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Fatigue in early rheumatoid arthritis: data from the Early Rheumatoid Arthritis Network

Ifesemen, Onosi Sylvia; McWilliams, Daniel Frederick; Norton, Sam; Kiely, Patrick D W; Young, Adam; Walsh, David Andrew

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Onosi Sylvia Ifesemen

Sam Norton

Patrick D W Kiely

Adam Young

Professor of Rheumatology


OBJECTIVES: Fatigue is a disabling symptom in people with RA. This study aims to describe the prevalence, risk factors and longitudinal course of fatigue in early RA. METHODS: Demographic, clinical, quality of life (QoL), comorbidities and laboratory data were from the Early RA Network (ERAN), a UK multicentre inception cohort of people with RA. Fatigue was measured using the vitality subscale of the 36-item Short Form Health Survey, where higher values represent better QoL. Baseline prevalences of fatigue classifications were age and sex standardized. Linear regression, hierarchical growth curve modelling and group-based trajectory modelling (GBTM) were utilized. RESULTS: At baseline (n = 1236, 67% female, mean age 57 years), the mean vitality was 41 (s.d. 11) and disease duration was 11 months (interquartile range 7-18). Age- and sex-standardized prevalence rates of fatigue and severe fatigue were 44% (95% CI 39, 50) and 19% (95% CI 15, 23), respectively. Fatigue changed little over 3 years and five measurement occasions β = -0.13 (95% CI -0.23, -0.02). GBTM identified two subgroups, which we named 'Fatigue' (53%) and 'No-fatigue' (47%). Female sex, worse pain, mental health and functional ability were associated with greater fatigue and predicted Fatigue group membership (area under the receiver operating characteristics curve = 0.81). Objective measures of inflammation-swollen joint count and ESR-were not significantly associated with fatigue. CONCLUSIONS: Fatigue is prevalent and persistent in early RA. Diverse characteristics indicative of central mechanisms are associated with persistent fatigue. Management of fatigue might require interventions targeted at central mechanisms in addition to inflammatory disease modification. People who require such interventions might be identified at presentation with early RA.

Journal Article Type Article
Acceptance Date Dec 20, 2021
Online Publication Date Dec 27, 2021
Publication Date 2022-09
Deposit Date Dec 21, 2021
Publicly Available Date Dec 28, 2022
Journal Rheumatology
Electronic ISSN 1462-0332
Peer Reviewed Peer Reviewed
Volume 61
Issue 9
Pages 3737-3745
Public URL
Publisher URL


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