POS0307 FATIGUE IN RHEUMATOID ARTHRITIS PATIENTS IS ASSOCIATED TO SUBJECTIVE BUT NOT OBJECTIVE ASSESSMENTS OF DISEASE ACTIVITY DURING TREATMENT WITH TOCILIZUMAB
Authors: Hammer H. B. , Agular B. , Terslev L. 
Published: May 2021

Background:

Fatigue is common in patients with rheumatoid arthritis (RA), and its association with inflammatory activity is not fully understood.

Objectives:

To explore the associations between fatigue and inflammation by clinical, laboratory and ultrasound examinations during follow-up of RA patients on biological treatment.

Methods:

A Nordic (Denmark, Finland, Norway, Sweden) open-label, single-arm study (part of the umbrella program – TOZURA (1)), enrolled patients with inadequate response to conventional synthetic (cs) DMARDs. Patients received tocilizumab 162 mg sc weekly for 24 weeks as monotherapy or in combination with a csDMARD. Stable oral NSAIDs and corticosteroids (≤10 mg/day prednisone or equivalent), were allowed. Patients were assessed at baseline, 4, 12 and 24 weeks for fatigue (FACIT-F questionnaire (total sum scores)), patient reported outcome measures ((PROMs) including joint pain and patient’s global visual analogue scale (VAS) as well as HAQ-DI), clinical assessments (tender and swollen joints, assessor’s global VAS), laboratory examinations (ESR, CRP) and ultrasound assessments (36 joints and 4 tendons, scored according to the Norwegian US atlas (2)). Spearman correlations, performed both at baseline and for changes from baseline of variables during follow-up, explored associations between fatigue and PROMs, clinical, laboratory as well as ultrasound variables. Predictive value of fatigue was investigated by linear regression.

Results:

110 patients were included (83% female, mean (SD) age 55.6 (12.1) years and RA duration 8.7 (9.5) years, 81% anti-CCP positive). All PROMs, clinical, laboratory and ultrasound variables decreased significantly, already after 4 weeks (p<0.001). Both for baseline assessments as well as for changes during follow-up, fatigue was associated with PROMs (Table 1 (baseline) and Table 2 (follow-up)). However, there were no or low associations between fatigue and clinical, laboratory and ultrasound assessments at baseline or during follow-up. In addition, baseline fatigue was predictive of joint pain, patient’s global VAS and HAQ-DI during follow-up (p<0.05-0.001), but not for the clinical, laboratory or ultrasound assessments.

Conclusion:

Fatigue assessed by an established questionnaire did not show any associations with several assessments of inflammatory activity in RA patients, neither at baseline nor during effective treatment. Thus, the present study adds to the increasing number of papers finding fatigue to reflect other aspects of RA disease activity than inflammation.

References:

[1]Choy E et al. Rheumatology 2018; 2. Hammer HB et al, ARD 2011

Table 1.

Spearman correlations between FACIT-F total score and patient reported outcomes, clinical, laboratory and ultrasound assessments. *p<0.05. **p<0.001

Table 2.

Spearman correlations between changes in FACIT-F total score from baseline to 4, 12 and 24 weeks and changes in patient reported outcomes, clinical, laboratory and ultrasound assessments. *p<0.05. **p<0.001

Disclosure of Interests:

Hilde Berner Hammer Speakers bureau: AbbVie, Pfizer, Roche, Lilly and Novartis, Consultant of: Novartis, Birte Agular Employee of: Roche, Lene Terslev Speakers bureau: Roche, MSD, BMS, Pfizer, AbbVie, Novartis and Janssen