疲劳与部分（而非全部）类风湿关节炎患者的疾病活动相关：厘清“个体间”和“个体内”的关联。
Fatigue is associated with disease activity in some, but not all, patients living with rheumatoid arthritis: disentangling "between-person" and "within-person" associations.
作者信息
Versteeg Grada A, Ten Klooster Peter M, van de Laar Mart A F J
机构信息
Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, P.O. box. 217, 7500 AE, Enschede, The Netherlands.
出版信息
BMC Rheumatol. 2022 Jan 7;6(1):3. doi: 10.1186/s41927-021-00230-2.
BACKGROUND
Previous research has shown an unclear and inconsistent association between fatigue and disease activity in patients with rheumatoid arthritis (RA). The aim of this study was to explore differences in "between-person" and "within-person" associations between disease activity parameters and fatigue severity in patients with established RA.
METHODS
Baseline and 3-monthly follow-up data up to one-year were used from 531 patients with established RA randomized to stopping (versus continuing) tumor necrosis factor inhibitor treatment enrolled in a large pragmatic trial. Between- and within-patient associations between different indicators of disease activity (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], swollen and tender joint count [ SJC and TJC], visual analog scale general health [VAS-GH]) and patient-reported fatigue severity (Bristol RA Fatigue Numerical Rating Scale) were disaggregated and estimated using person-mean centering in combination with repeated measures linear mixed modelling.
RESULTS
Overall, different indices of disease activity were weakly to moderately associated with fatigue severity over time (β's from 0.121 for SJC to 0.352 for VAS-GH, all p's < 0.0001). Objective markers of inflammation (CRP, ESR and SJC) were associated weakly with fatigue within patients over time (β's: 0.104-0.142, p's < 0.0001), but not between patients. The subjective TJC and VAS-GH were significantly associated with fatigue both within and between patients, but with substantially stronger associations at the between-patient level (β's: 0.217-0.515, p's < 0.0001). Within-person associations varied widely for individual patients for all components of disease activity.
CONCLUSION
Associations between fatigue and disease activity vary largely for different patients and the pattern of between-person versus within-person associations appears different for objective versus subjective components of disease activity. The current findings explain the inconsistent results of previous research, illustrates the relevance of statistically distinguishing between different types of association in research on the relation between disease activity and fatigue and additionally suggest a need for a more personalized approach to fatigue in RA patients. Trial registration Netherlands trial register, Number NTR3112.
背景
先前的研究表明，类风湿关节炎（RA）患者的疲劳与疾病活动之间的关联不明确且不一致。本研究的目的是探讨确诊RA患者疾病活动参数与疲劳严重程度之间“个体间”和“个体内”关联的差异。
方法
使用来自531例确诊RA患者的基线数据和长达一年的每3个月一次的随访数据，这些患者被随机分配至停止（与继续）肿瘤坏死因子抑制剂治疗组，该研究纳入了一项大型实用性试验。疾病活动的不同指标（C反应蛋白[CRP]、红细胞沉降率[ESR]、肿胀和压痛关节计数[SJC和TJC]、视觉模拟量表总体健康状况[VAS-GH]）与患者报告的疲劳严重程度（布里斯托尔RA疲劳数字评定量表）之间的个体间和个体内关联被分解，并使用个体均值中心化结合重复测量线性混合模型进行估计。
结果
总体而言，随着时间的推移，不同的疾病活动指标与疲劳严重程度呈弱至中度关联（SJC的β值为0.121，VAS-GH的β值为0.352，所有p值<0.0001）。炎症的客观标志物（CRP、ESR和SJC）随着时间的推移与个体内的疲劳呈弱关联（β值：0.104 - 0.142，p值<0.0001），但个体间无关联。主观的TJC和VAS-GH在个体内和个体间均与疲劳显著相关，但在个体间水平的关联更强（β值：0.217 - 0.515，p值<0.0001）。疾病活动的所有组成部分在个体患者中的个体内关联差异很大。
结论
疲劳与疾病活动之间的关联在不同患者中差异很大，疾病活动的客观与主观组成部分的个体间与个体内关联模式似乎不同。当前的研究结果解释了先前研究结果的不一致性，说明了在疾病活动与疲劳关系的研究中对不同类型关联进行统计学区分的相关性，此外还表明需要对RA患者的疲劳采取更个性化的方法。试验注册 荷兰试验注册中心，编号NTR3112。
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