P. Minnock1, B. Bresnihan1, G. McKee2, O. FitzGerald1, D. Veale1. 1Rheumatology, Our Lady's Hospice & St Vincent's University Hospital; 2School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland

Background: The unique contribution of fatigue to the assessment of patients with inflammatory arthritis has been demonstrated.
Objectives: The aim of this study was to elucidate the clinical characteristics of, and contributory factors to, fatigue in patients with inflammatory arthritis prescribed anti-TNF therapy.
Methods: Patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) commencing anti-TNF therapy underwent standard clinical assessment of disease activity and fatigue at baseline, 3-months and 6-months. Fatigue was measured using the multidimensional assessment of fatigue scales (MAF), validated for use in RA. The MAF comprises 16 questions concerning the quality, degree, distress, impact and timing of fatigue, compiled to give a final score of 1-50; a low score corresponds to a low level of fatigue. The clinical characteristics of, and the relationship between fatigue and 6 core outcome measures was evaluated.
Results: One-hundred thirty seven patients were evaluated (RA, 93; PsA, 44). Mean age (SD) years, and disease duration at inclusion were 52 (13), 12 (11), respectively. Both fatigue and the core outcome measures demonstrated a significant improvement over the 3-timepoints. Mean (SD) MAF levels were 27.5 (11.1) at baseline, 18.07 (12.1) at 3-months and 19.04 (11.8) at 6-months (p<0.001). Mean (SD) SJC were 7.6 (6.2) at baseline, 2.2 (3.1) at 3-months, and 1.6 (2.6) at 6-months (p<0.001). Mean (SD) TJC were 9.4 (7.8) at baseline, 2.9 (4.5) at 3-months and 2.6 (5.1) at 6-months (p<0.000). Mean (SD) Pain were 5.4 (2.1) at baseline, 3.5 (2.3) at 3-months and 3.5 (2.0) at 6-months (p<0.000). Mean (SD) GH were 5.9 (2.2) at baseline, 3.7 (2.4) at 3-months and 3.8 (2.1) at 6-months (p<0.000). Mean (SD) HAQ were 2.5 (1.0) at baseline, 0.78 (0.80) at 3-months and 0.75 (0.66) at 6-months (p<0.003). Mean (SD) CRP were 20.6 (25.4) at baseline, 71.0 (7.8) at 3-months and 8.8 (15.3) at 6-months (p<0.000). Tests were significant at the 0.01 level (2-tailed). Fatigue was moderately correlated with Pain 0.423 (0.578), (0.482); GH 0.425 (0.578), (0.500) and HAQ 0.470, (0.345), (0.344) (p<0.001) at baseline, at 3-months, and at 6-months, respectively. The strongest correlation found between fatigue and SJC (0.358) and TJC (0.409) were at 3-months only. All correlations were significant at the 0.01 level. The only variable that made a significant contribution to explanation of fatigue at 6-months was GH (R2=35%), F=0.65; p= 0.000; Beta=0.345). At 6-months the relative independent variance in fatigue was 17%, greater than most of all the core clinical measures: HAQ 17%, SJC 16%, TJC 15%, CRP 14%, Pain 10%, GH, 10%.
Conclusion: Fatigue provides unique information in the assessment of outcome for patients with inflammatory arthritis which warrants further in-depth examination.
Disclosure of Interest: P. Minnock: None Declared, B. Bresnihan: None Declared, G. McKee: None Declared, O. FitzGerald Grant/Research Support from: Abbott, Wyeth, D. Veale Grant/Research Support from: GlaxoSmithKline & Schering-Plough, Wyeth, Consultant for: Abbott, Wyeth

Citation: Ann Rheum Dis 2010;69(Suppl3):717

Session: Epidemiology, Health Services and Outcome research


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