Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Validation of the Functional Assessment of Chronic Illness Therapy Fatigue Scale relative to other instrumentation in patients with rheumatoid arthritis. Effects of Person-Centered Physical Therapy on Fatigue-Related Variables in Persons With Rheumatoid Arthritis: A Randomized Controlled Trial. Fatigue in rheumatoid arthritis: quantitative findings on the efficacy of tocilizumab and on factors associated with fatigue. The French multicentre prospective PEPS Study. The Effect of Exercise on Sleep and Fatigue in Rheumatoid Arthritis: A Randomized Controlled Study Identifying Preliminary Domains to Detect and Measure Rheumatoid Arthritis Flares: Report of the OMERACT 10 RA Flare Workshop Adalimumab plus methotrexate or standard therapy is more effective than methotrexate or standard therapies alone in the treatment of fatigue in patients with active, inadequately treated rheumatoid arthritis. Effect of etanercept on fatigue in patients with recent or established rheumatoid arthritis. Effects of exercise on fatigue, aerobic fitness, and disease activity measures in persons with rheumatoid arthritis. Determining the minimal clinically important differences in activity, fatigue, and sleep quality in patients with rheumatoid arthritis. Improvement and longterm maintenance of quality of life during treatment with adalimumab in severe rheumatoid arthritis.
OBJECTIVE Fatigue is commonly reported by patients with rheumatoid arthritis ( RA ) but is rarely a treatment target . The aim of this study was to explore the concept of fatigue as experienced by patients with RA . METHODS Fifteen patients with RA and fatigue ( > or = 7 on a 10-cm visual analog scale ) were individually interviewed and asked about the description , cause , consequence , and management of fatigue . Transcripts were systematic ally analyzed by 2 research ers independently , relevant phrases were coded , and earlier transcripts were checked for the emerging codes . A r and om sample of analyses were independently review ed . A total of 191 codes arising from the data were grouped into 46 categories and overarching themes . RESULTS Vivid descriptions reflect 2 types of fatigue : severe weariness and dramatic overwhelming fatigue . RA fatigue is different from normal tiredness because it is extreme , often not earned , and unresolving . Participants described physical , cognitive , and emotional components and attributed fatigue to inflammation , working the joints harder , and unrefreshing sleep . Participants described far-reaching effects on physical activities , emotions , relationships , and social and family roles . Participants used self-management strategies but with limited success . Most did not discuss fatigue with clinicians but when they did , they felt it was dismissed . Participants held negative views on the management of fatigue . CONCLUSION The data show that RA fatigue is important , intrusive , and overwhelming , and patients struggle to manage it alone . These data on the complexity of fatigue experiences will help clinicians design measures , interventions , and self-managment guidance OBJECTIVE This study vali date d a brief measure of fatigue in rheumatoid arthritis ( RA ) , the Functional Assessment of Chronic Illness Therapy ( FACIT ) Fatigue Scale . METHODS The FACIT Fatigue was tested along with measures previously vali date d in RA : the Multidimensional Assessment of Fatigue ( MAF ) and Medical Outcomes Study Short-Form 36 ( SF-36 ) Vitality . The sample included 636 patients with RA enrolled in a 24 week double blind , r and omized clinical trial ( RCT ) of adalimumab versus placebo . RESULTS The FACIT Fatigue showed good internal consistency ( alpha = 0.86 to 0.87 ) , strong association with SF-36 Vitality ( r = 0.73 to 0.84 ) and MAF ( r = -0.84 to -0.88 ) , and the ability to differentiate patients according to clinical change using the American College of Rheumatology ( ACR ) response criteria ( ACR 20/50/70 ) . Psychometric performance of the FACIT Fatigue scale was comparable to that of the other 2 fatigue measures . A minimally important difference in FACIT Fatigue change score of 3 - 4 points was confirmed in a separate sample of 271 patients with RA enrolled in a second double blind RCT of adalimumab versus placebo . CONCLUSION The FACIT Fatigue is a brief , valid measure for monitoring this important symptom and its effects on patients with RA OBJECTIVE To examine effects of person-centered physical therapy on fatigue and related variables in persons with rheumatoid arthritis ( RA ) . DESIGN R and omized controlled trial . SETTING Hospital outpatient rheumatology clinic . PARTICIPANTS Persons with RA aged 20 to 65 years ( N=70 ) :  intervention group ( n=36 ) and reference group ( n=34 ) . INTERVENTIONS The 12-week intervention , with 6-month follow-up , focused on partnership between participant and physical therapist and tailored health-enhancing physical activity and balancing life activities . The