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Improvements in Fatigue Lag Behind Disease Remission in Early Rheumatoid Arthritis: Results From the Canadian Early Arthritis Cohort
Author(s) -
Holdren Melissa,
Schieir Orit,
Bartlett Susan J.,
Bessette Louis,
Boire Gilles,
Hazlewood Glen,
Hitchon Carol A.,
Keystone Edward,
Tin Diane,
Thorne Carter,
Bykerk Vivian P.,
Pope Janet E.
Publication year - 2021
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.41499
Subject(s) - medicine , rheumatoid arthritis , erythrocyte sedimentation rate , cohort , physical therapy , arthritis , rating scale , psychology , developmental psychology
Objective To examine the relationship between disease activity and fatigue over time in early rheumatoid arthritis (RA). Methods Data were from patients with early RA (duration of symptoms ≤12 months) enrolled in the Canadian Early Arthritis Cohort (CATCH). Patients rated their fatigue over the past week using an 11‐point numerical rating scale (NRS) for up to 5 years of follow‐up. Fatigue severity was classified as low (≤2), moderate (>2 but <5), or high (≥5). Differences in fatigue ratings in patients who achieved a low disease state (Disease Activity Score in 28 joints [DAS28] <3.2) and those who did not within 3‐months of cohort entry were compared. Results Of 1,864 patients included, 88% met RA criteria, and 72% were women. The mean ± SD baseline DAS28 was 4.9 ± 1.5. Nineteen percent of the patients reported moderate baseline fatigue, and 59% reported severe baseline fatigue. Fatigue was correlated with pain and patient global ratings (r = 0.56–0.67, P < 0.001), and was weakly correlated with DAS28, tender joint count, swollen joint count, physician global assessment of disease activity, erythrocyte sedimentation rate, and C‐reactive protein level. Patients who reported low fatigue by 3 months had significantly lower fatigue throughout follow‐up compared to those who had moderate or high fatigue at 3 months ( P < 0.001). Patients who achieved a DAS28 <3.2 within 3 months had significantly lower fatigue ratings (mean ± SD 2.7 ± 2.6) than those with a DAS28 >3.2 (4.6 ± 3.0) ( P < 0.001), with improvements in fatigue that persisted through 5 years of follow‐up. Maximal improvements in fatigue lagged behind remission by 6 months. Conclusion Fatigue is common in early RA, and improvements may occur after remission. Early treatment response within 3‐months was associated with short‐term and long‐term benefits in fatigue over time.