they get diagnosed with depression... and now this author is trying to argue that the depression has caused the pain and fatigability. But those things were part of the criteria that you used to diagnose the depression in the first place! Its all totally circular!

Its the equivalent of sorting ducks into two categories - small and large - and then claiming that that being assigned to the "small" category is what actually made the ducks small in the first place! :facepalm::facepalm::facepalm::banghead::banghead::banghead::banghead:
 
Yup. Exact same process as with us and "MUS" in general: deny/dismiss symptoms, "diagnose" with anxiety and/or depression, take note of all those symptoms that have no clear cause, BAM!, reassign all the previously dismissed symptoms to depression and/or anxiety, hence the mythical trope that anxiety causes all sorts of physical symptoms, symptoms with multiple layers of sub-symptoms. Turtles all the way down.

I have never seen such irrational thinking outside of cults or bad faith people willfully acting in bad faith for bad faith's sake. It's so unbelievably broken that people don't believe it when it's described as neutrally as possible.

And it opens up the natural question of how much of medical practice suffers from such a broken process. All of it? Most of it? How much of it? Nobody knows, the same process that produces 100% failure is the same process that vets all other things.
 
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