RA fatigue is due to pain, not disease activity

[Guest guest]

RA fatigue is due to pain, not disease activity



Feb 16, 2006



Janis



London, UK -The high fatigue levels that plague rheumatoid arthritis

(RA) patients are due mainly to pain and depression, not to RA

disease activity levels, Dr Louise C Pollard (King's College London

School of Medicine, UK) and colleagues report in a paper published

online January 31, 2006 in Rheumatology [1]. Coauthor Dr Ernest H

Choy (King's College London School of Medicine) told rheumawire that

the data also show that TNF inhibitors are more effective than

disease-modifying antirheumatic drugs (DMARDs) for relieving fatigue

in established RA.



" TNF antagonists but not DMARDs improved fatigue, which suggests they

may have a greater effect on pain. "



" Our data suggested that in patients with RA, pain and depression

contribute more to fatigue than disease activity. Interestingly,

after adjustment for depression, pain remains the biggest determinant

of fatigue. TNF antagonists but not DMARDs improved fatigue, which

suggests they may have a greater effect on pain, " Choy said.

Pain more important than disease activity in causing RA fatigue

The researchers studied two cohorts of 238 and 274 RA patients and

examined treatment responses in 30 patients starting TNF-inhibitor

therapy and in 54 starting DMARD therapy. They used visual analog

scales (VAS) and the Medical Outcomes Study Short Form 36 (SF-36) to

measure fatigue. They also recorded disease activity score for 28

joints (DAS28), morning stiffness, health assessment questionnaire

(HAQ), physician global assessment, erosive disease, nodules,

rheumatoid factor, and concomitant medications and illnesses.

This analysis showed that:

Over 50% of RA patients had high fatigue levels (VAS >50 mm).

Over 80% of RA patients had clinically significant fatigue (VAS >20 mm).

Mean SF-36 energy and vitality score was 51 (vs 61-65 in normal

population).

Pain had the strongest association with fatigue, followed by HAQ

score and depression.

TNF-inhibitor treatment significantly reduced VAS fatigue scores

(p=0.009), but DMARDs did not (p=0.176).

" Interestingly, we found no association between fatigue and age or

disease duration, indicating that peripheral features such as muscle

mass, which decreases with age, and disease duration are unimportant.

Therefore, fatigue in RA is likely to be central in origin, " the

authors conclude.

Pollard LC, Choy EH, J, et al. Fatigue in rheumatoid

arthritis reflects pain, not disease activity. Rheumatology 2006; DOI:

10.1093/rheumatology/kel021. Available at: . 16449363

http://www.jointandbone.org/viewArticle.do?primaryKey=649965

[Guest guest]

It depends how you look at it.

You can't sleep because you are in pain, consequently, FATIGUE. So, fatigue

is caused by the lack of sleep caused by the pain from the disease's acitivites.

Does this make sense?

a <a54@...> wrote:

RA fatigue is due to pain, not disease activity



Feb 16, 2006



Janis



London, UK -The high fatigue levels that plague rheumatoid arthritis

(RA) patients are due mainly to pain and depression, not to RA

disease activity levels, Dr Louise C Pollard (King's College London

School of Medicine, UK) and colleagues report in a paper published

online January 31, 2006 in Rheumatology [1]. Coauthor Dr Ernest H

Choy (King's College London School of Medicine) told rheumawire that

the data also show that TNF inhibitors are more effective than

disease-modifying antirheumatic drugs (DMARDs) for relieving fatigue

in established RA.



" TNF antagonists but not DMARDs improved fatigue, which suggests they

may have a greater effect on pain. "



" Our data suggested that in patients with RA, pain and depression

contribute more to fatigue than disease activity. Interestingly,

after adjustment for depression, pain remains the biggest determinant

of fatigue. TNF antagonists but not DMARDs improved fatigue, which

suggests they may have a greater effect on pain, " Choy said.

Pain more important than disease activity in causing RA fatigue

The researchers studied two cohorts of 238 and 274 RA patients and

examined treatment responses in 30 patients starting TNF-inhibitor

therapy and in 54 starting DMARD therapy. They used visual analog

scales (VAS) and the Medical Outcomes Study Short Form 36 (SF-36) to

measure fatigue. They also recorded disease activity score for 28

joints (DAS28), morning stiffness, health assessment questionnaire

(HAQ), physician global assessment, erosive disease, nodules,

rheumatoid factor, and concomitant medications and illnesses.

This analysis showed that:

Over 50% of RA patients had high fatigue levels (VAS >50 mm).

Over 80% of RA patients had clinically significant fatigue (VAS >20 mm).

Mean SF-36 energy and vitality score was 51 (vs 61-65 in normal

population).

Pain had the strongest association with fatigue, followed by HAQ

score and depression.

TNF-inhibitor treatment significantly reduced VAS fatigue scores

(p=0.009), but DMARDs did not (p=0.176).

" Interestingly, we found no association between fatigue and age or

disease duration, indicating that peripheral features such as muscle

mass, which decreases with age, and disease duration are unimportant.

Therefore, fatigue in RA is likely to be central in origin, " the

authors conclude.

Pollard LC, Choy EH, J, et al. Fatigue in rheumatoid

arthritis reflects pain, not disease activity. Rheumatology 2006; DOI:

10.1093/rheumatology/kel021. Available at: . 16449363

http://www.jointandbone.org/viewArticle.do?primaryKey=649965