Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Validation of the Functional Assessment of Chronic Illness Therapy Fatigue Scale relative to other instrumentation in patients with rheumatoid arthritis. Effects of Person-Centered Physical Therapy on Fatigue-Related Variables in Persons With Rheumatoid Arthritis: A Randomized Controlled Trial. Fatigue in rheumatoid arthritis: quantitative findings on the efficacy of tocilizumab and on factors associated with fatigue. The French multicentre prospective PEPS Study. The Effect of Exercise on Sleep and Fatigue in Rheumatoid Arthritis: A Randomized Controlled Study Identifying Preliminary Domains to Detect and Measure Rheumatoid Arthritis Flares: Report of the OMERACT 10 RA Flare Workshop Adalimumab plus methotrexate or standard therapy is more effective than methotrexate or standard therapies alone in the treatment of fatigue in patients with active, inadequately treated rheumatoid arthritis. Effect of etanercept on fatigue in patients with recent or established rheumatoid arthritis. Effects of exercise on fatigue, aerobic fitness, and disease activity measures in persons with rheumatoid arthritis. Determining the minimal clinically important differences in activity, fatigue, and sleep quality in patients with rheumatoid arthritis. Improvement and longterm maintenance of quality of life during treatment with adalimumab in severe rheumatoid arthritis. Socioeconomic factors and self-reported health outcomes in African Americans with rheumatoid arthritis from the Southeastern United States: the contribution of childhood socioeconomic status Improved health-related quality of life for patients with active rheumatoid arthritis receiving rituximab: Results of the Dose-Ranging Assessment: International Clinical Evaluation of Rituximab in Rheumatoid Arthritis (DANCER) Trial. Secukinumab treatment in rheumatoid arthritis is associated with incremental benefit in the clinical outcomes and HRQoL improvements that exceed minimally important thresholds Responsiveness of patient reported outcomes including fatigue, sleep quality, activity limitation, and quality of life following treatment with abatacept for rheumatoid arthritis The Beck Depression Inventory, Center for Epidemiological Studies Depression Scale (CES-D), and General Well-Being Schedule depression subscale in rheumatoid arthritis. Criterion contamination of responses. Rehabilitation in rheumatoid arthritis: a critical review. Perceived work ability, quality of life, and fatigue in patients with rheumatoid arthritis after a 6‐month course of TNF inhibitors: prospective intervention study and partial economic evaluation Predictors of exercise and effects of exercise on symptoms, function, aerobic fitness, and disease outcomes of rheumatoid arthritis. The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century. Clinical effectiveness and cost‐effectiveness of nurse‐led care in Chinese patients with rheumatoid arthritis: A randomized trial comparing with rheumatologist‐led care Abatacept improves both the physical and mental health of patients with rheumatoid arthritis who have inadequate response to methotrexate treatment Improved health outcomes with Etanercept versus usual DMARD therapy in an Asian population with established rheumatoid arthritis
OBJECTIVE Fatigue is commonly reported by patients with rheumatoid arthritis ( RA ) but is rarely a treatment target . The aim of this study was to explore the concept of fatigue as experienced by patients with RA . METHODS Fifteen patients with RA and fatigue ( > or = 7 on a 10-cm visual analog scale ) were individually interviewed and asked about the description , cause , consequence , and management of fatigue . Transcripts were systematic ally analyzed by 2 research ers independently , relevant phrases were coded , and earlier transcripts were checked for the emerging codes . A r and om sample of analyses were independently review ed . A total of 191 codes arising from the data were grouped into 46 categories and overarching themes . RESULTS Vivid descriptions reflect 2 types of fatigue : severe weariness and dramatic overwhelming fatigue . RA fatigue is different from normal tiredness because it is extreme , often not earned , and unresolving . Participants described physical , cognitive , and emotional components and attributed fatigue to inflammation , working the joints harder , and unrefreshing sleep . Participants described far-reaching effects on physical activities , emotions , relationships , and social and family roles . Participants used self-management strategies but with limited success . Most did not discuss fatigue with clinicians but when they did , they felt it was dismissed . Participants held negative views on the management of fatigue . CONCLUSION The data show that RA fatigue is important , intrusive , and overwhelming , and patients struggle to manage it alone . These data on the complexity of fatigue experiences will help clinicians design measures , interventions , and self-managment guidance OBJECTIVE This study vali date d a brief measure of fatigue in rheumatoid arthritis ( RA ) , the Functional Assessment of Chronic Illness Therapy ( FACIT ) Fatigue Scale . METHODS The FACIT Fatigue was tested along with measures previously vali date d in RA : the Multidimensional Assessment of Fatigue ( MAF ) and Medical Outcomes Study Short-Form 36 ( SF-36 ) Vitality . The sample included 636 patients with RA enrolled in a 24 week double blind , r and omized clinical trial ( RCT ) of adalimumab versus placebo . RESULTS The FACIT Fatigue showed good internal consistency ( alpha = 0.86 to 0.87 ) , strong association with SF-36 Vitality ( r = 0.73 to 0.84 ) and MAF ( r = -0.84 to -0.88 ) , and the ability to differentiate patients according to clinical change using the American College of Rheumatology ( ACR ) response criteria ( ACR 20/50/70 ) . Psychometric performance of the FACIT Fatigue scale was comparable to that of the other 2 fatigue measures . A minimally important difference in FACIT Fatigue change score of 3 - 4 points was confirmed in a separate sample of 271 patients with RA enrolled in a second double blind RCT of adalimumab versus placebo . CONCLUSION The FACIT Fatigue is a brief , valid measure for monitoring this important symptom and its effects on patients with RA OBJECTIVE To examine effects of person-centered physical therapy on fatigue and related variables in persons with rheumatoid arthritis ( RA ) . DESIGN R and omized controlled trial . SETTING Hospital outpatient rheumatology clinic . PARTICIPANTS Persons with RA aged 20 to 65 years ( N=70 ) :  intervention group ( n=36 ) and reference group ( n=34 ) . INTERVENTIONS The 12-week intervention , with 6-month follow-up , focused on partnership between participant and physical therapist and tailored health-enhancing physical activity and balancing life activities . The reference group continued with regular activities ; both groups received usual health care . MAIN OUTCOME MEASURES Primary outcome was general fatigue ( visual analog scale ) . Secondary outcomes included multidimensional fatigue ( Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Question naire ) and fatigue-related variables ( ie , disease , health , function ) . RESULTS At posttest , general fatigue improved more in the intervention group than the reference group ( P=.042 ) . Improvement in median general fatigue reached minimal clinical ly important differences between and within groups at posttest and follow-up . Improvement was also observed for anxiety ( P=.0099 ) , and trends toward improvements were observed for most multidimensional aspects of fatigue ( P=.023-.048 ) , leg strength/endurance ( P=.024 ) , and physical activity ( P=.023 ) . Compared with the reference group at follow-up , the intervention group improvement was observed for leg strength/endurance ( P=.001 ) , and the trends toward improvements persisted for physical ( P=.041 ) and living-related ( P=.031 ) aspects of fatigue , physical activity ( P=.019 ) , anxiety ( P=.015 ) , self-rated health ( P=.010 ) , and self-efficacy ( P=.046 ) . CONCLUSIONS Person-centered physical therapy focused on health-enhancing physical activity and balancing life activities showed significant benefits on fatigue in persons with RA OBJECTIVES Fatigue is an important aspect of rheumatoid arthritis ( RA ) . The objective was to assess fatigue levels and its determinants over the first 4 months of tocilizumab ( TCZ ) treatment in RA patients . METHODS We performed a multicentre prospect i ve study of RA patients treated with intravenous TCZ in open-label prescription conditions . The first 5 infusions ( 4 months ) were assessed . The primary endpoint was the percentage of patients with variation of the FACIT fatigue scale from inclusion to 4 months , above the minimal clinical ly important difference ( MCID ) of 4 points . Fatigue was also assessed by the patient acceptable symptom state for fatigue ( PASS ) question . Variables related with fatigue and with fatigue improvement including other patient reported outcomes , depression and anxiety , and disease activity , were assessed before and after treatment . ANALYSES univariate and multivariate logistic regressions . RESULTS Of 719 patients , 610 had evaluable data : mean age 56±13 years , disease duration 12±10 years , 490 ( 81 % ) women . At baseline , fatigue levels were high : 73 % patients had unacceptable fatigue . At 4 months , 378 patients ( 62 % ) reached MCID improvement for fatigue . Fatigue reduction was rapid , seen as early as after 2 weeks . Fatigue was mainly related to functional status ( HAQ score ) , depression and anxiety , both before and after TCZ treatment . Moderate predictors of fatigue improvement were evidence d. CONCLUSIONS In these long-st and ing RA patients  , fatigue levels were high and mainly explained by HAQ and psychological distress but improved with treatment indicating a link with disease activity . The pathophysiological basis of RA fatigue should be further explored Objective . Sleep disturbance and chronic fatigue are common in rheumatoid arthritis ( RA ) and contribute to disability , symptomatology , and healthcare use . It has long been recognized in other population s that exercise can improve sleep and diminish fatigue . The effect of exercise on sleep quality and fatigue in RA has not been evaluated . Methods . Ours is a r and omized controlled study in RA to determine the effect of an exercise program on sleep quality and fatigue . These were measured using the Pittsburgh Sleep Quality Index and the Fatigue Severity Scale .  