Residual fatigue is prevalent even in patients with rheumatoid arthritis (RA) in remission and is associated with similar factors across severity levels, according to a study introduced at the American College of Rheumatology ACR Convergence 2024.

However, inflammatory activity appears to have a stronger association with cases of severe fatigue, the investigators noted.

The researchers studied the prevalence and associated factors of "residual" fatigue in patients with RA in clinical remission, with a focus on how these factors vary according to fatigue severity. Fatigue, a common symptom often overlooked in follow-ups, was measured using VAS Fatigue, with scores >2 indicating fatigue presence (group F2) and scores >5 indicating high fatigue levels (group F5).

Patients meeting the 2010 ACR criteria for RA, excluding those with chronic fatigue syndrome, were enrolled during routine visits across Catalonia over 6 months as part of the ARCat study. All patients were in strict clinical remission (DAS28 < 2.6). Clinical and sociodemographic data, disease activity markers, comorbidities, and responses to patient-reported outcome measures including Multidimensional Health Assessment Questionnaire (MDHAQ) and Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue, were analyzed to compare fatigue levels in groups F2 and F5.

Among 243 patients with RA, 95 were in remission, with a fatigue prevalence of 55.4% in the F2 group and 19.5% in F5. The factors associated with fatigue were generally similar between both groups. Women were significantly more affected in F2, but not F5, while osteoarthritis and depression were more common in the F2 group. Fatigue in both groups was positively correlated with clinical activity indices. However, higher tender and swollen joint counts and ESR were associated only with severe fatigue (F5). Patients with fatigue reported greater VAS Pain and scored significantly higher on all MDHAQ items, Rheumatoid Arthritis Impact of Disease, and FACIT-Fatigue.

The findings highlight the need for further attention to fatigue management in RA care, the investigators concluded.

Reference
Morlà R. Residual fatigue and its severity in patients with rheumatoid arthritis in clinical remission: prevalence and associated factors. Presented at: American College of Rheumatology. November 14-19, 2024; Washington, DC.