When Will I Get past This Exhaustion? Predictors of Improved Fatigue in the First Year of RA - 2019 ACR/ARP

Sly Saint · Nov 12, 2019

Background/Purpose: Although overwhelming fatigue is common at the onset of RA, some patients continue to experience debilitating high levels of fatigue that impact mood, interfere with work and home life, social participation, and result in poor QoL. Among people with high fatigue at diagnosis, we examined characteristics and identified predictors associated with improved vs. persistent fatigue in the first year of RA.

Methods: Data were from early RA patients (symptoms < 1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) from 01-2007 to 03-2017. All met ACR1987 or 2010 ACR/EULAR criteria, had active disease, were on DMARDS, and complete fatigue (0-10 NRS) data over ≥ 12 months. Patients were classified at baseline with low (< 4) or high (≥ 4) fatigue; patients who reported high fatigue at baseline were categorized at 12 months as having improved (↓ ≥ 2) or persistently (↓ < 2) high fatigue and multivariable logistic regression was used to identify baseline predictors of improvement.

Results: Participants (N=1002) were mostly white (81%) and female (71%) with a mean (SD) age of 54 (15); 32% were obese. At diagnosis, 70% reported high levels of fatigue; as compared to those with low fatigue, high fatigue patients were significantly (p >.05) more likely to have high disease activity and OA/back pain, be obese, and report greater pain, disability, sleep disturbance, depression, and major stressors in the previous year (Table 1). There was a trend for high fatigue patients to be female and seropositive.

At 12 months, 70% of patients with high fatigue reported significant improvements in fatigue. Patients with improved fatigue were significantly less likely to be obese or have fibromyalgia, and had fewer comorbidities, a shorter symptom duration, and lower initial fatigue (Table 2). In adjusted multivariable models, baseline predictors of improved fatigue at 1 year was BMI < 30 (OR 0.6; 95% CI 0.4, 0.9) after controlling for other Table 1 characteristics.

Conclusion: Debilitating fatigue is common around the time of RA diagnosis and is associated with more active disease, worse pain and disability, and OA/back pain, obesity, depression, poor sleep, and major stressors in the previous year. In patients who presented with high fatigue, 70% improved by the end of the first year. Obesity decreased the odds of improved fatigue at 12 months by 40%. In contrast, other RA presenting characteristics were not associated with improvement. Early MTX use and optimizing weight, sleep, and mood may help address persistent fatigue when RA inflammation is well controlled. These results underscore the potential benefits of multidisciplinary interventions in ERA.
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https://acrabstracts.org/abstract/w...-of-improved-fatigue-in-the-first-year-of-ra/

Hutan · Nov 12, 2019

I haven't read the paper, just the abstract. It's not too bad, it does find the link between fatigue and illness severity and recommend early treatment of the underlying illness (with MTX) as a response, along with 'optimising weight, sleep and mood'. And I guess a holistic approach is fine.

It would just be nice to see the explicit understanding that all of the characteristics they found to be associated with fatigue can be downstream effects of illness severity

obesity - because movement is decreased, comfort eating because more time is spent sitting being bored and in pain

poor sleep - due to pain, and also because it's harder to get healthily tired from physical activity

depression/mood/major stressors - due to not being able to do what you did before, financial and social issues arising from not being able to do what you did before and also being grumpy due to pain

And therefore, attempts to eliminate fatigue, obesity, poor sleep and depression without treating the underlying illness and pain may be rather futile and waste resources.

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When Will I Get past This Exhaustion? Predictors of Improved Fatigue in the First Year of RA - 2019 ACR/ARP

Sly Saint Senior Member (Voting Rights)

Hutan Moderator Staff Member

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When Will I Get past This Exhaustion? Predictors of Improved Fatigue in the First Year of RA - 2019 ACR/ARP

Sly Saint Senior Member (Voting Rights)

Hutan Moderator Staff Member

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