Patients were r and omized to either a 12-week , home-based exercise intervention or usual care . The exercise program consisted of specific exercises to target individual deficiencies identified using the Health Assessment Question naire ( HAQ ) with cardiovascular work as per the guidelines . The intervention group was evaluated on a 3-week basis . Full evaluation was carried out at baseline and at 12 weeks . Results . Forty patients were r and omized to the intervention with 38 controls . In the exercise intervention group , there was a statistically significant improvement in HAQ ( p = 0.00 ) , pain ( p = 0.05 ) , stiffness ( p = 0.05 ) , sleep quality ( p = 0.04 ) , and fatigue ( p = 0.04 ) . In our control group , there was a statistically significant improvement demonstrated in their overall perceptions of the benefits of exercise , but none of the other variables . Conclusion . Our study demonstrates that an exercise program result ed in significant improvement in sleep quality and fatigue . This is particularly interesting given the importance of fatigue as an outcome measure in RA and gives us yet another reason to prescribe exercise in this population Background . While disease flares in rheumatoid arthritis ( RA ) are a recognized aspect of the disease process , there is limited formative research to describe them . Methods . The Outcome Measures in Rheumatology Clinical Trials ( OMERACT ) RA Flare Definition Working Group is conducting an international research project to underst and the specific characteristics and impact of episodic disease worsening , or “ flare , ” so that outcome measures can be developed or modified to reflect this uncommonly measured , but very real and sometimes disabling RA disease feature . Patient research partners provided critical insights into the multidimensional nature of flare . The perspectives of patients and healthcare and research professionals are being integrated to ensure that any outcome measurement to detect flares fulfills the first OMERACT criteria of Truth . Through an iterative data -driven Delphi process , a preliminary list of key domains has been identified to evaluate flare . Results . At OMERACT 10 , consensus was achieved identifying features of flare in addition to the existing core set for RA , including fatigue , stiffness , symptom persistence , systemic features , and participation . Patient self-report of flare was identified as a component of the research agenda needed to establish criterion validity for a flare definition ; this can be used in prospect i ve studies to further evaluate the Discrimination and Feasibility components of the OMERACT filter for a flare outcome measure . Conclusion . Our work to date has provided better underst and ing of key aspects of the RA disease process as episodic , potentially disabling disease worsening even when a patient is in low disease activity . It also highlights the importance of developing ways to enhance communication between patients and clinicians and improve the ability to achieve “ tight control ” of disease OBJECTIVES Fatigue is an important systemic symptom of rheumatoid arthritis ( RA ) but has rarely been evaluated consistently after initiation of treatment in RA patients . This study examined the effects of adalimumab ( HUMIRA , Abbott Laboratories , Abbott Park , IL , USA ) , a fully human , anti-tumor necrosis factor ( anti-TNF ) monoclonal antibody , on reducing fatigue in patients with RA . METHODS A total of 1526 patients with RA were enrolled in 3 r and omized , placebo-controlled clinical trials of adalimumab versus placebo plus methotrexate ( MTX ) or placebo plus st and ard antirheumatic therapies .  Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy ( FACIT ) fatigue scale question naire ( which has been vali date d in RA ) at baseline , mid- study , and at the end of the study . Logistic regression models were constructed using baseline demographic variables to test for treatment effect . In addition , sensitivity analyses were performed to determine the robustness of the data . RESULTS At baseline in the 3 trials , patients ' fatigue ranged from 27.9 - 29.7 , representing considerable fatigue on the FACIT fatigue scale . Fatigue was significantly and consistently reduced in adalimumab-treated patients in the 3 clinical trials . Relative to placebo plus MTX , the adalimumab 40-mg-every-other-week dosage group reported statistically significantly less fatigue at all time points post-baseline . Improvements between adalimumab and placebo ranged from 3 - 7 points across all 3 trials , with a 3 - 4-point change representing a minimum clinical ly important difference . CONCLUSION Adalimumab treatment was shown to significantly reduce fatigue  in patients with moderate to severe RA . Changes in fatigue in all 3 trials were found to be clinical ly important OBJECTIVE To assess the long-term impact of etanercept on fatigue in patients with recent-onset ( mean duration 11 months ) or established ( mean duration 12 years ) rheumatoid arthritis ( RA ) . METHODS Patients participating in either of 2 multicenter , r and omized , double-blind clinical trials were included . In one trial , patients with recent-onset RA received either etanercept 25 mg twice weekly or methotrexate in a double-blind fashion for 12 months , then open label for 12 months . All patients then received open-label etanercept . In the second trial , patients with established RA received etanercept 25 mg or placebo twice weekly for 6 months in a double-blinded fashion , then open-label etanercept . Up to 