Fatigue worsens quality of life and productivity in patients with psoriatic arthritis | Latest news for Doctors, Nurses and Pharmacists

Patients with psoriatic arthritis (PAs) often complain of fatigue, which is diagnosed less often by many physicians, reports a study. Severe fatigue can lead to poorer physical functioning, work productivity, and health-related quality of life (HRQoL).

“Despite many patients receiving advanced therapy, fatigue is still highly prevalent among patients with PsA and underestimated by clinicians,” the researchers said.

Data on 831 patients with physician-confirmed PsA (mean age 47.5 years, mean disease duration 5.3 years, 46.9% female, 48.1% receiving a biologic drug) were obtained from Adelphi Disease Specific Programme, a cross-sectional survey conducted in 2018 in the US and Europe.

The researchers analyzed patient fatigue as a binary variable and through its severity (scale from 0 to 10, using the 12-item psoriatic arthritis disease impact fatigue question). Physicians also reported patient fatigue (yes or no).

Other patient-reported outcome measures (PROMs) were as follows: 5-Dimension EuroQol 5-Level Questionnaire (EQ-5D-5L) for HRQOL, Health Assessment Questionnaire-Work Disability and Productivity Index, and Work Commitment Questionnaire Activity. The association between fatigue severity and other PROMs was assessed using multivariate linear regression.

Of the patients, 78.3% reported fatigue. Those with greater fatigue severity had longer illness duration, greater PAs severity, pain levels, psoriasis-affected body surface area, and swollen and tender joint counts (p<0.05 for all). [J Rheumatol 2022;49:1221-1228]

In addition, multivariate analyzes revealed worse physical capacity, HRQoL and work productivity (p<0.001 for all) among patients with higher intensity of fatigue. Notably, clinicians underreported the presence of fatigue (reported in only 32% of patients who reported fatigue).

“Several previous studies have evaluated the association between PSA fatigue and patient characteristics, health status, physical functioning, and HRQOL,” the researchers said. “Overall, the results were similar to this study, although different PROMs were used.” [Clin Cosmet Investig Dermatol 2017;10:155-163; Rheumatol Int 2020;40:1803-1815;
Arthritis Res Ther 2017;19:72]

Mental health

Anxiety and depression also frequently occur among patients with severe fatigue. In a previous study, APs was significantly associated with mental health burden, showing several patients with APs suffering from these psychological disorders. [Rheumatol Ther 2020;7:287-300]

Other studies supported the finding of the strong association between fatigue and anxiety or depression. [Clin Cosmet Investig Dermatol 2017;10:155-163;
Arthritis Res Ther 2020;22:198; Ann Rheum Dis 2009;68:1553-1558]

“A multidisciplinary European working group concluded that the interdependence of fatigue and anxiety, along with pain, can form a vicious cycle with negative effects on PsA symptoms,” the researchers note. [J Eur Acad Dermatol Venereol 2016;30:576-585]

“Thus, anxiety/depression was not considered a confounder in our multivariate linear models because, given the strong correlation, adjusting for these variables could impair the ability to accurately assess the relationship between fatigue and measured outcomes, a concept known as collinearity,” they added.

“These findings highlight the importance of prioritizing fatigue in the research and management of APs,” the researchers said, adding that more research is needed to determine the causes and possible interventions to improve fatigue in PsA.

Fatigue worsens quality of life and productivity in patients with psoriatic arthritis | Latest news for Doctors, Nurses and Pharmacists

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