reference group continued with regular activities ; both groups received usual health care . MAIN OUTCOME MEASURES Primary outcome was general fatigue ( visual analog scale ) . Secondary outcomes included multidimensional fatigue ( Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Question naire ) and fatigue-related variables ( ie , disease , health , function ) . RESULTS At posttest , general fatigue improved more in the intervention group than the reference group ( P=.042 ) . Improvement in median general fatigue reached minimal clinical ly important differences between and within groups at posttest and follow-up . Improvement was also observed for anxiety ( P=.0099 ) , and trends toward improvements were observed for most multidimensional aspects of fatigue ( P=.023-.048 ) , leg strength/endurance ( P=.024 ) , and physical activity ( P=.023 ) . Compared with the reference group at follow-up , the intervention group improvement was observed for leg strength/endurance ( P=.001 ) , and the trends toward improvements persisted for physical ( P=.041 ) and living-related ( P=.031 ) aspects of fatigue , physical activity ( P=.019 ) , anxiety ( P=.015 ) , self-rated health ( P=.010 ) , and self-efficacy ( P=.046 ) . CONCLUSIONS Person-centered physical therapy focused on health-enhancing physical activity and balancing life activities showed significant benefits on fatigue in persons with RA OBJECTIVES Fatigue is an important aspect of rheumatoid arthritis ( RA ) . The objective was to assess fatigue levels and its determinants over the first 4 months of tocilizumab ( TCZ ) treatment in RA patients . METHODS We performed a multicentre prospect i ve study of RA patients treated with intravenous TCZ in open-label prescription conditions . The first 5 infusions ( 4 months ) were assessed . The primary endpoint was the percentage of patients with variation of the FACIT fatigue scale from inclusion to 4 months , above the minimal clinical ly important difference ( MCID ) of 4 points . Fatigue was also assessed by the patient acceptable symptom state for fatigue ( PASS ) question . Variables related with fatigue and with fatigue improvement including other patient reported outcomes , depression and anxiety , and disease activity , were assessed before and after treatment . ANALYSES univariate and multivariate logistic regressions . RESULTS Of 719 patients , 610 had evaluable data : mean age 56±13 years , disease duration 12±10 years , 490 ( 81 % ) women . At baseline , fatigue levels were high : 73 % patients had unacceptable fatigue . At 4 months , 378 patients ( 62 % ) reached MCID improvement for fatigue . Fatigue reduction was rapid , seen as early as after 2 weeks . Fatigue was mainly related to functional status ( HAQ score ) , depression and anxiety , both before and after TCZ treatment . Moderate predictors of fatigue improvement were evidence d. CONCLUSIONS In these long-st and ing RA patients  , fatigue levels were high and mainly explained by HAQ and psychological distress but improved with treatment indicating a link with disease activity . The pathophysiological basis of RA fatigue should be further explored Objective . Sleep disturbance and chronic fatigue are common in rheumatoid arthritis ( RA ) and contribute to disability , symptomatology , and healthcare use . It has long been recognized in other population s that exercise can improve sleep and diminish fatigue . The effect of exercise on sleep quality and fatigue in RA has not been evaluated . Methods . Ours is a r and omized controlled study in RA to determine the effect of an exercise program on sleep quality and fatigue . These were measured using the Pittsburgh Sleep Quality Index and the Fatigue Severity Scale .  Patients were r and omized to either a 12-week , home-based exercise intervention or usual care . The exercise program consisted of specific exercises to target individual deficiencies identified using the Health Assessment Question naire ( HAQ ) with cardiovascular work as per the guidelines . The intervention group was evaluated on a 3-week basis . Full evaluation was carried out at baseline and at 12 weeks . Results . Forty patients were r and omized to the intervention with 38 controls . In the exercise intervention group , there was a statistically significant improvement in HAQ ( p = 0.00 ) , pain ( p = 0.05 ) , stiffness ( p = 0.05 ) , sleep quality ( p = 0.04 ) , and fatigue ( p = 0.04 ) . In our control group , there was a statistically significant improvement demonstrated in their overall perceptions of the benefits of exercise , but none of the other variables . Conclusion . Our study demonstrates that an exercise program result ed in significant improvement in sleep quality and fatigue . This is particularly interesting given the importance of fatigue as an outcome measure in RA and gives us yet another reason to prescribe exercise in this population Background . While disease flares in rheumatoid arthritis ( RA ) are a recognized aspect of the disease process , there is