PARE0022 TARGETING FATIGUE IN RHEUMATOID ARTHRITIS: A SELF-HELP BOOKLET
Authors: R. Geenen
Journal: Annals of the Rheumatic Diseases (2020)

Background: Fatigue in rheumatoid arthritis (RA) is prevalent, intrusive, and disabling [1-3]. It has been shown that fatigue can be reduced, in at least some people with rheumatoid arthritis, using group interventions based on cognitive-behavioral principles [1]. However, the vast majority of the (about 40% [2]) severely fatigued people with rheumatoid arthritis does not have or does not want access to group therapy. Objectives: To develop a self-help booklet aimed at targeting fatigue in rheumatoid arthritis based on cognitive-behavioral principles. Methods: Based on the assumption that the most strongly influencing factors of fatigue differ between people [3], a comprehensive patient-centered approach was chosen. The booklet should be easy to read (big fonts, text boxes, bulleted text, and illustrations). Needed materials should be included. Results: In the booklet, factors that may influence fatigue are demonstrated by a hanging mobile toy, a device with stars or other figures hanging from the ceiling. If one piece moves, all the other pieces move as well. Every individual piece that is part of the mobile influences the other. However, every mobile is different. The large differences in balance between components of mobiles can be compared to the large variety of influences on fatigue in people. Patients first need to identify which factors seem especially important influencers of their own fatigue by sorting seven cards that are included in the booklet. They put the factor of which they think that it most influences their fatigue at the top and the factor that least influences their fatigue at the bottom. The seven cards are: 1) severe overweight, 2) disease activity, 3) day-night rhythm and sleep, 4) physical activity, 5) emotions and negative thoughts, 6) pain, and 7) another influence. Interventions targeting these factors are discussed in separate sections of the booklet. Users are invited to start reading the sections with advice regarding the factors that most influence their fatigue. The foldable back cover of the booklet includes the set of seven cards of influencing factors, a diagram to make a 7-day 24-hours day-night rhythm schedule, and instructions to make an action plan. Conclusion: In the Netherlands, the text can be obtained online and as a booklet in rheumatology departments of hospitals and through a national patient association, free of charge. The booklet was translated into English, which makes it accessible to a larger group of patients. It may take up to two months to successfully change lifestyle. It’s an, as yet not empirically verified, hope that the booklet will be more successful than a traditional educational brochure. References: [1]Hewlett S, Almeida C, Ambler N, et al. Reducing arthritis fatigue impact: two-year randomised controlled trial of cognitive behavioural approaches by rheumatology teams (RAFT). Ann Rheum Dis 2019;78(4):465–472. [2]Overman CL, Kool MB, Da Silva JA, Geenen R. The prevalence of severe fatigue in rheumatic diseases: an international study. Clin Rheumatol 2016;35(2):409–415. [3]Geenen R, Dures E. A biopsychosocial network model of fatigue in rheumatoid arthritis: a systematic review. Rheumatology (Oxford) 2019;58(Supplement_5):v10–v21. Disclosure of Interests: Rinie Geenen Speakers bureau: Sanofi Genzyme paid for a lecture on depression in RA.