The prevalence & meaning of fatigue in rheumatic disease

OBJECTIVE: To determine the prevalence of fatigue in rheumatic
disease; to characterize the strength of associations between
demographic andclinical features and fatigue; to identify
predictors of fatigue, and todetermine the consequence of
clinically significant fatigue.

METHODS:1488 consecutive
patients with rheumatic disease were assessed with the
Clinical Health Assessment Questionnaire, a health status
instrument withscales for fatigue, pain, global severity,
sleep disturbance,gastrointestinal problems, anxiety,
depression, health status, healthsatisfaction, and work
ability. All patients underwent rheumatic disease
examinations and laboratory testing.

RESULTS: Fatigue measured
by visualanalog scale (VAS) was present in 88-98% of
patients, but clinicallyimportant levels of fatigue (> or =
2.0 on VAS) were present in more than41% of patients with
rheumatoid arthritis (RA) or osteoarthritis (OA) and76% of
those with fibromyalgia (FM). Fatigue was related to almost
all demographic and clinical variables, but in multivariate
analyses the strongest independent predictors of fatigue were
pain, sleep disturbance, depression, tender point count and
Health Assessment Questionnaire (HAQ)disability. About 90%
of the R2 of the model (all patients = 0.51, RA =0.49, OA =
0.45, FM = 0.41) was explained by pain, sleep disturbance, and
depression. In RA assessed by erythrocyte sedimentation rate,
joint countand grip strength, no association of the
inflammatory process with fatigue could be found in the
multivariate analyses. In measuring health status, fatigue
was strongly associated with work dysfunction and general
measures of health (VAS of global severity, health status, and

CONCLUSION: Fatigue is common across
all rheumaticdiseases, associates with all measures of
distress, and is a predictor of work dysfunction and overall
health status. The correlates of fatigue are generally
similar across RA, OA and FM. Fatigue assessment adds much to
understanding and management of patients and diseases.

Wolfe F, Hawley DJ, Wilson K

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