Rheumatology Rehabilitation, Our Lady's Hospice, Harold's Cross, Dublin 6, Ireland.
Rheumatology (Oxford). 2009 Dec;48(12):1533-6. doi: 10.1093/rheumatology/kep287. Epub 2009 Sep 22.
Fatigue is an important symptom in patients with RA. Measurement of fatigue in clinical trials and in clinical practice requires scales that are reproducible, sensitive to change and practical. This study examined the reliability and sensitivity to change of fatigue and its relative independence as an outcome measure in RA.
Successive patients referred to the rheumatology clinic at St Vincent's University Hospital and Our Lady's Hospice were evaluated. Clinical assessments were undertaken at baseline and 3 months after commencing TNF-alpha blockade. Fatigue was measured using an 11-point numeric rating scale (NRS). Sensitivity to change when compared with current core set outcome measures was determined by calculation of the standardized response mean (SRM). Multiple regression analysis was employed to determine the independent variance of fatigue scores relative to the core set.
Forty-nine patients were evaluated. At baseline, mean (s.d.) fatigue scores were 6.7 +/- 2.1. At 3 months, fatigue scores had fallen to 4.3 +/- 2.6 (P < 0.001). Test-retest intraclass correlation coefficient for the NRS was 0.79 (P < 0.008). Fatigue was ranked third for relative sensitivity to change as shown by SRM: pain, 1.37; tender joint count (TJC), 1.09; fatigue, 0.92; swollen joint count (SJC), 0.86; HAQ, 0.82; CRP, 0.69; and patient global health (GH), 0.25. The relative independent variance in fatigue of 22% was higher than that of the core set: TJC, 20%; pain, 19%; SJC, 16%; GH, 8%; HAQ, 7%; and CRP, 8%.
This study demonstrates that measures of fatigue are reliable and sensitive to change, and should be considered for inclusion as a core outcome measure in RA.
疲劳是 RA 患者的一个重要症状。临床试验和临床实践中对疲劳的测量需要可重复、敏感和实用的量表。本研究旨在检验疲劳及其作为 RA 结局测量指标的相对独立性的可靠性和对变化的敏感性。
连续评估来自圣文森特大学医院和圣母临终关怀医院风湿病科的患者。在开始使用 TNF-α 阻滞剂前和 3 个月时进行临床评估。使用 11 点数字评分量表（NRS）评估疲劳。通过计算标准化反应均值（SRM）来确定与当前核心结局测量指标相比变化的敏感性。采用多元回归分析确定疲劳评分相对于核心结局的独立方差。
共评估了 49 例患者。基线时，平均（标准差）疲劳评分为 6.7（2.1）。3 个月时，疲劳评分下降至 4.3（2.6）（P＜0.001）。NRS 的测试-再测试组内相关系数为 0.79（P＜0.008）。根据 SRM，疲劳的相对变化敏感性在所有指标中排名第三：疼痛，1.37；压痛关节计数（TJC），1.09；疲劳，0.92；肿胀关节计数（SJC），0.86；健康评估问卷（HAQ），0.82；C 反应蛋白（CRP），0.69；患者总体健康（GH），0.25。疲劳的相对独立方差为 22%，高于核心结局：TJC，20%；疼痛，19%；SJC，16%；GH，8%；HAQ，7%；和 CRP，8%。
本研究表明，疲劳测量具有可靠性和对变化的敏感性，应考虑将其作为 RA 的核心结局测量指标之一。
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