High Fatigue Rates Exist in Economically Disadvantaged Patients with RA

Sariu Ali Didi

Credit: LinkedIn

A recent study highlighted the substantial prevalence of severe fatigue among poor patients with rheumatoid arthritis (RA).¹ Investigators presented the data at the 2024 European Alliance of Associations for Rheumatology (EULAR) from June 12 – 15, in Vienna, Austria.

“Younger age, smoking, and multimorbidity were also significant [in the association with fatigue among patients with RA],” wrote investigators, led by Sariu Ali Didi, from the University of Cape Town in South Africa.

Studies have shown RA can cause fatigue just as much as depression, cancer, and lung disease can.² According to the Arthritis Foundation, 1 in 6 people with RA have severe fatigue, and it can significantly hinder a patient’s health-related quality of life. Fatigue may be caused by various reasons unrelated to RA disease activity, including inflammation/swollen tender joints, pain, depression or other mental health issues, anemia, thyroid problems, infections, certain medications, low levels of Vitamin D, and sleep problems due to insomnia, sleep apnea, work schedules, or lifestyle.³

Although the prevalence of fatigue in RA patients is well-researched, few studies assessed the fatigue prevalence among patients with RA in South Africa.¹ Thus, investigators sought to explore the prevalence, severity, and root causes of fatigue among indigent patients with RA in South Africa.

They conducted a cross-sectional study with 550 RA patients from a tertiary academic hospital and collected data on demographics, socioeconomic status, clinical disease activity index, comorbidities, and patient-reported outcomes through the Brief Pain Questionnaire, Health Assessment Questionnaire-Disability Index, and the Hospital Anxiety and Depression Scale.

Furthermore, the team measured fatigue using the Functional Assessment of Chronic Illness Therapy-Fatigue scale. They compared patients with “mild fatigue” (scores ≥ 27) with “severe fatigue” (scores ≤ 26).

Most patients in the sample (mean age: 55.8 years) were female (84.9%) and had a poor socioeconomic status (67.1%). The mean disease duration was 11.5 years, and the clinical disease activity index was 14.4.

In total, 73.3% of patients experienced fatigue, reported as “some” for 30.5%, “a lot” for 26.9%, and “extreme” for 15.8%. Patients with high disease activity were more likely to have severe or extreme fatigue than patients with low disease activity. Moreover, multivariate analyses demonstrated smoking (95% CI, 1.136 – 2.673; P = .011), ≥ 2 comorbidities (95% CI, 1.062 – 2.794; P = .027), pain severity (95% CI, 1.047 – 1.390; P = .010), pain interference (95% CI, 1.016 – 1.306; P = .027), anxiety (95% CI, 1.771 – 4.433; P < .001), and depression (1.171 – 2.934; P = .008).

“This study highlights a substantial prevalence of severe fatigue among economically disadvantaged RA patients in South Africa,” investigators concluded. Similar to studies elsewhere, fatigue was associated with psychological distress including anxiety and depression, and with pain. Studies assessing the impact of pain management and psychological interventions are planned.”

References

1. ^{Didi SA, Hodkinson BAB0511 PAIN, ANXIETY, DEPRESSION, AND MULTIMORBIDITY ARE ASSOCIATED WITH FATIGUE AMONG RHEUMATOID ARTHRITIS PATIENTS IN SOUTH AFRICAAnnals of the Rheumatic Diseases 2024;83:1527-1528.}
2. ^{Rath, L. How to Beat Arthritis Fatigue. November 14, 2023. Arthritis Foundation. https://www.arthritis.org/health-wellness/healthy-living/managing-pain/fatigue-sleep/how-to-beat-arthritis-fatigue. Accessed June 26, 2024.}
3. ^{Berman and Jasphy. Managing Fatigue in Rheumatoid Arthritis: Strategies and Skills. Hospital for Special Surgery. https://www.hss.edu/conditions_managing-fatigue-rheumatoid-arthritis.asp. Accessed June 26, 2024.}