FRI0082 Predictors of fatigue and persistent fatigue in early rheumatoid arthritis: a longitudinal observational study
Authors: S. Rodríguez-Muguruza, B. Combe, F. Guillemin, B. Fautrel, A. Olive, S. Marsal, O. Valero, N. Rincheval, C. Lukas
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Fatigue is a multifactorial and persistent symptom reported by patients with rheumatoid arthritis (RA). It is considered as frequent as pain. It would be of value to identify potential predictive factors of fatigue that can influence on its evolution. <h3>Objectives</h3> To identify predictive factors of fatigue and of persistent fatigue in a large prospective cohort of early RA patients. <h3>Methods</h3> <i>The Etude et Suivi des polyarthrites Indifferenciees Récentes</i> (ESPOIR) is a multicenter French cohort of patients with early arthritis. We selected patients fulfilling the 2010 ACR/EULAR criteria for RA during the first year of follow-up. We recorded sociodemographic and clinical characteristics, the SF-36 vitality score, Health Assessment Questionnaire (HAQ) score and 28-joint Disease Activity Score (DAS28) at baseline and every 6 months up to 5 years. The association of fatigue (SF vitality score ≤40) or persistent fatigue (SF vitality score ≤40 at the end of the study and at least in 50% of visits in the 5 years follow up) with other characteristics were evaluated by bivariate logistic regression models/tests (chi-squared test for qualitative variables and t-test/Mann-Whitney test for quantitative variables). A multivariate logistic regression model was used to determine independent predictors of persistent fatigue. <h3>Results</h3> We included 677 patients (73.4% women, mean ±SD age 48.6±12 years); 46.5%, 28% and 22% of RA patients presented fatigue at baseline, 6 months and 5 years of follow up respectively. At baseline, fatigue was independently and significantly associated with single patients (OR=2.5 95% CI [0.30–0.70] p&lt;0.001), higher BMI (OR=1.1 95% CI [1.01–1.10] p=0.007), higher DAS28 (OR=1.3 95% CI [1.08–1.60] p=0.006), higher severity of morning stiffness (scored 0–10) (OR=1.0 95% CI [1.00–1.01] p=0.012), higher HAQ (OR=2.4 95% CI [1.70–3.44] p&lt;0.001), negativity of FR (OR=1.5 95% CI [1.09–2.29] p=0.016) and history of depression or anxiety (OR=6.1 95% CI [3.90–9.83] p&lt;0.001). A 14.9% of patients presented persistent fatigue. Independent predictors of persistent fatigue at 5 years of follow-up were HAQ (OR=2.5 95% CI [1.63–3.67] p&lt;0.001), history of depression/anxiety (OR=3.7 95% CI [1.53–9.15] p=0.004),&gt;3 comorbidity (OR=2.1 95% CI [1.23–3.73] p=0.007), dry syndrome (OR=2.4 95% CI [1.39–4.17] p=0.002), and negativity in RF (OR=1.85 95% CI [1.07–3.21] p=0.027). <h3>Conclusions</h3> Fatigue was frequent in this cohort of early RA patient, its presence decreased at 6 months and remained stable over time. Baseline fatigue and persistent fatigue were both predicted by functional impairment, negativity of RF and history of depression or anxiety. Disease activity measured by DAS28 was strongly associated to fatigue at baseline but it was not a predictor of persistent fatigue. <h3>Disclosure of Interest</h3> None declared