Variables Associated With Fatigue in Patients With Crohn’s Disease

Background: Fatigue in Crohn’s disease (CD) is debilitating and costly for the patient and healthcare system. It does not have well-established therapies, and it is important to investigate risk factors and, therefore, collaborate to prevent or reduce symptoms. Objective: To investigate variables associated with fatigue in outpatients with Crohn’s disease undergoing pharmacological treatment. Methods: Cross-sectional study, carried out at the IBD outpatient clinic of Hospital Geral Roberto Santos (HGRS), approved by the Ethics and Research Committee of the Roberto Santos General Hospital - registration 5,681,087. Inclusion criteria: being an HRGS patient; CD diagnosis; 18 years or older; use medications for CD. Exclusion criteria: condition that limits the ability of pregnant women to respond to the questionnaires. Data collection: sociodemographic profile, Montreal, Harvey and Bradshaw Index, Inflammatory Disease Questionnaire – Fatigue (IBD-F), Visual Analogue Fatigue Scale (VAS) and Depression, Anxiety and Stress Scale. All statistical analyzes were performed in SPSS version 21.0. Results: 84 patients were included in this first phase of the research, 59.5% of whom were female. Mean age 40.17 years (SD 13.26). Of these patients, only 5 (6%) were diagnosed with diabetes mellitus and 4 (4.8%) were diagnosed with asthma. The predominant location of CD was in the colon (42.9%) and the predominant behavior was non-stenosing, non-penetrating (38.1%). According to IBD-F, 67 (79.8%) of the patients presented fatigue, 23 (34.3%) were male and 44 (65.7%) were female. The mean fatigue intensity according to the VAS was 5.59 (SD 1.94). Regarding pharmacological treatment, the most used medications were infliximab (44 patients, of which 86.36% have fatigue, p = 0.226), azathioprine (29 patients, of which 86.20% have fatigue, p = 0.662) and adalimumab (21 patients, of which 71.43% have fatigue, p= 0.272). Of the 67 patients with fatigue, 55.2% had insomnia (p= 0.001), 41.8% had symptoms of depression (p=0.001) and 49.3% had anxiety (p=0.005) and 47.8% had symptoms of stresses (p=0.002). 48 patients (74.6%) had the disease in remission, and 81.25% of them had fatigue (p=0.504). 20 patients had active disease and of these 85% had fatigue. Among the 67 patients with fatigue, 28 (41.8%) (p=0.166) underwent surgeries related to CD. Fatigue intensity (VAS) among patients with remission was 5.44 (SD 1.86) and among active disease 5.94 (SD 1.96). Conclusions: The prevalence of fatigue is high. Regarding the variables associated with fatigue in patients with CD, the following stand out: insomnia, depression, anxiety and stress.