Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Scand J Rheumatol. 2013;42(1):15-9. doi: 10.3109/03009742.2012.709878. Epub 2012 Sep 20.
Fatigue is experienced frequently by patients with rheumatoid arthritis (RA). Fatigue may be caused by high levels of pain and disease activity in RA but can remain present while disease activity is moderate to low. It is not clear whether RA patients receiving anti-tumour necrosis factor (TNF) treatment reach lower levels of acute fatigue than RA patients receiving disease-modifying anti-rheumatic drug (DMARD) treatment. The aim of our study was to analyse whether, in patients with RA, the effect of anti-TNF on fatigue is greater than the effect of DMARD treatment.
Sixty-seven RA patients receiving anti-TNF treatment and 104 RA patients receiving DMARDs were included. All patients were on stable treatment for at least 6 months prior to baseline measurement. Fatigue was measured monthly over 1 year with the fatigue severity subscale of the Checklist Individual Strength (CIS-fatigue). The association between persistent severe fatigue and medication group was analysed using multiple linear regression including confounders.
In the anti-TNF group the mean (SD) level of persistent fatigue was significantly higher than in the DMARD group [32.2 (11.4) vs. 28.3 (10.9), p = 0.025] and more patients experienced persistent severe (CIS-fatigue score ≥ 35) fatigue (42% and 27% respectively, p = 0.043). However, when correcting for age, disease activity, haemoglobin, treatment duration, pain, physical disability, and clinical depression, medication type seemed to influence neither the mean level of persistent fatigue (p = 0.251) nor the percentage of patients with persistent severe fatigue (p = 0.745).
When taking into account probable confounders including disease activity, medication type did not influence persistent fatigue in RA patients. It seems that, besides its anti-inflammatory effect, anti-TNF has no complementary effect on persistent fatigue.
类风湿关节炎（RA）患者常经历疲劳。疲劳可能是由 RA 中高水平的疼痛和疾病活动引起的，但即使疾病活动处于中低水平时也可能持续存在。目前尚不清楚接受肿瘤坏死因子（TNF）抑制剂治疗的 RA 患者是否比接受改善病情抗风湿药（DMARD）治疗的 RA 患者达到更低水平的急性疲劳。我们的研究旨在分析 RA 患者中，抗 TNF 治疗对疲劳的影响是否大于 DMARD 治疗的影响。
纳入 67 例接受抗 TNF 治疗的 RA 患者和 104 例接受 DMARDs 治疗的 RA 患者。所有患者在基线测量前至少稳定治疗 6 个月。在 1 年内每月使用慢性病疲乏量表（CIS-fatigue）的疲劳严重程度亚量表评估疲劳。采用多元线性回归分析包括混杂因素在内的持续性严重疲劳与药物治疗组之间的关系。
在抗 TNF 组中，持续性疲劳的平均（SD）水平显著高于 DMARD 组[32.2（11.4）比 28.3（10.9），p=0.025]，且更多患者出现持续性严重疲劳（CIS-fatigue 评分≥35）[分别为 42%和 27%，p=0.043]。然而，当校正年龄、疾病活动度、血红蛋白、治疗持续时间、疼痛、身体残疾和临床抑郁时，药物类型似乎既不影响持续性疲劳的平均水平（p=0.251），也不影响持续性严重疲劳患者的比例（p=0.745）。
考虑到可能的混杂因素，包括疾病活动度，药物类型并未影响 RA 患者的持续性疲劳。除了抗炎作用外，抗 TNF 似乎对持续性疲劳没有额外的作用。
