Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
A Simple Fatigue Severity Scale Predicts Poor Health Outcomes, Frailty and Death in the Long-Term Follow-Up of Patients with Rheumatoid Arthritis.
Zink, Gisela Westhoff and Angela
Rheumatoid arthritis (RA) patients highlighted fatigue as permeating every sphere of life. The EULAR/ACR task force recommended that fatigue should be implemented in an RA outcome measure core set. We investigated the association between baseline fatigue severity and 8-year outcomes in an early RA inception cohort.
Data from 1,057 RA patients with a disease duration <24 months at inclusion were used. Self reports of functional capacity, pain, global health (GH) and fatigue, measured by 11-point numerical rating scales (NRS 010), were collected for up to 8 years. Reasons for drop out were investigated thoroughly. Clinical and self-reported baseline parameters were compared between patients who attained the 8th year in favorable GH (06) and those who did so with unfavorable outcomes, i.e. they attained the 8th year in poor GH (710), had stopped participation without specifying reasons, had dropped out due to frailty or had died. Multivariate logistic regression analyses were performed to identify baseline predictors of adverse outcomes.
At inclusion, 42.6% of the patients reported no or mild fatigue, 36.2% reported moderate fatigue and 21.2% reported severe fatigue. At 8 years, 12.7% of the patients had died, 7.0% had terminated participation due to frailty, 6.2% had withdrawn without specifying reasons, 3.2% were lost to follow-up and 13.2% reported poor GH (710). Three baseline parameters were significantly associated with unfavorable outcomes in the multivariate analyses. Besides higher age and substantial functional limitations, severe fatigue almost doubled the risk for adverse outcomes (adjusted OR 1.82; 95% CI 1.212.75). Furthermore, severe fatigue at inclusion was the only parameter predicting each individual type of drop-out, i.e. drop-out without specifying reasons (OR 2.8; CI 1.45.3), drop-out due to frailty (OR 2.3; CI 1.24.5) or death (OR 2.3; CI 1.34.2). Acute phase reactants, DAS28, erosiveness, rheumatoid factor and pain were not predictive of unfavorable outcomes.
Severe fatigue in early RA is indicative of poor long-term outcomes; it outranges all other baseline parameters taken into consideration. Therefore, fatigue should be implemented in an RA outcome measure core set, and, equally important, high attention should be paid to RA patients suffering from substantial fatigue.
To cite this abstract, please use the following information:
Zink, Gisela Westhoff and Angela; A Simple Fatigue Severity Scale Predicts Poor Health Outcomes, Frailty and Death in the Long-Term Follow-Up of Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1736