Leon Leticia, Freites-Núñez Dalifer, Madrid Alfredo, Rodriguez-Mariblanca María, Fernandez-Gutierrez Benjamín, Abasolo Lydia
Musculoskeletal Pathology Group, Rheumatology Department, IdISSC, Hospital Clínico San Carlos, Calle Martín Lagos, s/n, Madrid, Spain.
Faculty of Health Sciences -HM Hospitals, Universidad Camilo José Cela, Madrid, Spain.
BMC Rheumatol. 2024 Sep 30;8(1):49. doi: 10.1186/s41927-024-00423-5.
A subset of patients with rheumatoid arthritis (RA) who remains symptomatic after failing to multiple drugs are deemed to have "difficult-to-treat RA" (D2T RA). Fatigue is a burdensome symptom for RA patients, hindering their improvement. Our purpose was to evaluate the role of fatigue in D2T RA.
This cross-sectional study included rheumatoid arthritis (RA) patients between 2018 and 2022, treated with biological agents or targeted synthetic disease-modifying antirheumatic drugs. D2T RA was defined attending EULAR criteria. Independent variable was fatigue (dimensions and impact) assessed by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire and Numerical Rating Scales. Covariables: sociodemographic, clinical and treatment. To identify factors independently associated to D2T RA, multivariable logistic regression was run.
The study included 145 patients and 38 (26.21%) developed D2T RA. D2T RA group were older, with more comorbidity and disability. D2T RA patients scored higher for global fatigue (p = 0.003), and almost for all their dimensions except for cognitive fatigue (p = 0.06) and fatigue coping (p = 0.07). Females with D2T RA showed more fatigue than those with non-D2T RA. In the adjusted models, all fatigue dimensions were associated with D2T RA: global fatigue RA (OR: 1.03; p = 0.007), physical (OR: 1.09; p = 0.008), living (OR: 1.09; p = 0.016), cognitive (OR: 1.1; p = 0.046) and emotional (OR: 1.18; p = 0.012).
Despite the absence of an explicit mention of fatigue in the definition of D2T RA, it appears to be associated to this outcome. Fatigue should be evaluated in a multidimensional perspective, and gender-specific differences should be considered.
一部分类风湿关节炎（RA）患者在多种药物治疗失败后仍有症状，被认为患有“难治性类风湿关节炎”（D2T RA）。疲劳是RA患者的一个负担性症状，阻碍他们的病情改善。我们的目的是评估疲劳在D2T RA中的作用。
这项横断面研究纳入了2018年至2022年间接受生物制剂或靶向合成改善病情抗风湿药物治疗的类风湿关节炎（RA）患者。D2T RA根据欧洲抗风湿病联盟（EULAR）标准定义。自变量是通过布里斯托尔类风湿关节炎疲劳多维问卷和数字评分量表评估的疲劳（维度和影响）。协变量包括：社会人口统计学、临床和治疗情况。为了确定与D2T RA独立相关的因素，进行了多变量逻辑回归分析。
该研究纳入了145名患者，其中38名（26.21%）发展为D2T RA。D2T RA组患者年龄更大，合并症和残疾更多。D2T RA患者在整体疲劳方面得分更高（p = 0.003），除认知疲劳（p = 0.06）和疲劳应对（p = 0.07）外，几乎在所有维度上得分都更高。患有D2T RA的女性比未患D2T RA的女性表现出更多疲劳。在调整模型中，所有疲劳维度都与D2T RA相关：整体疲劳RA（比值比：1.03；p = 0.007）、身体疲劳（比值比：1.09；p = 0.008）、生活疲劳（比值比：1.09；p = 0.016）、认知疲劳（比值比：1.1；p = 0.046）和情绪疲劳（比值比：1.18；p = 0.012）。
尽管在D2T RA的定义中没有明确提及疲劳，但它似乎与这一结果相关。应从多维角度评估疲劳，并考虑性别差异。
