RESEARCH - Fatigue less important to RA patients than pain or loss of function and not helped by TNF inhibitors

[Guest guest]

Fatigue less important to RA patients than pain or loss of function and

not helped by TNF inhibitors

Rheumawire

Dec 1, 2004

Janis

Wichita, KS - Fatigue is " a variable whose time has come " in

rheumatoid-arthritis (RA) outcomes research, but data reported by Dr

Frederick Wolfe (National Data Bank for Rheumatic Diseases, Wichita, KS)

in the November 2004 issue of the Journal of Rheumatology indicate that

this rising concern might have more to do with marketing than with

medical facts [1]. Despite the widely held assumption that TNF

inhibitors relieve RA-related fatigue, Wolfe found that they were no

more effective than other treatments, and that in any case, few RA

patients ranked fatigue as their most important problem.

" Knowledge of fatigue and its importance have most recently been driven

by commercial interests. Fatigue levels are no different in RA than in

OA. They are important in all patients with all illnesses, and they

respond to any treatment that reduces the burden of illness, " Wolfe

tells rheumawire.

Wolfe and colleagues asked 825 RA patients from the National Data Bank

For Rheumatic Diseases database to rank the severity of 6 medical

conditions: moderate difficulty in daily function, moderate pain or

discomfort, moderate fatigue, moderate sleep disturbance, moderate

problems with memory and concentration, and moderate stomach or

digestive problems. The researchers also evaluated clinical change

scores over 6 months for 17 625 patients (including 12 217 RA patients).

Finally, 1 random observation from each patient was collected from a

database of 24 831 participants, which included 21 016 with RA and 3815

with OA of the hip or knee (the last group included the first 2).

The study's key findings were that:

Relatively few RA patients (8%) rated fatigue as their most

important symptom.

RA and OA patients reported similar levels of fatigue.

TNF inhibitors were not significantly better than other RA

treatments at reducing fatigue.

In the ranking of symptom importance, fatigue was ranked fifth of the 6

symptoms and was ranked as the most important symptom by 8% of patients,

only slightly more than the 7% who ranked sleep problems as most

important. Functional status (32.1%), pain (21.5%), cognition (21.5%),

and gastrointestinal (GI) symptoms (9.8%) were symptoms ranked first by

patients.

Patient with the highest current fatigue levels were more likely to rank

fatigue as the most important symptom. Interestingly, neither use of TNF

inhibitors nor use of prednisone affected the ranking of fatigue.

The analysis of actual clinical outcome data supported these rankings.

Scores for Health Assessment Questionnaire (HAQ) functional disability

index and visual analog scale (VAS) for pain were the 2 clinical

measures most strongly associated with a change in health status.

Regression analyses found no association between the use of biologic

agents and fatigue scores, regardless of the patient group or other

covariates.

Fatigue scores were only 0.17 units (3.6%) higher in patients with RA

than in patients with OA. " In contrast to diagnostic category (RA vs

OA), which had little association with fatigue score, scores for pain,

depression, and HAQ, as well as age, were strongly associated with

fatigue score, " the investigators reported.

The authors emphasize that they are not dismissing the importance of

fatigue. " Few measures identify patients with distress as well as do

high levels of fatigue, and it is not our purpose in this report to

denigrate fatigue measurement, but rather to place it properly within

the context of patient measurement and importance, " they write.

" Fatigue is important in all patients, " Wolfe emphasizes. " That it is

not the most important symptom does not make it unimportant. I find it

among the most helpful of all symptoms in clinical care. At the

patient-care level, fatigue is a very important symptom. I have measured

it in every patient that I have treated, and at each visit, as does my

colleague [and study coauthor] Dr Ted Pincus. The way to pay attention

to fatigue is to measure it with a simple visual analog (VAS) scale. All

rheumatologists should do this in all patients. " Wolfe offers a series

of simple and complex questionnaires that include fatigue scales on the

website for the National Databank for Rheumatic Diseases or via email

from him (fwolfe@...).

