Fatigue in patients with early rheumatoid arthritis undergoing treat-to-target therapy: predictors and response to treatment

Objectives: Fatigue is a frequent symptom in rheumatoid arthritis (RA) and has high impact on quality of life. We explored associations between disease activity and fatigue in patients with early RA during the initial 24 months of modern treat-to-target therapy and predictors of fatigue after 24 mon...

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Bibliographic Details
Published in:Annals of the Rheumatic Diseases
Main Authors: Holten, Karen, Sundlisæter, Nina Beate Paulshus, Lillegraven, Siri, Sexton, Joseph, Nordberg, Lena Kristine Bugge, Moholt, Ellen, Hammer, Hilde Berner, Uhlig, Till, Kvien, Tore Kristian, Haavardsholm, Espen A., Aga, Anna-Birgitte
Format: Article in Journal/Newspaper
Language:English
Published: HighWire Press 2021
Subjects:
Arctic
Online Access:http://hdl.handle.net/10852/91904
http://urn.nb.no/URN:NBN:no-94562
https://doi.org/10.1136/annrheumdis-2021-220750
Description
Summary:Objectives: Fatigue is a frequent symptom in rheumatoid arthritis (RA) and has high impact on quality of life. We explored associations between disease activity and fatigue in patients with early RA during the initial 24 months of modern treat-to-target therapy and predictors of fatigue after 24 months of follow-up. Methods: Data were obtained from the treat-to-target, tight control Aiming for Remission in Rheumatoid Arthritis: a Randomised Trial Examining the Benefit of Ultrasound in a Clinical Tight Control Regime (ARCTIC) trial. Fatigue was measured on a visual analogue scale (VAS) from 0 to 100 mm and defined as clinically relevant if VAS was ≥20 mm. Baseline predictors of fatigue at 24 months were analysed by multivariable logistic regression. Results: 205 patients with fatigue data at baseline and 24 months were included. Median (25th, 75th percentiles) symptom duration was 5.4 months (2.8, 10.4), fatigue VAS 37.0 mm (13.0, 62.0) and mean Disease Activity Score (DAS) 3.4 (SD 1.1) at baseline. Prevalence of fatigue declined from 69% at baseline to 38% at 24 months. Fewer swollen joints (OR 0.92, 95% CI 0.87 to 0.98, p=0.006), lower power Doppler ultrasound score (OR 0.95, 95% CI 0.90 to 0.99, p=0.027) and higher patient global assessment (PGA) (OR 1.03, 95% CI 1.01 to 1.04, p<0.001) increased the risk of clinically relevant fatigue at 24 months. Not achieving remission at 6 months was associated with a higher risk of reporting fatigue at 24 months. Conclusions: Fatigue in patients with early RA was prevalent at disease onset, with a rapid and sustained reduction during treatment. Low objective disease activity and high PGA at baseline were predictors of clinically relevant fatigue at 24 months.

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