Is there a relationship between fatigue and disease activity in patients with early rheumatoid arthritis?

This study investigated the occurrence of fatigue (tiredness) in patients with early rheumatoid arthritis (RA) and identified predictors of fatigue after 24 months. The data showed that patients with early disease remission had a rapid, sustained reduction in fatigue and that low disease activity at diagnosis predicted a higher risk of fatigue at 24 months.

RA is a chronic inflammatory disease that results in inflammation and destruction of joints, with impaired function. Many patients with RA experience constant tiredness or weakness (fatigue) that can be overwhelming and debilitating. Fatigue affects the quality of life (QoL) of patients, reduces work productivity, and leads to more frequent visits to physicians.

Modern RA treatments focus on achieving sustained remission and long-term improvements in the QoL of patients. However, the relationship between fatigue and early RA in patients treated with modern strategies remains unclear.

The study involved 205 patients with early RA. Patients received 15 mg of methotrexate (Otrexup) weekly, which was increased up to 20 to 25 mg per week. Additionally, they received 15 mg of prednisolone (Orapred), which was reduced to 0 mg over 7 weeks. Patients were followed for 2 years.

At the beginning of the study, 69% of patients had clinically relevant fatigue compared to 38% of patients at 24 months. 80% of patients had moderate or high disease activity at baseline compared to 9% at 24 months.

At 24 months, fewer swollen joints, a lower power Doppler ultrasound score, and higher patient global assessment (PGA) increased the risk of clinically relevant fatigue. PGA is a measure of patient-perceived disease activity and overall health. A higher PGA score means a higher disease activity. 

Patients not achieving remission by 6 months were associated with a higher risk of fatigue at 24 months. At 24 months, sleep disturbances were also associated with higher fatigue.

The study showed that a rapid, sustained reduction in fatigue was associated with disease activity reduction in patients with early RA.

The study did not include standardized measurements for fatigue and definitions in RA.