Wolfe tells rheumawire that the appropriate role for fatigue as an

outcome measure differs for randomized, controlled trials and for

clinical care. " For randomized, controlled trials almost all clinical

variables can function as outcome measures. What is most important is

whether the variable represents a separate domain or is rather a

restatement of other variables. If it is a restatement then it will not

work as well as an 'outcome measure,' " Wolfe says. This seems to be the

case with fatigue.

Source

Wolfe F, Michaud K, and Pincus T. Fatigue, rheumatoid

arthritis, and anti-tumor necrosis factor therapy: an investigation in

24,831 patients. J Rheumatol 2004; 31:2115-2120.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[Guest guest]

This was interesting to me, as fatigue has been my greatest

frustration. I think it would concern me less if I wasn't working and

didn't have to make tough decisions, communicate clearly, hustle to

meet deadlines and manage a heavy load of requests and demands. It

would be interesting to know how many of the study's participants

were working.

S.

> Fatigue less important to RA patients than pain or loss of function

and

> not helped by TNF inhibitors

>

>

> Rheumawire

> Dec 1, 2004

> Janis

few RA

> patients ranked fatigue as their most important problem.

> Relatively few RA patients (8%) rated fatigue as their most

> important symptom.

>

[Guest guest]

This was interesting to me, as fatigue has been my greatest

frustration. I think it would concern me less if I wasn't working and

didn't have to make tough decisions, communicate clearly, hustle to

meet deadlines and manage a heavy load of requests and demands. It

would be interesting to know how many of the study's participants

were working.

S.

> Fatigue less important to RA patients than pain or loss of function

and

> not helped by TNF inhibitors

>

>

> Rheumawire

> Dec 1, 2004

> Janis

few RA

> patients ranked fatigue as their most important problem.

> Relatively few RA patients (8%) rated fatigue as their most

> important symptom.

>

[Guest guest]

I disagree with the part of this article that says that TNF inhibitors

are no better at relieving fatigue than other DMARD's. I got great pain

relief from Arava, but it didn't help the fatigue at all. Enbrel does

help the fatigue.

Since I'm 65 and retired, I don't have to worry about having to work.

But it requires a certain amount of work to just maintain a house. I

used to do much better at that when I was working than I do now. I

guess I have different priorities. Also, I never know if my problem is

RA, old age, or laziness, or maybe a combination of the three.

Anytime I have to choose between having pain or having fatigue, I'll

always take the fatigue.

I guess I was a participant in this study, since I fill out their

questionnaire twice a year. As I understand it, this research was based

on these questionnaires. Any of you could participate if you wish. The

questionnaires can be filled out online. Here is the URL:

https://www.arthritis-research.org/

Sue

On Friday, December 3, 2004, at 10:11 AM, snowdrift52003 wrote:

>

> This was interesting to me, as fatigue has been my greatest

> frustration. I think it would concern me less if I wasn't working and

> didn't have to make tough decisions, communicate clearly, hustle to

> meet deadlines and manage a heavy load of requests and demands. It

> would be interesting to know how many of the study's participants

> were working.

[Guest guest]

> I disagree with the part of this article that says that TNF

inhibitors

> are no better at relieving fatigue than other DMARD's. I got great

pain

> relief from Arava, but it didn't help the fatigue at all. Enbrel

does

> help the fatigue.

I was surprised by that, too. While I can't speak from personal

experience, I have read many, many reports from people on these lists

about fatigue relief from TNF inhibitors.

S.

[Guest guest]

I find fatigue to be more frustrating than the pain. With the

amount of physical demands at my job, the fatigue is the most

troublesome....Marina in Ohio

[Guest guest]

I find fatigue to be more frustrating than the pain. With the

amount of physical demands at my job, the fatigue is the most

troublesome....Marina in Ohio