Department of Development and Regeneration, KU Leuven, Leuven, Belgium
Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Belgium.
Ann Rheum Dis. 2022 Oct;81(10):1385-1391. doi: 10.1136/annrheumdis-2022-222517. Epub 2022 Jun 20.
Fatigue is common in rheumatoid arthritis (RA). We aimed to explore its longitudinal course, predictors and association with disease activity in early RA.
Data came from the 2-year treat-to-target trial CareRA (Care in early RA) and its 3-year extension. Fatigue was measured on Visual Analogue Scale, Multidimensional Fatigue Inventory and Short Form-36 (SF-36) vitality. Longitudinal fatigue trajectories were identified with multivariate growth mixture modelling. Early predictors of fatigue and the association of fatigue and its trajectories with disease activity and clinical/psychosocial outcomes were studied with linear mixed models and multilevel mediation.
We included 356 and 244 patients in the 2-year and 5-year analyses, respectively. Four fatigue trajectories were identified: rapid, gradual, transient improvement and early deterioration, including 10%, 14%, 56% and 20% of patients. Worse pain, mental health and emotional functioning were seen in the early deterioration group. Higher pain, patient global assessment (PGA) and disability (Health Assessment Questionnaire), lower SF-36 mental components, and fewer swollen joints at baseline predicted higher fatigue over 5 years, while early disease remission strongly improved 5-year fatigue. The association between Simple Disease Activity Index and fatigue was mediated by PGA, pain, mental health and sleep quality.
Although fatigue evolves dynamically over time in early RA, most patients do not achieve sustained fatigue improvement despite intensive disease-modifying antirheumatic drug therapy. Higher 5-year fatigue levels were seen in patients with more perceived disease impact and fewer swollen joints at baseline. Conversely, early inflammatory disease control strongly improved long-term fatigue, pointing towards an early window of opportunity to prevent persistent fatigue.
类风湿关节炎（RA）患者常出现疲劳。本研究旨在探讨早期 RA 患者疲劳的纵向病程、预测因素及其与疾病活动度的关系。
数据来自于 2 年靶向治疗的 CareRA（早期 RA 的护理）试验及其 3 年的扩展研究。疲劳采用视觉模拟量表、多维疲劳量表和健康调查简表 36 项（SF-36）活力分量表进行评估。采用多变量增长混合模型确定疲劳的纵向轨迹。采用线性混合模型和多层次中介分析研究疲劳及其轨迹的早期预测因素与疾病活动度以及临床/心理社会结局的关系。
我们纳入了 2 年和 5 年分析的 356 例和 244 例患者。确定了 4 种疲劳轨迹：快速、逐渐、短暂改善和早期恶化，分别占 10%、14%、56%和 20%的患者。早期恶化组患者疼痛、心理健康和情绪功能更差。基线时更高的疼痛、患者总体评估（PGA）和残疾（健康评估问卷）、更低的 SF-36 心理成分以及更少的肿胀关节数预示着 5 年内更高的疲劳，而早期疾病缓解可显著改善 5 年内的疲劳。简单疾病活动指数与疲劳之间的关系可通过 PGA、疼痛、心理健康和睡眠质量来介导。
尽管早期 RA 患者的疲劳随时间动态演变，但尽管接受了强化疾病修饰抗风湿药物治疗，大多数患者仍未实现持续的疲劳改善。基线时疾病影响感知度更高、肿胀关节数更少的患者，5 年时的疲劳水平更高。相反，早期炎症性疾病控制可显著改善长期疲劳，提示存在预防持续性疲劳的早期机会窗口。