limited formative research to describe them . Methods . The Outcome Measures in Rheumatology Clinical Trials ( OMERACT ) RA Flare Definition Working Group is conducting an international research project to underst and the specific characteristics and impact of episodic disease worsening , or “ flare , ” so that outcome measures can be developed or modified to reflect this uncommonly measured , but very real and sometimes disabling RA disease feature . Patient research partners provided critical insights into the multidimensional nature of flare . The perspectives of patients and healthcare and research professionals are being integrated to ensure that any outcome measurement to detect flares fulfills the first OMERACT criteria of Truth . Through an iterative data -driven Delphi process , a preliminary list of key domains has been identified to evaluate flare . Results . At OMERACT 10 , consensus was achieved identifying features of flare in addition to the existing core set for RA , including fatigue , stiffness , symptom persistence , systemic features , and participation . Patient self-report of flare was identified as a component of the research agenda needed to establish criterion validity for a flare definition ; this can be used in prospect i ve studies to further evaluate the Discrimination and Feasibility components of the OMERACT filter for a flare outcome measure . Conclusion . Our work to date has provided better underst and ing of key aspects of the RA disease process as episodic , potentially disabling disease worsening even when a patient is in low disease activity . It also highlights the importance of developing ways to enhance communication between patients and clinicians and improve the ability to achieve “ tight control ” of disease OBJECTIVES Fatigue is an important systemic symptom of rheumatoid arthritis ( RA ) but has rarely been evaluated consistently after initiation of treatment in RA patients . This study examined the effects of adalimumab ( HUMIRA , Abbott Laboratories , Abbott Park , IL , USA ) , a fully human , anti-tumor necrosis factor ( anti-TNF ) monoclonal antibody , on reducing fatigue in patients with RA . METHODS A total of 1526 patients with RA were enrolled in 3 r and omized , placebo-controlled clinical trials of adalimumab versus placebo plus methotrexate ( MTX ) or placebo plus st and ard antirheumatic therapies .  Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy ( FACIT ) fatigue scale question naire ( which has been vali date d in RA ) at baseline , mid- study , and at the end of the study . Logistic regression models were constructed using baseline demographic variables to test for treatment effect . In addition , sensitivity analyses were performed to determine the robustness of the data . RESULTS At baseline in the 3 trials , patients ' fatigue ranged from 27.9 - 29.7 , representing considerable fatigue on the FACIT fatigue scale . Fatigue was significantly and consistently reduced in adalimumab-treated patients in the 3 clinical trials . Relative to placebo plus MTX , the adalimumab 40-mg-every-other-week dosage group reported statistically significantly less fatigue at all time points post-baseline . Improvements between adalimumab and placebo ranged from 3 - 7 points across all 3 trials , with a 3 - 4-point change representing a minimum clinical ly important difference . CONCLUSION Adalimumab treatment was shown to significantly reduce fatigue  in patients with moderate to severe RA . Changes in fatigue in all 3 trials were found to be clinical ly important OBJECTIVE To assess the long-term impact of etanercept on fatigue in patients with recent-onset ( mean duration 11 months ) or established ( mean duration 12 years ) rheumatoid arthritis ( RA ) . METHODS Patients participating in either of 2 multicenter , r and omized , double-blind clinical trials were included . In one trial , patients with recent-onset RA received either etanercept 25 mg twice weekly or methotrexate in a double-blind fashion for 12 months , then open label for 12 months . All patients then received open-label etanercept . In the second trial , patients with established RA received etanercept 25 mg or placebo twice weekly for 6 months in a double-blinded fashion , then open-label etanercept . Up to 46 months of followup data were included . Fatigue was measured regularly using the Health Assessment Question naire vitality domain . RESULTS Patients with recent-onset RA who received etanercept had a significantly faster improvement in fatigue than those receiving methotrexate in the first 2 months . Subsequently , patients receiving etanercept and methotrexate had 23 - 29 % and 17 - 24 % reductions in fatigue scores , respectively . In the group with established RA , patients who received etanercept had significantly greater reductions in fatigue than those receiving placebo during the blinded period . Patients initially receiving etanercept sustained a mean fatigue reduction of 25 - 36 % for the entire followup . Patients