46 months of followup data were included . Fatigue was measured regularly using the Health Assessment Question naire vitality domain . RESULTS Patients with recent-onset RA who received etanercept had a significantly faster improvement in fatigue than those receiving methotrexate in the first 2 months . Subsequently , patients receiving etanercept and methotrexate had 23 - 29 % and 17 - 24 % reductions in fatigue scores , respectively . In the group with established RA , patients who received etanercept had significantly greater reductions in fatigue than those receiving placebo during the blinded period . Patients initially receiving etanercept sustained a mean fatigue reduction of 25 - 36 % for the entire followup . Patients achieving clinical ly meaningful improvement in fatigue were more likely to meet the American College of Rheumatology improvement criteria . CONCLUSION Etanercept therapy reduces fatigue in patients with recent-onset or established RA . Improvement in fatigue was sustained for up to 46 months , and correlated with other RA-relevant outcomes The effects of 12 weeks of low-impact aerobic exercise on fatigue , aerobic fitness , and disease activity were examined in a quasi-experimental time series study of 25 adults with rheumatoid arthritis ( RA ) . Measures were obtained preintervention , midtreatment ( after 6 weeks of exercise ) , end of treatment ( after 12 weeks of exercise ) , and at a 15-week follow-up . ANOVAS for repeated measures showed that those subjects who participated more frequently reported decreased fatigue , while those who participated less frequently reported an increase in fatigue . All subjects , on average , showed increased aerobic fitness and increased right and left h and grip strength , decreased pain , and decreased walk time . There were no significant increases in joint count or sedimentation rate . Significant improvements in measures at the 15-week follow-up also were found . Findings indicate that persons with RA who participate in appropriate exercises may lessen fatigue levels and experience other positive effects without worsening their arthritis OBJECTIVE To determine the minimal clinical ly important differences ( MCID ) in the patient-reported outcomes of activity ( 0 - 30 , number of days of limitation ) , fatigue ( 0 = none , 100 = complete ) , and sleep quality ( 0 = no problems , 100 = worst case ) for patients with rheumatoid arthritis ( RA ) . METHODS Two r and omized controlled trials comparing abatacept to placebo  in RA patients were considered : ATTAIN ( n = 391 ) and AIM ( n = 652 ) . An internal anchor-based approach was used to derive the MCID using the Health Assessment Question naire , patient global assessment , and pain as anchors . Minimal important change in activity , fatigue , and sleep were determined by estimating mean changes in these outcomes in patients showing change in a narrow range about the MCID of the internal anchor . Correlation analysis was used to determine the consistency of the changes in the outcomes and anchors , and a Delphi process was used to determine the final MCID values . RESULTS For the 2 trials , consistent patterns of change for activity , fatigue , and sleep and the internal anchors were found with correlations in the range of 0.5 , 0.7 , and 0.4 , respectively . The mean changes for activity , fatigue , and sleep in a narrow range about the MCID of the 3 internal anchors corresponding to the 2 trials were : 3.4 to 4.3 for activity ; 6.7 to 17.0 for fatigue ; and 4.1 to 7.3 for sleep . Following the Delphi process the MCID determined were 4 for activity , 10 for fatigue , and 6 for sleep . CONCLUSION These MCID for activity limitation , fatigue , and sleep problems can be used in design ing clinical trials and providing benchmarks in assessing patient improvement OBJECTIVE In patients with longst and ing severe rheumatoid arthritis ( RA ) receiving chronic treatment with adalimumab  , health related quality of life ( HRQOL ) was assessed using new instruments [ Functional Assessment of Chronic Illness Therapy-Fatigue scale ( FACIT-Fatigue ) and Health Utilities Index Mark 3 ( HUI3 ) ] and a more conventional instrument [ Medical Outcomes Study Short Form-36 Health Survey ( SF-36 ) ] . METHODS Different measures for collecting patient-reported outcomes were applied simultaneously during the 3-year study period . Sociodemographic and medical history data were assessed at the baseline visit . Clinical examinations ( e.g. , joint examination and morning stiffness ) , disease assessment s , and HRQOL data  were recorded every 8 weeks . For dichotomous and categorical variables , absolute and relative frequencies were calculated . Metric measures were described using mean and st and ard deviation and /or st and ard error of the mean . HRQOL data were analyzed using observed cases . RESULTS All assessed measures ( FACIT-Fatigue , HUI3 , SF-36 ) showed a rapid and statistically significant improvement from baseline following initiation of adalimumab therapy . This effect was maintained over the study period for a mean of 1.6 years in all applied measures . HRQOL data from all tested instruments were significantly correlated with each other . CONCLUSION Chronic therapy with adalimumab improved measures of fatigue and HRQOL  in patients with longst and ing RA Background There is abundant evidence that low socioeconomic status ( SES ) is associated with worse health outcomes among people with Rheumatoid Arthritis ( RA ) ; however , the influence of socioeconomic disadvantage in early life has yet to be studied within that population . Methods Data originated from the cross-sectional arm of the Consortium Evaluation of African-Americans with Rheumatoid Arthritis ( CLEAR II ) , which recruited African-Americans with RA from six sites in the Southeastern United States . We used linear regression models to evaluate associations of parental homeownership status and educational level at participant time of birth with participant-reported fatigue ( Visual Analog scale , cm ) , pain ( Visual Analog scale , cm ) , disability ( Health Assessment Question naire ) and helplessness ( Rheumatology Attitudes Index ) , independently of participant homeownership status and educational level . Models included r and om effects to account for intra-site correlations , and were adjusted for variables identified using backward selection , from : age , disease- duration , sex , medication use , body-mass index , smoking history . Results Our sample included 516 CLEAR II participants with full data on demographics and covariates . 89 % of participants were women , the mean age was 54.7 years and mean disease duration was 10.8 years . In age adjusted models , parental non-homeownership was associated with greater fatigue ( β = 0.75 , 95 % CI = 0.36–1.14 ) , disability ( β = 0.12 , 95 % CI = 0.04–0.19 ) and helplessness ( β = 0.12 , 95 % CI = 0.03–0.21 ) , independently of participant homeownership and education ; parental education had a further small influence on self-reported fatigue ( β = 0.20 , 95 % CI = 0.15–0.24 ) . Conclusions Parental homeownership , and to a small extent parental education , had modest but meaningful relationships with self-reported health among CLEAR II participants OBJECTIVE To evaluate the effect of rituximab treatment on health-related quality of life ( HRQOL ) in patients with active rheumatoid arthritis ( RA ) , who have had an inadequate response to disease-modifying antirheumatic drugs , including biologic agents . METHODS A r and omized , multicenter , double-blind , placebo-controlled clinical trial involving 367 rheumatoid factor-positive patients was conducted . Patients received 2 infusions 2 weeks apart of placebo ( n = 122 ) , rituximab 500 mg ( n = 123 ) , or rituximab 1000 mg ( n = 122 ) , with or without glucocorticoids . All patients received stable doses of methotrexate ( 10 25 mg/wk ) . Measures included SF-36 , assessed at baseline and at 24 weeks , as well as the HAQ and FACIT-Fatigue scale assessed at baseline and monthly for 24 weeks . Patients exceeding prespecified minimal clinical ly important differences ( MCID ) were examined . Clinical efficacy measurements ( ACR20/50/70 and EULAR responses ) were compared with HRQOL outcomes . RESULTS At 24 weeks , the rituximab 500 mg and 1000 mg groups both reported statistically significantly greater improvements on the SF-36 physical component summary ( 4.37 and 4.89 points higher , respectively , vs placebo ; p < 0.001 ) . SF-36 physical function , bodily pain , vitality , social function , and role-physical subscale scores also statistically significantly improved vs placebo . At 24 weeks , 62.6 % and 67.2 % of the rituximab 500 mg and 1000 mg groups , respectively , exceeded the MCID of 0.22 in HAQ ( p < 0.001 ) . For FACIT-Fatigue , 55.3 % and 65.6 % of patients exceeded the MCID of 3.5 points compared with 35.2 % of placebo over 24 weeks ( p < 0.001 ) . ACR20/50/70 and EULAR responders demonstrated greater improvements in mean baseline to 24 week changes in SF-36 and FACIT-Fatigue scores compared with nonresponders ( p < 0.05 ) . CONCLUSION Both rituximab doses in combination with methotrexate were effective in improving all HRQOL outcomes in patients with active RA consistent with clinical efficacy Background The primary aim of rheumatoid arthritis ( RA ) treatment is to induce remission , the absence of disease activity . The objective of this study was to explore the association between clinical endpoints used to gauge RA treatment efficacy and patient-reported outcomes of health-related quality of life , fatigue , and physical function in RA patients treated with secukinumab in a phase 2 r and omized controlled trial ( RCT ) . Method Adult RA patients ( n = 237 ) with incomplete responses to methotrexate were r and omized equally to receive monthly s.c . injections of secukinumab 25 mg , 75 mg , 150 mg , 300 mg or placebo . Clinical endpoints used in this study included the ACR response criteria and its components and simplified disease activity score . Patient-reported outcomes ( PRO ) included Health Assessment Question naire-Disability Index ( HAQ-DI ) , Medical Outcomes Study Short Form-36 [ SF-36 ] Survey , and Functional Assessment of Chronic Illness Therapy-Fatigue ( FACIT-Fatigue ) . Patients were categorized into mutually exclusive groups according to the magnitude and direction of change from baseline to week 16 in each clinical endpoint . Definitions of minimal important differences [ MID ] in each clinical endpoint were used to categorize patients , as well as thresholds beyond MID . Mean changes from baseline to week 16 were computed for each PRO and analyses of variance to test the differences in PRO changes observed across groups of patients that differed in each