Fatigue worsens quality of life, productivity in patients with psoriatic arthritis

Patients with psoriatic arthritis (PsA) usually complain of fatigue, which is less frequently diagnosed by many physicians, reports a study. Severe fatigue may lead to poorer physical functioning, work productivity, and health-related quality of life (HRQOL).

“Despite many patients receiving advanced therapy, fatigue is still highly prevalent among patients with PsA and underrecognized by physicians,” the researchers said

Data from 831 patients with physician confirmed PsA (mean age 47.5 years, mean disease duration 5.3 years, 46.9 percent female, 48.1 percent receiving a biologic drug) were obtained from the Adelphi Disease Specific Programme, a cross-sectional survey conducted in 2018 in the US and Europe.

The researchers analysed patient fatigue as a binary variable and through its severity (0‒10 scale, using the 12-item Psoriatic Arthritis Impact of Disease fatigue question). Physicians also reported patient fatigue (yes or no).

Other patient-reported outcome measures (PROMs) were as follows: 5-level EuroQol 5-dimension questionnaire (EQ-5D-5L) for HRQOL, Health Assessment Questionnaire–Disability Index, and Work Productivity and Activity Impairment Questionnaire. The association between fatigue severity and other PROMs were assessed using multivariate linear regression.

Of the patients, 78.3 percent reported fatigue. Those with greater fatigue severity showed longer disease duration, greater PsA severity, pain levels, body surface area affected by psoriasis, and swollen and tender joint counts (p<0.05 for all). [J Rheumatol 2022;49:1221-1228]

Furthermore, multivariate analyses revealed worse physical functioning, HRQOL, and work productivity (p<0.001 for all) among patients with greater fatigue severity. Notably, physicians underreported the presence of fatigue (reported in only 32 percent of patients who self-reported fatigue).

“A number of previous studies have evaluated the association between fatigue in PsA and patient characteristics, health status, physical functioning, and HRQOL,” the researchers said. “Overall, findings were similar to this study, though different PROMs were used.” [Clin Cosmet Investig Dermatol 2017;10:155-163; Rheumatol Int 2020;40:1803-1815; Arthritis Res Ther 2017;19:72]

Mental health

Anxiety and depression also occur frequently among patients with severe fatigue. In an earlier study, PsA was significantly associated with mental health burden, showing several PsA patients suffering from these psychological disorders. [Rheumatol Ther 2020;7:287-300]

Other studies supported the finding on the robust association between fatigue and anxiety or depression. [Clin Cosmet Investig Dermatol 2017;10:155-163; Arthritis Res Ther 2020;22:198; Ann Rheum Dis 2009;68:1553-1558]

“A multidisciplinary European working group concluded that the interdependence of fatigue and anxiety, together with pain, may form a vicious cycle with negative effects on PsA symptoms,” the researchers noted. [J Eur Acad Dermatol Venereol 2016;30:576-585]

“As such, anxiety/depression was not considered a confounding factor in our multivariate linear models because, given the strong correlation, adjustment for these variables could impair the ability to accurately evaluate the relationship between fatigue and the outcomes measured, a concept known as collinearity,” they added.

“These findings highlight the importance of prioritizing fatigue in the research and management of PsA,” the researchers said, adding that further research is warranted to determine the causes and potential interventions to improve fatigue in PsA.