achieving clinical ly meaningful improvement in fatigue were more likely to meet the American College of Rheumatology improvement criteria . CONCLUSION Etanercept therapy reduces fatigue in patients with recent-onset or established RA . Improvement in fatigue was sustained for up to 46 months , and correlated with other RA-relevant outcomes The effects of 12 weeks of low-impact aerobic exercise on fatigue , aerobic fitness , and disease activity were examined in a quasi-experimental time series study of 25 adults with rheumatoid arthritis ( RA ) . Measures were obtained preintervention , midtreatment ( after 6 weeks of exercise ) , end of treatment ( after 12 weeks of exercise ) , and at a 15-week follow-up . ANOVAS for repeated measures showed that those subjects who participated more frequently reported decreased fatigue , while those who participated less frequently reported an increase in fatigue . All subjects , on average , showed increased aerobic fitness and increased right and left h and grip strength , decreased pain , and decreased walk time . There were no significant increases in joint count or sedimentation rate . Significant improvements in measures at the 15-week follow-up also were found . Findings indicate that persons with RA who participate in appropriate exercises may lessen fatigue levels and experience other positive effects without worsening their arthritis OBJECTIVE To determine the minimal clinical ly important differences ( MCID ) in the patient-reported outcomes of activity ( 0 - 30 , number of days of limitation ) , fatigue ( 0 = none , 100 = complete ) , and sleep quality ( 0 = no problems , 100 = worst case ) for patients with rheumatoid arthritis ( RA ) . METHODS Two r and omized controlled trials comparing abatacept to placebo  in RA patients were considered : ATTAIN ( n = 391 ) and AIM ( n = 652 ) . An internal anchor-based approach was used to derive the MCID using the Health Assessment Question naire , patient global assessment , and pain as anchors . Minimal important change in activity , fatigue , and sleep were determined by estimating mean changes in these outcomes in patients showing change in a narrow range about the MCID of the internal anchor . Correlation analysis was used to determine the consistency of the changes in the outcomes and anchors , and a Delphi process was used to determine the final MCID values . RESULTS For the 2 trials , consistent patterns of change for activity , fatigue , and sleep and the internal anchors were found with correlations in the range of 0.5 , 0.7 , and 0.4 , respectively . The mean changes for activity , fatigue , and sleep in a narrow range about the MCID of the 3 internal anchors corresponding to the 2 trials were : 3.4 to 4.3 for activity ; 6.7 to 17.0 for fatigue ; and 4.1 to 7.3 for sleep . Following the Delphi process the MCID determined were 4 for activity , 10 for fatigue , and 6 for sleep . CONCLUSION These MCID for activity limitation , fatigue , and sleep problems can be used in design ing clinical trials and providing benchmarks in assessing patient improvement OBJECTIVE In patients with longst and ing severe rheumatoid arthritis ( RA ) receiving chronic treatment with adalimumab  , health related quality of life ( HRQOL ) was assessed using new instruments [ Functional Assessment of Chronic Illness Therapy-Fatigue scale ( FACIT-Fatigue ) and Health Utilities Index Mark 3 ( HUI3 ) ] and a more conventional instrument [ Medical Outcomes Study Short Form-36 Health Survey ( SF-36 ) ] . METHODS Different measures for collecting patient-reported outcomes were applied simultaneously during the 3-year study period . Sociodemographic and medical history data were assessed at the baseline visit . Clinical examinations ( e.g. , joint examination and morning stiffness ) , disease assessment s , and HRQOL data  were recorded every 8 weeks . For dichotomous and categorical variables , absolute and relative frequencies were calculated . Metric measures were described using mean and st and ard deviation and /or st and ard error of the mean . HRQOL data were analyzed using observed cases . RESULTS All assessed measures ( FACIT-Fatigue , HUI3 , SF-36 ) showed a rapid and statistically significant improvement from baseline following initiation of adalimumab therapy . This effect was maintained over the study period for a mean of 1.6 years in all applied measures . HRQOL data from all tested instruments were significantly correlated with each other . CONCLUSION Chronic therapy with adalimumab improved measures of fatigue and HRQOL  in patients with longst and ing RA
However , the 4 generic scales would benefit from further validation in patients with RA , the VAS requires st and ardization , and the MAF would benefit from further sensitivity data .
OBJECTIVE Fatigue is an important outcome for patients with rheumatoid arthritis ( RA ) .
The purpose of this study was to identify the scales being used to measure RA fatigue , and to systematic ally examine the evidence for their validation .