Faculty of Medicine, University of Coimbra, Portugal.
Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, and Coimbra Institute of Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal.
Clin Exp Rheumatol. 2020 Mar-Apr;38(2):314-321. doi: 10.55563/clinexprheumatol/hkhbad. Epub 2019 Jul 19.
Fatigue is one of the most prevalent and disabling symptoms among patients with rheumatoid arthritis (RA), however, it is frequently neglected by health professionals. This study aimed to develop a multidimensional explanatory model of fatigue in patients with RA as a basis for better understanding and intervention.
This was an ancillary analysis of an observational, cross-sectional, single centre study. Patients completed a questionnaire including demographic data and measures of pain, sleep, disability, anxiety, depression, and personality. Fatigue was assessed by the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F). Disease activity and haemoglobin levels were assessed. Path analysis was performed to test and improve a hypothesised model for fatigue.
This analysis included 142 patients, with a mean (SD) age of 61.1 (11.7) years. The final path analysis model presented acceptable fit and explained 60.0% of the variance of fatigue. The predominant direct explanatory factors identified were disability (46.5%) and depression (41.2%), the latter having an additional indirect influence of 19% through disability. Age (-16.2%) and sleep disturbance (15.7%) were also directly linked to fatigue. Personality trait extroversion (-22.4%), pain (20.0%), and disease activity (14.9%) are only indirectly related to fatigue.
Depression, disability and sleep disturbance appear to be the main factors explaining fatigue in patients with RA. Disease activity, pain, and personality seem to play only a secondary role, extroversion being the only personality trait associated with fatigue. These findings foster a shift in the paradigm of care towards a more holistic management of fatigue, integrating adjunctive therapies beyond measures targeted solely at disease remission.
疲劳是类风湿关节炎（RA）患者最常见和最具致残性的症状之一，但它经常被医疗保健专业人员忽视。本研究旨在建立一个 RA 患者疲劳的多维解释模型，以便更好地理解和干预。
这是一项观察性、横断面、单中心研究的辅助分析。患者完成了一份问卷，包括人口统计学数据以及疼痛、睡眠、残疾、焦虑、抑郁和人格的测量。疲劳通过慢性疾病治疗功能评估-疲劳量表（FACIT-F）进行评估。疾病活动度和血红蛋白水平也进行了评估。通过路径分析来测试和改进疲劳的假设模型。
这项分析纳入了 142 名患者，平均（SD）年龄为 61.1（11.7）岁。最终的路径分析模型拟合度较好，解释了疲劳方差的 60.0%。确定的主要直接解释因素是残疾（46.5%）和抑郁（41.2%），后者通过残疾产生了 19%的间接影响。年龄（-16.2%）和睡眠障碍（15.7%）也与疲劳直接相关。人格特质外向性（-22.4%）、疼痛（20.0%）和疾病活动度（14.9%）仅与疲劳存在间接关系。
抑郁、残疾和睡眠障碍似乎是 RA 患者疲劳的主要解释因素。疾病活动度、疼痛和人格似乎只起次要作用，外向性是唯一与疲劳相关的人格特质。这些发现推动了护理模式的转变，朝着更全面的疲劳管理方向发展，将辅助疗法整合到疾病缓解之外的治疗措施中。
