Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands.
Rheumatology (Oxford). 2024 May 3;63(6):1574-1581. doi: 10.1093/rheumatology/kead429.
The severity of fatigue in RA has improved very little in recent decades, leaving a large unmet need. Fortunately, not all RA patients suffer from persistent fatigue, but the subgroup of patients who suffer the most is insufficiently recognizable at diagnosis. As disease activity is partly coupled to fatigue, DAS components may associate with the course of fatigue. We aimed to identify those RA patients who remain fatigued by studying DAS components at diagnosis in relation to the course of fatigue over a 5-year follow-up period in two independent early RA cohorts.
In all, 1560 consecutive RA patients included in the Leiden Early Arthritis Cohort and 415 RA patients included in the tREACH trial were studied. Swollen joint count, tender joint count, ESR and Patient Global Assessment (PGA) [on a Visual Analogue Scale (VAS)] were studied in relation to fatigue (VAS, 0-100 mm) over a period of 5 years, using linear mixed models.
Higher tender joint count and higher PGA at diagnosis were associated with a more severe course of fatigue. Furthermore, patients with mono- or oligo-arthritis at diagnosis remained more fatigued. The swollen joint count, in contrast, showed an inverse association. An investigation of combinations of the aforementioned characteristics revealed that patients presenting with mono- or oligo-arthritis and PGA ≥ 50 remained the most fatigued over time (+20 mm vs polyarthritis with PGA < 50), while the DAS course over time did not differ. This subgroup comprised 14% of the early RA population. Data from the tREACH trial showed similar findings.
The RA patients who remain the most fatigued were those characterized by mono- or oligo-arthritis and high PGA (VAS ≥ 50) at diagnosis. This understanding may enable early-intervention with non-pharmacological approaches in dedicated patient groups.
近年来，类风湿关节炎（RA）患者的疲劳严重程度改善甚微，存在大量未满足的需求。幸运的是，并非所有 RA 患者都持续存在疲劳，而是在诊断时无法充分识别出最易受影响的亚组患者。由于疾病活动与疲劳部分相关，DAS 成分可能与疲劳的发生相关。我们旨在通过研究诊断时的 DAS 成分，来识别那些持续存在疲劳的 RA 患者，这项研究纳入了两个独立的早期 RA 队列，在 5 年的随访期间研究了疲劳的发生。
共纳入莱顿早期关节炎队列的 1560 例连续 RA 患者和 tREACH 试验的 415 例 RA 患者。使用线性混合模型，研究肿胀关节计数、压痛关节计数、红细胞沉降率和患者整体评估（PGA）[视觉模拟量表（VAS）]与 5 年内疲劳（VAS，0-100mm）的关系。
诊断时较高的压痛关节计数和 PGA 与更严重的疲劳病程相关。此外，诊断时存在单关节炎或寡关节炎的患者仍更易疲劳。相比之下，肿胀关节计数呈负相关。对上述特征的组合进行研究发现，在诊断时存在单关节炎或寡关节炎且 PGA≥50 的患者在整个随访期间最易疲劳（增加 20mm，与多关节炎且 PGA<50 的患者相比），而 DAS 随时间的变化无差异。这一亚组占早期 RA 人群的 14%。tREACH 试验的数据显示了类似的结果。
在诊断时存在单关节炎或寡关节炎且 PGA（VAS≥50）较高的 RA 患者是最易疲劳的患者。这一认识可能使我们能够针对特定患者群体，采用非药物干预措施进行早期干预。
