THU0320 A short, easily readable, only 3-item tool – bristol rheumatoid arthritis fatigue scale (BRAF) – is valid in patients with psoriatic arthritis
Authors: M. Haroon, K. Iqbal, M. Ashraf, P. Gallagher, O. FitzGerald
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Fatigue in Psoriatic arthritis is very little studied. Recently, an instrument, the Functional Assessment of Chronic Illness Therapy (FACIT), has been validated in PsA, which is a relatively long, 13-item, instrument. An alternative instrument, the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales (BRAF-NRS), is an easily readable, much shorter, 3-item tool. The BRAF-NRS has been studied and validated in rheumatoid arthritis population; however, this has not been validated in patients with PsA. <h3>Objectives</h3> The purpose of this study was firstly to determine the internal consistency, test–retest reliability, criterion validity of the BRAF-NRS in patients with PsA. Secondly, we also examined the potential clinical associations of worse fatigue in patients with established PsA. <h3>Methods</h3> Two independent cohorts fulfilling CASPAR criteria were enrolled. STUDY PHASE 1: BRAF-NRS SCALE VALIDATION COHORT (n=70) A consecutive cohort of 70 PsA patients completed the 3-item BRAF-NRS scale and 13 items of the FACIT-F scale, alongside laboratory testing and disease activity assessments. Moreover, all these patients completed BRAF-NRS questionnaires twice, one day apart. Internal consistency was measured by Cronbach's alpha; test–retest reliability by the intra class correlation coefficient (ICC); and validity by the correlation of the BRAF-NRS results with validated FACIT-F measures. STUDY PHASE-2: IDENTIFYING THE POTENTIAL CLINICAL ASSOCIATIONS OF FATIGUE BY USING BRAF-NRS (n=283) Following informed consent, patients underwent a detailed skin and rheumatologic assessment including disease activity measures, and whether patient has achieved minimal disease activity (MDA). Moreover, we measured comorbidity using the Charlson Comorbidity Index (CCI). The factors predicting worse fatigue as measured by the BRAF-NRS score were determined using univariate and multivariate linear regression analysis. <h3>Results</h3> STUDY PHASE 1: BRAF-NRS SCALE VALIDATION COHORT (n=70): 67 patients had the complete assessments [mean age 52±9 years, 54% female, mean PsA duration of 5±3 years). The internal consistency of the 3 items BRAF-NRS questionnaire as measured by Cronbach's alpha was 0.92. Test–retest reliability as measured by the intraclass correlation coefficient between the first and repeat questionnaires was 0.98. The BRAF-NRS scores were compared with the FACIT fatigue scores. There was an excellent correlation between the BRAF-NRS and FACIT fatigue (r=-0.83 (p≤0.001). STUDY PHASE-2: IDENTIFYING THE POTENTIAL CLINICAL ASSOCIATIONS OF FATIGUE BY USING BRAF-NRS (n=283) On multiple linear regression analysis, the model predicted the significant association of low education status (p=0.03), number of deformed joints (p=0.01), not achieving MDA (p&lt;0.001), higher CCI scores and worse HAQ (p&lt;0.001) with worse fatigue scores. <h3>Conclusions</h3> BRAF-NRS provides a reliable, reproducible and valid instrument of measuring fatigue in PsA. Fatigue is associated with low education status, higher number of deformed joints and comorbidities, not achieving remission and worse functional index. This short assessment tool can be especially valuable in the context of a busy clinic, and also in large epidemiological studies when other core domains warrant assessment. <h3>Disclosure of Interest</h3> M. Haroon Grant/research support from: Abbvie, Pfizer, Speakers bureau: Abbvie, Pfizer, UCB, K. Iqbal: None declared, M. Ashraf: None declared, P. Gallagher: None declared, O. FitzGerald Grant/research support from: Pfizer, Abbvie, MSD, Roche, UCB, Janssen and Cellgene