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Severe Fatigue May Be Prevalent Among Patients With Inflammatory Rheumatic Diseases
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Patients with inflammatory rheumatic diseases were more likely than patients with osteoarthritis to experience severe fatigue, which was prevalent among patients, according to allied researchers from Europe and the United States.
Researchers studied 6,120 patients with rheumatic diseases enrolled in an online study of patient perceptions about invalidation between November 2009 and September 2011. Perceptions included beliefs that others deny, lecture, do not acknowledge or are unsupportive of the patients’ disease.
Rheumatic diseases included fibromyalgia (n = 2,993; 49%), osteoarthritis (n = 1,249; 20%), rheumatoid arthritis (n = 1,054; 17%), systemic lupus erythematosus (n = 804; 13%), ankylosing spondylitis/Bechterew’s disease (n = 621; 10%), Sjögren’s syndrome (n = 567; 9%), psoriatic arthritis (n = 240; 4%), scleroderma (n = 147; 2%), polymyalgia rheumatica (n = 93; 2%), Ehlers-Danlos syndrome or hypermobility syndrome (n = 85; 1%), juvenile idiopathic arthritis (n = 81, 1%), gout or pseudogout (n = 62; 1%), mixed connective tissue disease (n = 56; 1%), Tietze’s syndrome/costochondritis (n = 54; 1%) and another rheumatic disease (n = 149; 2%).
Participants were asked to identify their disease(s) and disease duration and share demographic characteristics.
Fatigue was measured using the Vitality scale of the RAND SF-36. Confounding variables included age, gender, years of education, marital status, language and presence of comorbidities, including fibromyalgia, reported by nearly half of participants.
The most common combinations of rheumatic diseases were fibromyalgia and osteoarthritis (OA); fibromyalgia, OA and another rheumatic disease; OA and another rheumatic disease other than fibromyalgia, including 102 with rheumatoid arthritis (RA); RA and another rheumatic disease other than OA or fibromyalgia.
Severe fatigue was identified in 65% of all patients and in about 80% of all patients with fibromyalgia. Patients with a single inflammatory disease had severe fatigue in 41% to 57% of the patient group, while 35% of patients with osteoarthritis reported severe fatigue.
The presence of fibromyalgia, multiple rheumatic diseases without fibromyalgia and non-Dutch language was associated with an increased likelihood of severe fatigue. Older age, longer disease duration and more years of education decreased the risk for fatigue. Patients with fibromyalgia were four times as likely to have severe fatigue than patients without fibromyalgia, and French-speaking participants were six times as likely to have severe fatigue compared with Dutch-speaking participants. About 64% of Dutch-speaking patients had severe fatigue compared with 85% to 91% of patients with fibromyalgia who spoke another language. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Ashira Blazer, MD
Chronic fatigue in patients with rheumatic diseases is a difficult problem that is often untreated or undertreated in our practices. Overman and colleagues attempted to estimate the scope of this problem in a large sample of 6,120 patients across 13 Western European and Latin American countries. Participants included a subset of individuals with self-reported rheumatic diseases partaking in an online study of invalidation (perceptions of unsupportive language from others), and who also agreed to complete an online survey (RAND SF-36) to measure chronic fatigue. The authors found that 65% of patients reported severe fatigue as defined by a score of 35 or less on the RAND SF-36 survey.
To fully appreciate the implications of these findings, the study design must be put in perspective. Individuals who experience fatigue are more likely to volunteer for an online study than those who are not fatigued — particularly in this subgroup of people experiencing invalidation with regard to their disease. Further, this study included a greater percentage of fibromyalgia patients than would be expected in a general rheumatic diseases cohort. It is estimated that 11% to 30% of rheumatology patients also have fibromyalgia compared to 49% among the participants in this study.
Considering that chronic fatigue is a diagnostic component of fibromyalgia, the prevalence in this cohort likely overestimates that of a general rheumatic diseases population. In sum, while this study highlights chronic fatigue as an important issue in the rheumatic diseases, due to the patient selection process, online reporting structure and lack of validation through medical records, it likely overestimates disease prevalence.
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