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Variations of fatigue in persons with Rheumatoid Arthritis- a 1 year longitudinal study.

Authors Caroline Feldthusen
Anna Grimby-Ekman
Helena Forsblad d'Elia
Lennart T. H. Jacobsson
Kaisa Mannerkorpi
Published in DOI: 10.1136/annrheumdis-2014-eular.3502. Ann Rheum Dis
Volume 73
Issue Suppl2
Publication year 2014
Published at Institute of Medicine, School of Public Health and Community Medicine
University of Gothenburg Centre for person-centred care (GPCC)
Institute of Medicine, Department of Rheumatology and Inflammation Research
Language en
Keywords Fatigue, rheumatoid arthritis, longitudinal study
Subject categories Health Sciences


Background: Beside pain, fatigue is expressed as the most prominent symptom in RA [1,2] and has been described as having a greater impact on daily life than pain [2]. Persons with RA experience that their fatigue vary over time concerning duration and frequency [3]. Longitudinal studies assessing change in fatigue after a period of one year have reported relatively stable fatigue [4] or considerable variations of fatigue [5]. More knowledge is needed about how fatigue in persons with RA vary over time. Objectives: To study variations of fatigue during one year in persons with RA of working age. Methods: Sixty-five participants having RA and being of working age (20-65 years) were recruited from a rheumatology clinic in West Sweden. Questionnaires assessing fatigue were given to the participants every other month during 1 year, in total seven times. Fatigue was assessed using both single-item and multidimensional measures: – VAS for global fatigue (0-100 mm) (endpoints no fatigue and worst imaginable fatigue) – The Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire, (BRAF-MDQ) consisting a global score (Total) and four subscales (Physical, Living, Cognition, Emotion) [6-7]. Results: The fatigue showed statistically significant variation over time for the outcome measures VAS fatigue (p<0.01), BRAF-MDQ Total and the subscales Living, Cognition (p<0.001) and Physical (p<0.05), when analyzed by mixed models. For the subscale Emotion (p=0.08) the variation of fatigue over time was not statistically significant. A statistically significant seasonal variation was shown for global fatigue (VAS p<0.01 and BRAF-MDQ Total p<0.001) and physical aspects of fatigue (BRAF-MDQ Physical and Living p<0.01) indicating less physical fatigue in the summer. No statistical differences over time were seen in fatigue between women and men or between age-groups. Conclusions: This study show that fatigue in persons with RA vary significantly during one year and further acknowledges the dynamic nature of fatigue and the complexity of its different facets. References: Wolfe, F., D.J. Hawley, and K. Wilson, The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol, 1996. 23(8): p. 1407-17. Repping-Wuts, H., et al., Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study. Int J Nurs Stud, 2008. 45(7): p. 995-1002. Hewlett, S., et al., Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Arthritis Rheum, 2005. 53(5): p. 697-702. Mancuso, C.A., et al., Psychosocial variables and fatigue: a longitudinal study comparing individuals with rheumatoid arthritis and healthy controls. J Rheumatol, 2006. 33(8): p. 1496-502. Treharne, G.J., et al., Predictors of fatigue over 1 year among people with rheumatoid arthritis. Psychol Health Med, 2008. 13(4): p. 494-504. Nicklin, J., et al., Measuring fatigue in rheumatoid arthritis: a cross-sectional study to evaluate the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional questionnaire, visual analog scales, and numerical rating scales. Arthritis Care Res (Hoboken), 2010. 62(11): p. 1559-68. Dures, E.K., et al., Reliability and sensitivity to change of the Bristol Rheumatoid Arthritis Fatigue Scales. Rheumatology (Oxford), 2013.

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