clinical endpoint . Analyses were limited to patients r and omized to secukinumab treatment . All dose groups were combined ( n = 187 ) . Results Mean changes from baseline in each PRO differed significantly across groups of patients in the expected direction . With few exceptions , there was considerable agreement between clinical endpoints and PROs concerning the magnitude of change defined as clinical ly meaningful . More importantly , results demonstrated that greater improvements in clinical endpoints were associated with incrementally better improvements in HRQoL , fatigue , and physical function . Conclusion Results of this study show considerable agreement between minimal thresholds of improvement established for PROs and clinical outcome measures used in RA treatment studies and provide thresholds to be considered in gauging the importance of a treatment effect that goes beyond what is considered as minimally important for PRO measures Objective : To evaluate the responsiveness of patient reported outcomes ( PROs ) , including fatigue , sleep , activity limitation , and quality of life , in patients with rheumatoid arthritis ( RA ) . Methods : Data were considered from a r and omised controlled trial comparing  abatacept ( n = 258 )  with placebo ( n = 133 ) on a background of DMARD treatment in RA patients who were inadequate responders to anti-TNF therapy ( ATTAIN study ) . PROs assessed included SF-36 , activity limitation , fatigue , and sleep . For each outcome the treatment difference , relative per cent improvement , st and ardised response mean ( SRM ) , and relative efficiency for assessing an outcome ’s ability to detect a treatment effect relative to tender joint count ( TJC ) were calculated . A relative efficiency > 1 suggests a measure that is more efficient than TJC in detecting treatment effect . Results : Moderate to large SRMs ( ⩾0.6 ) were observed for the PRO measures . In particular , SRMs ( 95 % confidence interval ) were : physician global , 0.72 ( 0.51 to 0.94 ) ; HAQ , 0.63 ( 0.42 to 0.85 ) ; SF-36 physical component score , 0.62 ( 0.40 to 0.83 ) ; SF-36 bodily pain , 0.68 ( 0.46 to 0.90 ) ; and fatigue , 0.59 ( 0.38 to 0.81 ) . Relative efficiencies for physician global ( 1.6 ) , SF-36 bodily pain domain ( 1.4 ) , pain intensity ( 1.4 ) , HAQ ( 1.2 ) , SF-36 physical component score ( 1.2 ) , fatigue ( 1.1 ) , and patient global assessment ( 1.04 ) were all more responsive than TJC . The SF-36 mental component score ( 0.3 ) , swollen joint count ( 0.6 ) , activity limitation ( 0.8 ) , sleep ( 0.7 ) , and C reactive protein ( 0.9 ) were less responsive . Conclusions : Using PROs for evaluating treatments for RA can detect improvements and will identify changes that are important to patients . In general , physical assessment s are more responsive to an effective treatment than mental assessment Three widely used  depression scales -- the  Beck Depression Inventory ( BDI ) , Center for Epidemiological Studies Depression scale ( CES-D ) , and  General Well-Being Schedule depression subscale (GWB-D)--were studied in rheumatoid arthritis ( RA ) . Twenty-three rheumatologists identified 19 of the 45 items on these three question naires as likely to differ in patients with RA and control subjects because of the presence of RA , regardless of psychological status . Responses to 13 of these 19 individual scale items , design ated as " RA-related items , " differed significantly in 41 RA patients versus 57 age-matched control subjects . Only three of the other 26 items differed significantly in the two groups . These data extend evidence that responses of people with RA on widely used depression scales might be affected by somatic disease regardless of psychological status This article considers the evidence for effectiveness and timing of rehabilitation  for people with rheumatoid arthritis ( RA ) . The Cochrane Library , DARE , Medline , Embase , CINAHL and AMED were search ed to identify systematic review s and r and omized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis . Many trials identified had method ological limitations ( e.g. short follow-up periods , small sample sizes ) . Evidence to date is that symptomatic relief results from thermotherapy , laser therapy , acupuncture and assistive devices . In the short-term , comprehensive occupational therapy ( in established rheumatoid arthritis ) , orthoses , and mind-body approaches can help maintain function . Over at least a one-year period , the following are effective in reducing pain and maintaining function :  patient education and joint protection training using behavioural approaches ; dynamic exercise therapy , h and exercises and hydrotherapy ; and cognitive-behavioural therapy ( in people with poorer psychological status ) . Many trials have recruited people with moderate to severe , established RA and relatively little is known about the long-term effectiveness of early rehabilitation , although this is becoming much more common in practice . Despite the increased availability of guidelines and systematic review s , most conclude there is insufficient evidence for many areas of rheumatology rehabilitation . Further well- design ed clinical trials are needed recruiting people with early disease using patient-centred outcomes Objective : The objective of this exploratory study was to evaluate the effects and costs of a 6‐month