AB0173 FACTORS ASSOCIATED WITH FATIGUE AND PERSISTENT FATIGUE IN RHEUMATOID ARTHRITIS
Authors: A. Fazaa, H. Boussaa, K. Ouenniche, S. Miladi, M. Sellami, L. Souabni, S. Chekili, S. Kassab, K. Ben Abdelghani, A. Laatar
Journal: Annals of the Rheumatic Diseases (2021)

Background: Fatigue is a common and debilitating symptom in patients with rheumatoid arthritis (RA). Fatigue in RA is poorly understood and appears to be multifactorial. Interactions between three factors were suggested: ‘personal’, ‘disease processes’, and ‘cognitive, behavioural’. Objectives: The aim of this study was to determine factors associated with fatigue and persistent fatigue in RA. Methods: We conducted a longitudinal study including patients with RA (ACR/EULAR 2010). Patients with other acute or chronic diseases that may induce fatigue (such as cancer, infection or depression) were excluded. Patients were evaluated at inclusion (T0) and 12 months later (T12). Demographic and disease-related data were collected: age, gender, professional status, physical activity, disease duration, Rheumatoid Factor (RF), Anti-citrullinated peptides antibodies (ACPA), pain Visual Analog Scale (VAS), Erythrocyte Sedimentation Rate (ESR), C Protein Reactive (CRP), Disease Activity Score 28 (DAS28), and Health Assessment Questionnaire (HAQ). Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) which is a short 13-item questionnaire validated in RA. The score FACIT-F ranges between 0 and 52. Fatigue was considered mild if the FACIT-F score was ≥40, moderate if 20≤FACIT-F&lt;40 and severe if 0≤FACIT-F&lt;20. We defined ‘persistent fatigue’ as reported fatigue at T0 and T12. A p value inferior to 0.05 was considered significant. Results: We included 100 patients (84 women and 16 men) with a mean age of 49.5±10 years old [18-65]. Among them, 25% were professionally active and 15% had a regular physical activity. At inclusion, the mean disease duration was 87.3 months [1-360]. RF and ACPA were positive in 75% and 72.6% of cases respectively. The mean pain VAS was 49 cm [0-100]. The mean levels of ESR and CRP were 38.1 mm [10-120] and 10.8 mg/l [2-61] respectively. The mean DAS28 ESR was 3.68 [1.90-8.33] and the mean HAQ score was 0.90 [0-2.75]. The mean FACIT-F score was 27.1 [0-51] at T0. Fifty-seven percent of patients had moderate fatigue and 26% had severe fatigue. At T12, the mean FACIT-F score was 33.4 [5-50]. Persistent severe fatigue was noted in 17% of patients. A significant negative correlation was noted between FACIT-F score at T0 and the following variables: age (r=-0,258, p=0.01), pain VAS (r=-0,605, p&lt;0.001), ESR (r=-0,621, p&lt;0.001), DAS28 ESR (r=-0.744, p&lt;0.001), and HAQ (r=-0.634, p&lt;0.001). A significant negative correlation was noted between FACIT-F score at T12 and the following variables: age (r=-0,229, p=0.022), disease duration (r=-0,296, p=0.003), pain VAS (r=-0,754, p&lt;0.001), ESR (r=-0,405, p&lt;0.001), CRP (r=-0,468, p&lt;0.001), DAS28 ESR (r=-0.744, p&lt;0.001), and HAQ (r=-0.678, p&lt;0.001). Fatigue and persistent fatigue were not associated with gender, professional status, physical activity, and immunological profile. Multivariable analysis showed that DAS28 ESR (OR=-0.157, 95% CI [-4.614;-0.153], p=0.036) and HAQ (OR=-0.563, 95% CI [-6.916;-2.995], p&lt;0.001) were independently associated with persistent fatigue. Conclusion: Fatigue is a frequent and complex symptom in RA. Higher disease activity and greater disability are suggested as predictors of persistent fatigue. Disclosure of Interests: None declared