Maximal improvement in fatigue lags behind remission in RA patients
medwireNews: Fatigue among patients with early rheumatoid arthritis (RA) improves significantly following the initiation of DMARDs, but maximal improvements may not occur until 6 months after remission, research shows.
Janet Pope (St Joseph's Health Care London, Ontario, Canada) and team found that patients with an early treatment response benefit from the greatest reductions in fatigue in both the short- and long-term, and they suggest that “[c]ontrolling disease activity and also pain may have the greatest benefits to reduce fatigue in RA patients.”
The findings are based on an analysis of data for 1864 members of the Canadian Early Arthritis Cohort. Participants had RA symptoms for a year or less, a baseline average DAS28 of 4.9 points, a mean age of 54.5 years, and were mainly women (72%).
At baseline, 23% reported low fatigue, defined as a score of 2 or less on a scale of 0–10, 19% had moderate fatigue (a score of 3 or 4), and 59% had severe fatigue (a score of 5 or more).
As reported in Arthritis & Rheumatology, fatigue was strongly and positively correlated with patient global score and pain throughout the first year of follow-up and was weakly correlated with DAS28, tender joint count, swollen joint count, physician global assessment, erythrocyte sedimentation rate, and C-reactive protein levels.
Fatigue levels fell with time, with the greatest reductions observed during the first 3 months of DMARD treatment.
And the researchers observed that patients who reported low fatigue at 3 months had significantly lower fatigue during the 5-year follow-up period than with those who reported moderate or high fatigue at 3 months. Furthermore, fatigue at 3 months significantly correlated with patient global score, pain, DAS28, tender joint count, swollen joint count, and physician global assessment at 1 year.
Pope and co-investigators also found that patients who achieved low disease activity (DAS28 <3.2 points) during the first 3 months had a significantly lower fatigue score at 3 months than those who did not, at 2.7 versus 4.6 points, and that the difference between the two groups persisted up to 5 years.
Finally, the team noted that lowest fatigue level experienced by patients who achieved sustained remission (DAS28 <2.6) occurred approximately 6 months after the time of first remission.
They say: “Improvements in fatigue that occurred after first remission were small and may not be clinically meaningful when compared to the larger improvement in fatigue that occurred at time of first remission.”
“This may have implications when counselling patients who have ongoing fatigue despite achieving disease remission for the first time,” the investigators conclude.
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