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‘Unmet need’ exists in treatment for fatigue in patients with RA
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Fatigue was associated with inflammation in patients with rheumatoid arthritis, but treatment did not eliminate fatigue, indicating a continuing unmet need in this patient population, according to recently published research.
Researchers studied 626 patients with rheumatoid arthritis (RA) enrolled in the Leiden Early Arthritis Clinic cohort, an ongoing, population-based, inception cohort in the Netherlands, between 1993 and March 2013. Patients were included in the study if fatigue data and 8 years of follow-up were available.
Patients were evaluated for 66 swollen and 68 tender joint counts (SJC and TJC), and hand and foot radiographs were taken. Blood samples were collected and analyzed for C-reactive protein (CRP), hemoglobin, rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA). Questionnaires included the Health Assessment Questionnaire (HAQ) and a 100-mm visual VAS for fatigue.
Follow-up visits were annual and included SJC and TJC, CRP, hemoglobin, HAQ, additional radiographs and assessment of fatigue.
An additional group of 902 patients with RA and 1,540 patients without RA who had undifferentiated arthritis, septic arthritis, reactive arthritis, inflammatory osteoarthritis, psoriatic arthritis, spondyloarthropies and other types of arthritis was also studied, but follow-up data were inconsistent, according to the researchers.
Patients who experienced fatigue did not differ in age, gender, SJC, TJC or frequency of positive ACPA or RF status from patients who did not report fatigue at baseline, but had slightly higher CRP levels. Patients with undifferentiated arthritis and septic arthritis experienced significantly less fatigue than patients with RA after adjusting for age and gender, the researchers found.
Of the group of 902 patients with RA at baseline, independent variables associated with fatigue included female gender, a high level of morning stiffness, more tender joints, negative ACPA status, longer disease duration and higher self-reported disability. Mean VAS was 49 mm.
In the group of 626 patients who were followed for 8 years, median fatigue severity was 45 mm VAS at baseline, which decreased slightly after 1 year but thereafter remained stable.
The effect size of inflammatory markers was small, according to the researchers. CRP level increases of 1 mg/mL resulted in about a 0.1-mm increase in VAS, and each additional swollen joint yielded 0.7-mm increase in VAS.
Patients with RA treated with mild disease-modifying anti-rheumatic drugs (DMARDs) or methotrexate did not report lower severity of fatigue over time compared with patients who were treated with NSAIDs or delayed DMARDs. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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