AB0257 FATIGUE LEVELS PREDICT OTHER PATIENT REPORTED OUTCOMES AND DISEASE ACTIVITY SCORES: RESULTS FROM A LONGITUDINAL STUDY OF RA PATIENTS INITIATING BDMARD THERAPY
Authors: Hilde Berner Hammer, Brigitte Michelsen, Sella Aarrestad Provan, Till Uhlig, Tore K. Kvien
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Fatigue is a sensation of weakness and lack of energy which is common in patients with rheumatoid arthritis (RA), contributing to reduced quality of life. However, there are few studies on the longitudinal influence of fatigue on patient reported outcome measures (PROMs). <h3>Objectives</h3> The present study explores the impact of fatigue on PROMs, clinical, laboratory and ultrasound (US) assessments. <h3>Methods</h3> A total of 208 patients with established RA (mean (SD) age 53 (13) years, disease duration 10 (9) years, 81% women, 79% anti-CCP positive) were examined when initiating bDMARDs and assessed at baseline and after 1, 2, 3, 6 and 12 months, including fatigue (0-10, as part of the RAID score), PROMs (joint pain VAS, patient's global disease activity VAS (PGA), MHAQ, pain catastrophizing (PC), SF-36 Mental Health scale score (SF36MH)), clinical examinations (performed by a study nurse including examiner's global disease activity VAS (EGA), 28 tender and swollen joint counts (TJC, SJC)) and laboratory variables (ESR and CRP). US examinations (semi-quantitative scoring (0-3)) of grey scale (GS) and power Doppler (PD) were performed of 36 joints and 4 tendons by one rheumatologist (HBH; Siemens Acuson Antares, excellence version, 5-13 MHz probe). The clinical disease activity scores (CDAS) DAS28, CDAI and SDAI were calculated for all visits. Correlations were assessed by Spearman's rho. The predictive value of baseline fatigue on several dependent variables (PROMs, CDAS, clinical assessments) at all visits after baseline was explored by use of multiple linear regression analysis with adjustment for demographic values (age, sex and disease duration) and baseline inflammatory activity (CRP and sum score GS). <h3>Results</h3> Fatigue levels diminished during follow-up (baseline median (IQR) 5 (3-7), 12 months 2 (1-5)). Table 1 shows the high cross-sectional correlations between fatigue and PROMs/CDAS scores, low correlations with EGA/SJC/CRP and lack of correlations with US assessments. Baseline fatigue predicted PROMs and CDAS scores at all examinations (table 2). No/low associations were found between baseline fatigue and SJC/EGA/sum score PD at follow-up. <h3>Conclusion</h3> Fatigue was highly correlated with PROMS and composite scores at all timepoints. The level of baseline fatigue predicted PROMs and composite scores at follow-up, but not objective inflammatory measures. Thus, the degree of fatigue should be taken into account when composite scores are used for evaluation of inflammatory activity in established RA patients. <h3>Disclosure of Interests</h3> Hilde Berner Hammer Grant/research support from: AbbVie, Pfizer and Roche, Paid instructor for: AbbVie, Pfizer, UCB, Novartis, Roche, Speakers bureau: AbbVie, Pfizer, UCB, Novartis, Roche, Brigitte Michelsen Grant/research support from: Unrestricted grant: Novartis, Consultant for: Novartis, UCB, Sella Aarrestad Provan Consultant for: Novartis, Speakers bureau: Lilly, Till Uhlig Consultant for: Grünenthal, Novartis, Speakers bureau: Grünenthal, Novartis, Tore K. Kvien Grant/research support from: AbbVie, BMS, MSD, Pfizer, Roche and UCB., Consultant for: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi, Mylan and UCB, Speakers bureau: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi and UCB