course of tumour necrosis factor ( TNF ) inhibitors on work ability , quality of life , and fatigue in patients with rheumatoid arthritis ( RA ) . Methods : In this prospect i ve single‐arm intervention study 59 consecutive patients of working age with established RA were recruited from an outpatient clinic in Amsterdam , the Netherl and s. All patients received fortnightly subcutaneous injections of 40 mg adalimumab . The three outcomes at baseline and 6 months were : perceived work ability [ Work Ability Index ( WAI ) ] , quality of life [ Rheumatoid Arthritis Quality of Life instrument ( RAQoL ) ] , and fatigue [ Checklist Individual Strength ( CIS ) , Need for Recovery ( NFR ) scale ] . Cost data of the preceding 6 months were collected using a self‐administered patient question naire at baseline and follow‐up . Results : At 6 months , all outcomes showed a statistically significant improvement in mean scores from baseline , ranging from 10.0 % ( WAI ) , to 11.7 % ( RAQoL ) , to 15 % ( NFR ) ( subgroup paid work , n = 26 ) . The total mean costs showed a twofold increase in mean costs per week per patient [ difference EUR 169 , 95 % confidence interval ( CI ) EUR 113–226 ] . Conclusions : In this short‐term exploratory evaluation , a 6‐month course of TNF inhibitors  improved work ability and quality of life , and reduced fatigue in patients with established RA . These effects are associated with an increase in total healthcare costs , attributable to the costs of TNF inhibitors . R and omized controlled trials with a longer follow‐up are needed to show a long‐term effect on work disability and the potential cost‐effectiveness of TNF inhibitors OBJECTIVE To determine the effects of participation in a low-impact aerobic exercise program on fatigue , pain , and depression ; to examine whether intervention groups compared with a control group differed on functional ( grip strength and walk time ) and disease activity ( total joint count , erythrocyte sedimentation rate , and C-reactive protein ) measures and aerobic fitness at the end of the intervention ; and to test which factors predicted exercise participation . METHODS A convenience sample of 220 adults with rheumatoid arthritis ( RA ) , ages 40 - 70 , was r and omized to 1 of 3 groups : class exercise , home exercise using a videotape , and control group . Measures were obtained at baseline ( T1 ) , after 6 weeks of exercise ( T2 ) , and after 12 weeks of exercise ( T3 ) . RESULTS Using structural equation modeling , overall symptoms ( latent variable for pain , fatigue , and depression ) decreased significantly at T3 ( P < 0.04 ) for the class exercise group compared with the control group . There were significant interaction effects of time and group for the functional measures of walk time and grip strength : the treatment groups improved more than the control group ( P < or= 0.005 ) . There were no significant increases in measures of disease activity . Fatigue and perceptions of benefits and barriers to exercise affected participants ' amount of exercise , supporting previous research . CONCLUSION This study supported the positive effects of exercise on walk time and grip strength , and demonstrated that fatigue and perceived benefits /barriers to exercise influenced exercise participation . Furthermore , overall symptoms of fatigue , pain , and depression were positively influenced in this selective group of patients with RA ages 40 - 70 years BACKGROUND It is 40 yr since the last age- and sex-specific estimates of the prevalence of rheumatoid arthritis ( RA ) for the UK were published . Since then the classification criteria for RA have been revised and there has been evidence of a fall in the incidence of RA , especially in women . OBJECTIVES To estimate the age- and sex-specific point prevalence of RA ( defined as fulfilment of a modification of the 1987 ACR classification criteria for RA on the day of assessment ) . The estimate was made in the primary care setting in Norfolk , UK . METHODS A stratified r and om sample was drawn from seven age and gender b and s. The 7050 individuals selected were mailed a screening question naire . Positive responders were invited to attend for a clinical examination . The sample was matched against the names in the Norfolk Arthritis Register ( NOAR ) , a register of incident cases of inflammatory polyarthritis which has been in existence since 1990 . RESULTS The overall response rate was 82 % . Sixty-six cases of RA were identified . Extrapolated to the population of the UK , the overall minimum prevalence of RA is 1.16 % in women and 0.44 % in men . A number of incident cases of RA previously notified to NOAR were not identified as cases in the survey because they had entered into treatment-induced remission . In addition , some cases who failed to attend for examination had significant disability . These prevalence figures are therefore an underestimate . CONCLUSIONS The prevalence of RA in women , but not in men , in the UK may have fallen since the 1950s BACKGROUND AND AIM The concept of nurse-led care ( NLC ) was not familiar in China . This study was design ed to evaluate the clinical effectiveness and cost-effectiveness of NLC versus rheumatologist-led care ( RLC ) in Chinese patients with rheumatoid arthritis ( RA ) . METHODS Patients of either gender ( aged ≥18 years ) with RA were enrolled at Wenhai Central Hospital , China ( January 2015 to December 2015 ) . The participants were then r and omized to NLC or RLC . Outcomes of both the groups were compared in terms of effectiveness by measuring the Disease Activity Score 28 , visual analogue scores pertaining to pain and fatigue , and duration of morning stiffness . Costs associated with re source use for RA were assessed and compared between both groups . RESULTS A total of 214 RA patients in 2 groups ( n = 107 in each group ) were enrolled and analysed . Improvements in clinical outcomes ( disease activity , pain , fatigue , and morning stiffness ) over 12 months were significantly greater in the NLC group compared to RLC ( P < 0.001 ) . Overall , costs associated with re source use were higher in the RLC group compared to the NLC group ( P < 0.05 ) . CONCLUSIONS Our preliminary finding suggested that RA patients managed by NLC compared to RLC may have better clinical outcomes and more cost-effective care in China Objective : To examine the impact of added abatacept treatment on health related quality of life ( HRQoL ) in patients with rheumatoid arthritis ( RA ) who have inadequate response to methotrexate ( MTX ) .  Methods : The impact of abatacept treatment on HRQoL was examined in a longitudinal , r and omised double blind , placebo controlled clinical trial . Effects of treatment on HRQoL were examined using repeated measures analysis of covariance and comparing rates of change in HRQoL across treatment groups . The relationship between American College of Rheumatology ( ACR ) clinical markers and disease duration with changes in HRQoL indicators was also examined . Finally , a responder analysis was used to examine the percentage of patients who improved by 0.5 SD in 12 months or who reached the normative levels seen in the US general population . Results : Statistically significant improvements in the abatacept group relative to controls were observed across a range of HRQoL measures , including physical function , fatigue , all eight domains of the SF-36 , and the physical and mental component summaries ( PCS and MCS ) . Improvements were seen as early as day 29 for fatigue and for five out of eight SF-36 domains . By day 169 , all HRQoL measures were significantly better with abatacept than with placebo .  HRQoL gains were associated with greater ACR clinical improvement , and the effects were consistent for patients with different disease duration . A significantly greater percentage of patients treated with abatacept reached normative levels of PCS , MCS , physical functioning , and fatigue compared with patients treated with MTX alone . Conclusion : Combined abatacept and MTX treatment produces significant improvements across a wide range of HRQoL domains in patients with RA Background Patient reported outcomes ( PROs ) are especially useful in assessing treatments for rheumatoid arthritis ( RA ) since they measure dimensions of health-related quality of life that can not be captured using strictly objective physiological measures . The aim of this study was to compare the effects of combination etanercept and methotrexate ( ETN + MTX ) versus combination synthetic disease modifying antirheumatic drugs ( DMARDs ) and methotrexate ( DMARD + MTX ) on PRO measures among RA patients from the Asia-Pacific region , a population not widely studied to date . Patients with established moderate to severe rheumatoid arthritis who had an inadequate response to methotrexate  were studied . Methods Patients were r and omized to either ETN + MTX ( N = 197 ) or DMARD + MTX ( N = 103 ) in an open-label , active-comparator , multicenter study , with PRO measures design ed as prospect i ve secondary endpoints . The Health Assessment Question naire ( HAQ ) , Functional Assessment of Chronic Illness Therapy Fatigue Scale ( FACIT-Fatigue ) , Medical Outcomes Short Form-36 Health Survey ( SF-36 ) , Hospital Anxiety and Depression Scale ( HADS ) and the Work Productivity and Activity Impairment Question naire : General Health ( WPAI : GH ) were used . Results Significantly greater improvements were noted for the ETN + MTX group at week16 for HAQ mean scores and for proportion of patients achieving HAQ score ≤ 0.5 , compared to patients in the DMARD + MTX group . SF-36 Summary Scores for physical and mental components and for 6 of 8 health domains showed significantly greater improvements at week16 for the ETN + MTX group ; only scores for physical functioning and role-emotional domains did not differ significantly between the two treatment arms . Greater improvements at week16 were noted for the ETN + MTX group for FACIT-Fatigue , HADS , and WPAI : GH mean scores . Conclusion Combination therapy using ETN + MTX demonstrated superior improvements using a comprehensive set of PRO measures , compared to combination therapy with usual st and ard of care DMARDs plus MTX  in patients with established rheumatoid arthritis from the Asia-Pacific region . Trial registration clintrials.gov #
However , the 4 generic scales would benefit from further validation in patients with RA , the VAS requires st and ardization , and the MAF would benefit from further sensitivity data .
OBJECTIVE Fatigue is an important outcome for patients with rheumatoid arthritis ( RA ) .
The purpose of this study was to identify the scales being used to measure RA fatigue , and to systematic ally examine the evidence for their validation .