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Fatigue linked to activity impairment in patients with RA, AS starting Enbrel
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Fatigue has a significant and independent effect on absenteeism, presenteeism, productivity loss and activity impairment among patients with rheumatoid arthritis who are beginning treatment with etanercept, according to findings published in Arthritis Research & Therapy.
Researchers also noted that fatigue has a significant, yet dimensionally-selective effect on work disability among patients with ankylosing spondylitis who are beginning etanercept (Enbrel, Amgen).
“Biological therapies have significantly minimized the physical sequelae of poorly controlled inflammation, such as joint destruction,” Katie L. Druce, PhD, of the University of Manchester, England, and colleagues wrote. “Despite these gains, work disability remains an issue for the majority of RA and AS patients, and it has become increasingly clear that the determinants of work disability in inflammatory diseases are not necessarily inflammatory in origin. ... We now hypothesize that, in this current era of biological therapies, fatigue is independently associated with continuing levels of work disability among patients with inflammatory rheumatic diseases.”
To test their hypothesis that fatigue longitudinally predicts work disability over a period of 1 year among patients with RA and AS who are starting treatment with etanercept, the researchers analyzed data from two observational studies in Germany. The studies included 6,518 patients — 1,663 with AS and 4,885 with RA — who had commenced etanercept therapy, and featured information on work disability and fatigue. Patients in both groups were followed for 1 year, with data collected at baseline, 6 months and 12 months.
Focusing on participants who had been working at baseline, Druce and colleagues ultimately included 1,003 patients with AS and 1,747 patients with RA in their analysis. They conducted a series of repeated measures models, including baseline variables, follow-up visits and the interaction between visit and each of the explanatory variables.
According to the researchers, fatigue was significantly associated with presenteeism (linear mixed model coefficient = 3.75; 95% CI, 2.14-5.36) and activity impairment (coefficient = 2.62; 95% CI, 1.26-3.98) among patients with AS, but not work productivity loss (coefficient = 1.81; 95% CI, –0.4 to 4.02) or absenteeism (OR = 1.18; 95% CI, 0.92-1.51). Among patients with RA, fatigue was associated with presenteeism (coefficient = 3.44; 95% CI, 2.17-4.7), activity impairment (coefficient = 1.52; 95% CI, 0.79-2.26), work productivity loss (coefficient = 4.16; 95% CI, 2.47-5.85) and absenteeism (OR= 1.23; 95% CI, 1.02-1.49).
“This is the largest study to examine the longitudinal association between fatigue and work impairment and, by selecting two cohorts which underwent near-identical interventions and data collection procedures, the first to enable the comparison of this relationship between two different rheumatic diseases,” Druce and colleagues wrote. “In addition to pharmacological treatment of inflammation, fatigue-alleviating interventions such as cognitive behavioral therapy and exercise should be tested in both RA and AS patients with a view to modifying the course of this crucial outcome.” – by Jason Laday
Disclosure: The researchers report funding from Pfizer. Druce reports no additional relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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This is the largest study of its kind investigating fatigue and work impairment, comparing patients with two separate rheumatic disorders who had started etanercept. The results of this trial further reinforce the importance of addressing the often-unmanaged symptoms of fatigue in patients with inflammatory diseases.
In addition to pharmacologic medications to treat the patients’ underlying disease, nonpharmacologic modalities for addressing persistent fatigue – such as sleep hygiene, diet, exercise, weight loss and mental health – can be discussed with patients. Formally discussing these issues with our patients and involving other appropriate health care professionals to assist in treatment can help improve our patients’ personal outcomes, as well as the societal economic impact that work disability creates.
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