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

• Published in: Annals of the rheumatic diseases 2022-03, Vol.81 (3), p.344-350
• Main Authors: Holten, Karen, Paulshus Sundlisater, Nina, Lillegraven, Siri, Sexton, Joseph, Nordberg, Lena Bugge, Moholt, Ellen, Hammer, Hilde Berner, Uhlig, Till, Kvien, Tore K, Haavardsholm, Espen A, Aga, Anna-Birgitte
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antirheumatic Agents - therapeutic use; arthritis; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Comorbidity; Doppler effect; Fatigue; Fatigue - drug therapy; Fatigue - etiology; Female; Follow-Up Studies; Gender; Humans; Induction Chemotherapy; inflammation; Inflammatory diseases; Joint diseases; Logistic Models; Male; Mental health; Middle Aged; Patient Reported Outcome Measures; Patients; Quality of Life; Randomized Controlled Trials as Topic; Remission; Remission (Medicine); rheumatoid; Rheumatoid Arthritis; Rheumatology; Severity of Illness Index; Sleep; Ultrasonic imaging; ultrasonography; Ultrasonography, Doppler; Ultrasound; Variables; Young Adult
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2021-220750

ObjectivesFatigue 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.MethodsData 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.Results205 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