Druce Katie L, Jones Gareth T, Macfarlane Gary J, Basu Neil
Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Rheumatology (Oxford). 2015 Jun;54(6):964-71. doi: 10.1093/rheumatology/keu390. Epub 2014 Oct 13.
Pro-inflammatory cytokines such as TNF-α are important in the pathogenesis of fatigue in conditions such as RA. This study aimed to determine whether fatigue improved in a cohort of RA patients with clinically relevant fatigue commencing anti-TNF-α therapy and, if so, to identify predictors of improvement.
Participants recruited to a long-term observational cohort study (the British Society for Rheumatology Biologics Register for RA) provided information on fatigue using the 36-item Short Form Health Survey (SF-36) vitality subscale. The prevalence of severe baseline fatigue (SF-36 vitality ≤12.5) was calculated and improvements, considered as (i) absolute values and (ii) improvement from severe to non-severe fatigue (SF-36 vitality >12.5), were examined 6 months subsequently. A comprehensive set of putative predictors of fatigue improvement were evaluated using multivariable logistic regression.
In 6835 participants the prevalence of severe baseline fatigue was 38.8%. Of those with severe fatigue, 70% reported clinically relevant improvement and 66% moved to the non-severe fatigue category (i.e. improvers). The mean change for improvers was three times the minimum clinically important difference for improvement (33.0 U). Independent baseline predictors of improvement were female sex [odds ratio (OR) 1.3 (95% CI 1.1, 1.7)], not being unemployed due to ill health [OR 1.5 (95% CI 1.2, 1.7)], low disability [OR 1.2 (95% CI 1.001, 1.5)], seropositivity [OR 1.2 (95% CI 0.98, 1.4)], not using steroids [OR 1.2 (95% CI 1.03, 1.5)], no history of hypertension [OR 1.4 (95% CI 1.1, 1.6)] or depression [OR 1.3 (95% CI 1.1, 1.5)] and good mental health [SF-36 mental health subscale >35; OR 1.4 (95% CI 1.2, 1.7)].
Fatigued RA patients reported substantial improvement in their fatigue after commencing anti-TNF-α therapy. Further, a number of clinical and psychosocial baseline factors identified those most likely to improve, supporting future stratified approaches to RA fatigue management.
促炎细胞因子如肿瘤坏死因子-α在类风湿关节炎（RA）等疾病的疲劳发病机制中起重要作用。本研究旨在确定一组患有临床相关疲劳的RA患者在开始抗TNF-α治疗后疲劳是否有所改善，若有改善，则确定改善的预测因素。
招募参加长期观察队列研究（英国风湿病学会RA生物制剂注册研究）的参与者，使用36项简明健康调查问卷（SF-36）活力子量表提供疲劳相关信息。计算严重基线疲劳（SF-36活力≤12.5）的患病率，并在随后6个月检查改善情况，改善情况被视为（i）绝对值，以及（ii）从严重疲劳改善为非严重疲劳（SF-36活力>12.5）。使用多变量逻辑回归评估一组全面的疲劳改善假定预测因素。
在6835名参与者中，严重基线疲劳的患病率为38.8%。在那些患有严重疲劳的患者中，70%报告有临床相关改善，66%转变为非严重疲劳类别（即改善者）。改善者的平均变化是改善的最小临床重要差异的三倍（33.0单位）。改善的独立基线预测因素为女性[比值比（OR）1.3（95%置信区间1.1，1.7）]、不因健康问题失业[OR 1.5（95%置信区间1.2，1.7）]、低残疾程度[OR 1.2（95%置信区间1.001，1.5）]、血清阳性[OR 1.2（95%置信区间0.98，1.4）]、未使用类固醇[OR 1.2（95%置信区间1.03，1.5）]、无高血压病史[OR 1.4（95%置信区间1.1，1.6）]或抑郁症病史[OR 1.3（95%置信区间1.1，1.5）]以及良好的心理健康[SF-36心理健康子量表>35；OR 1.4（95%置信区间1.2，1.7）]。
疲劳的RA患者在开始抗TNF-α治疗后报告其疲劳有显著改善。此外，一些临床和社会心理基线因素可确定最有可能改善的患者，为未来RA疲劳管理的分层方法提供支持。
