RESEARCH - Fatigue in RA reflects pain, not disease activity

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Rheumatology Advance Access originally published online on January 31, 2006

Rheumatology 2006 45(7):885-889; doi:10.1093/rheumatology/kel021

Fatigue in rheumatoid arthritis reflects pain, not disease activity

L. C. Pollard, E. H. Choy, J. , B. Khoshaba and D. L.

Department of Rheumatology, King's College London School of Medicine

at Guy's, King's College and St ' Hospitals, Weston Education

Centre, London, UK.

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 20 mm), over 50% had high levels (VAS 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.

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Read the entire article here:

http://rheumatology.oxfordjournals.org/cgi/content/full/45/7/885

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