RESEARCH - Persistent severe fatigue in patients with RA

[Guest guest]

J Clin Nurs. 2007 Nov;16(11C):377-83.

Persistent severe fatigue in patients with rheumatoid arthritis.

Repping-Wuts H, Fransen J, van Achterberg T, Bleijenberg G, van Riel P.

Department of Rheumatology, Radboud University Nijmegen Medical

Centre, Nijmegen, The Netherlands.

AIM: To determine whether persistent severe fatigue in patients with

rheumatoid arthritis can be predicted by inflammation and disability.

METHODS: A follow-up study with a one-year duration was performed.

From an existing rheumatoid arthritis cohort, 150 consecutive

patients, with established rheumatoid arthritis, were asked to assess

fatigue, using the subscale Checklist Individual Strength-fatigue of

the Checklist Individual Strength at baseline and 12 months later. The

Checklist Individual Strength-fatigue scores were classified into

'normal' (score between 8-27), 'moderate' (score between 27-34) or

'severe' (score 35 or above) fatigue. Disease-related variables were:

tender joints, swollen joints, general health, disability and

laboratory measures (erythrocyte sedimentation rate, rheumatoid factor

and haemoglobin). Predictors of persistent severe fatigue were

identified by multiple logistic regression analyses with backward

selection (selection criteria: p<0.05). RESULTS: At baseline, 137

patients agreed to participate and 123 patients completed the study.

Severe fatigue was experienced by as many as 50% of the patients, both

at baseline and at the end of the study (n = 123). Moreover, 49

patients (40%) experienced severe fatigue at baseline as well as at

follow-up, which we called 'persistent severe fatigue'. Persistent

severe fatigue was predicted by mean general health and disability at

baseline [odds ratio (OR) = 2.03 and 2.83, respectively] in this group

of rheumatoid arthritis patients with a low-to-moderate level of

disease activity and disability. CONCLUSION: The data show that severe

fatigue is not resolved spontaneously in rheumatoid arthritis

patients, and persistent severe fatigue is mainly predicted by general

health and disability. The relation with inflammation or a low level

of haemoglobin, which is often assumed in clinical practice, was not

found.

RELEVANCE TO CLINICAL PRACTICE: Fatigue in patients with rheumatoid

arthritis has to be considered as a symptom that needs to be addressed

by professionals in the same way as pain and disability. In current

care, fatigue is insufficiently addressed.

PMID: 17931330

http://www.ncbi.nlm.nih.gov/pubmed/17931330

--

Not an MD