Druce Katie L, Bhattacharya Yagnaseni, Jones Gareth T, Macfarlane Gary J, Basu Neil
Musculoskeletal Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK.
Musculoskeletal Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
Rheumatology (Oxford). 2016 Oct;55(10):1786-90. doi: 10.1093/rheumatology/kew241. Epub 2016 Jun 21.
RA-related fatigue is common and debilitating, but does not always respond to immunotherapy. In the context of anti-TNF therapy, we aimed to examine whether patients achieving disease remission experienced remission of fatigue.
Data from the British Society for Rheumatology Biologics Register for RA were used. In participants with severe baseline fatigue [36-item Short Form Health Survey (SF-36) vitality score ⩽12.5], we identified those in disease remission [28-joint DAS (DAS28) <2.6] by 6 months. Fatigue response was evaluated according to partial (SF-36 vitality score >12.5) and complete remission (SF-36 vitality score >50) at follow-up. Demographic (e.g. sex, age), clinical (e.g. inflammation, joint erosion and co-morbidities) and psychosocial (e.g. SF-36 domains and HAQ) characteristics were compared between responder and non-responder groups.
Severe baseline fatigue was reported by 2652 participants, of whom 271 (10%) achieved a DAS28 <2.6 by 6 months. In total, 225 participants (83%) reported partial remission and were distinguished from those who did not by better health status on all psychosocial domains. Far fewer [n = 101 (37.3%)] reported full fatigue remission. In addition to reporting clinically poorer health status, they were distinguished on the basis of a history of hypertension, depression and stroke as well as baseline treatment use of steroids and antidepressants.
Despite achieving clinical remission, many RA patients do not achieve complete remission of their fatigue. Therefore, despite being important in overall disease control, reductions in disease activity are not always sufficient to ameliorate fatigue, so other symptom-specific management approaches must be considered for those for whom fatigue does not resolve.
类风湿关节炎（RA）相关疲劳常见且使人衰弱，但并非总是对免疫疗法有反应。在抗TNF治疗的背景下，我们旨在研究疾病缓解的患者是否也实现了疲劳缓解。
使用来自英国风湿病学会RA生物制剂注册库的数据。在基线时有严重疲劳的参与者（36项简明健康调查（SF - 36）活力评分≤12.5）中，我们确定了在6个月时疾病缓解（28关节疾病活动评分（DAS28）<2.6）的患者。根据随访时部分缓解（SF - 36活力评分>12.5）和完全缓解（SF - 36活力评分>50）评估疲劳反应。比较缓解组和未缓解组之间的人口统计学（如性别、年龄）、临床（如炎症、关节侵蚀和合并症）以及心理社会（如SF - 36领域和健康评估问卷（HAQ））特征。
2652名参与者报告有严重的基线疲劳，其中271名（10%）在6个月时DAS28<2.6。总共225名参与者（83%）报告部分缓解，并且在所有心理社会领域的健康状况方面与未缓解者有所区别。报告完全疲劳缓解的人数要少得多（n = 101（37.3%））。除了报告临床健康状况较差外，他们在高血压、抑郁症和中风病史以及基线时使用类固醇和抗抑郁药治疗方面也有所不同。
尽管实现了临床缓解，但许多RA患者并未实现疲劳的完全缓解。因此，尽管疾病活动度降低在整体疾病控制中很重要，但并不总是足以改善疲劳，所以对于疲劳未缓解的患者必须考虑其他针对症状的管理方法。
