RESEARCH - Fatigue in RA reflects pain, not disease activity

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Rheumatology (Oxford). 2006 Jul;45(7):885-9. Epub 2006 Jan 31.

Fatigue in rheumatoid arthritis reflects pain, not disease activity.

Department of Rheumatology, King's College London, Weston Education Centre,

Denmark Hill, 10 Cutcombe Road, London SE5 9RJ, UK. louise.pollard@...

OBJECTIVE: We determined the amount of fatigue experienced by patients with

RA, and its relationship to synovitis, pain and other common clinical

features. We also examined to what extent RA fatigue is improved by

disease-modifying antirheumatic drugs (DMARDs) and anti-tumour necrosis

factor (TNF) therapy. METHODS: We studied two cohorts of 238 and 274 RA

patients cross-sectionally and examined treatment responses in 30 RA

patients starting anti-TNF and 54 starting DMARDs followed for 3 and 6

months. We measured fatigue using visual analogue scores (VAS) and Medical

Outcomes Study Short Form 36 (SF-36) vitality scores. We recorded the

disease activity score for 28 joints and its components (tender/swollen

joint counts, patient global assessment, ESR), morning stiffness, health

assessment questionnaire, physician global assessment, erosive disease,

nodules, rheumatoid factor, concomitant medications and illnesses, and the

SF-36 questionnaire. RESULTS: Fatigue was common in RA patients; over 80%

had clinically relevant fatigue (VAS > or =20 mm), over 50% had high levels

(VAS > or =50 mm). It was associated with pain and changes in mental health,

particularly depression. In each of the two cross-sectional cohorts, this

relationship was similar whichever measures of fatigue and mental health

were used. Fatigue fell with DMARDs and anti-TNF: before treatment, 87% of

patients had high fatigue, after treatment this fell to 50%. These treatment

effects were mainly linked to improvements in pain.

CONCLUSIONS: High fatigue levels characterize RA and are mainly linked to

pain and depression. The association with disease activity is secondary.

Fatigue falls with DMARD and anti-TNF therapy. The balance of evidence

suggests that fatigue is centrally mediated in established RA.

PMID: 16449363

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16449363

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