Fatigue common in early rheumatoid arthritis

Many patients with early rheumatoid arthritis (RA) experience fatigue, which is associated with pain, a study has found.

The analysis included 1,864 patients (mean age, 54.5 years; 71.8 percent female) who reported fatigue at baseline. Fatigue was low in 23 percent of patients, moderate in 19 percent, and severe in 59 percent. At baseline, mean fatigue numerical rating scale (NRS) was 5.1, while that of pain was 5.4; mean pain scores markedly differed among the three fatigue levels.

Mean Disease Activity Score in 28 joints (DAS28) at baseline was 4.86, with all fatigue groups having scores consistent with moderate disease activity although still different among the three fatigue levels. Median erythrocyte sedimentation rate (ESR) at baseline was 20.0 mm/hr, while median C-reactive protein (CRP) level was 6.7 mg/L. There were 38 patients (2 percent) with fibromyalgia, 227 (12 percent) with osteoarthritis, and 184 (10 percent) with depression.

Fatigue showed a significant association with pain and patient global disease activity ratings (p<0.001), as well as a weak correlation with the DAS28, tender joint count, swollen joint count, physician global assessment of disease activity, ESR, and CRP.

At 3 months, patients who reported low fatigue had significantly lower fatigue compared with those who had moderate or high fatigue (p<0.001), as did those patients who achieved a DAS28 ≤3.2 vs >3.2 (p<0.001). The improvements in fatigue persisted through 5 years of follow‐up. Maximal improvements in fatigue lagged behind remission by 6 months.

Early treatment response within 3 months after treatment initiation was associated with short‐term and long‐term improvements in fatigue over time.