High Rates of Fatigue Reported in Patients with PsA, Negatively Impacting Quality of Life

A high prevalence of patient-reported fatigue was reported in patients with psoriatic arthritis (PsA), which tended to be underrecognized by clinicians. Severity of fatigue impacted physical functioning, work productivity, and health-related quality of life (HRQoL), according to a study published in The Journal of Rheumatology.¹

“Fatigue is a common symptom of PsA and is considered a prioritized domain of PsA, in particular by outcomes research specialists,” investigators noted. “Given the introduction of new medicines and treatment strategies for PsA over the past decade, updated research on fatigue in a real-world contemporary population of treated PsA patients will help identify the current prevalence and effect of fatigue on these patients and may inform strategies to manage this important symptom in PsA.”

Investigators extracted data from the Adelphia Disease Specific Programme, a cross-sectional survey conducted in Europe and the United States. Enrolled patients had clinically confirmed PsA. Fatigue was assessed via a severity scale (0-10) using the 12-item Psoriatic Arthritis Impact of Disease fatigue (PsAID-12) question and a binary variable. Clinicians also reported any patient fatigue. Various patient-reported outcome measures (PROMs) included the Health Assessment Questionnaire-Disability Index (HAQ-DI), Work Productivity and Activity Impairment Questionnaire (WPAI), and the 5-level EuroQoL 5-dimension questionnaire (EQ-5D-5L). A multivariate linear regression model assessed the association between the severity of fatigue and PROMs.

Of the 831 patients, fatigue was reported by 78.3%. The mean age of patients was 47.5 years, 46.1% were female, with a mean disease duration of 5.3 years. Nearly half (48.1%) were currently treated with a biologic agent. Patients with greater fatigue severity described greater PsA severity, pain levels, higher swollen and tender joint counts, body severity area affected by psoriasis, and a greater disease duration. Those reporting greater fatigue were older on average (P < 0.001) and those with a PsAID fatigue score of > 7 were less likely to work full-time when compared with those with a score of 0 or 1 (38.3% vs 71%, respectively).

Anxiety and depression were also evaluated and compared with fatigue. Patients experiencing anxiety or depression, similar to fatigue, had worse HRQoL, overall work and total activity impairment, and worse physical functioning. They also tended to have higher mean PsAID-12 scores.

Further, according to multivariate analyses, those experiencing greater fatigue severity had worse physical functioning, work productivity, and HRQoL (P < 0.001). Results indicated that fatigue was underreported by doctors, documenting the symptom in only 32% of patients.

The study was limited as participation in the survey only included participants who volunteered to complete the survey and patient identification was based on clinical judgement of the physician, as opposed to a diagnostic checklist. It is also possible that more severely affected patients were recruited to the study, as the study was based on successive consultations and those with more severe disease may visit their clinician more frequently. Additionally, the study design prevented any conclusions about causal relationships to be made and underlying confounders were not accounted for. Another limitation of this design is the possibility of recall bias. Lastly, as it was impossible to determine whether information was shared between patients and clinicians, investigators were unable to guarantee that the physicians were unaware of patient responses.

“Despite many patients receiving advanced therapy, fatigue is still highly prevalent among patients with PsA and underrecognized by physicians,” investigators concluded. “These findings highlight the importance of prioritizing fatigue in the research and management of PsA. Additional research that evaluates the causes and potential interventions to improve fatigue in PsA are needed.”

Reference:

Gossec L, Walsh JA, Michaud K, et al. Effect of Fatigue on Health-Related Quality of Life and Work Productivity in Psoriatic Arthritis: Findings From a Real-World Survey. J Rheumatol. 2022;49(11):1221-1228. doi:10.3899/jrheum.211288