Korean J Health Promot.  2022 Dec;22(4):222-228. 10.15384/kjhp.2022.22.4.222.

Factors Affecting Fatigue in Patients with Rheumatoid Arthritis

• Boo S
• Choi B

• KMID: 2537442
• DOI: http://doi.org/10.15384/kjhp.2022.22.4.222

Abstract

Background
Despite the fact that disease activity, including blood inflammation level, has been lowered with the recent improvement in rheumatoid arthritis treatment, the number of patients appealing of symptoms, such as fatigue, is maintained at a certain level. Fatigue is the most common subjective symptom of patients with rheumatoid arthritis and a major factor influencing health behavior and quality of life. Therefore, this study aimed to identify the factors affecting fatigue to prepare basic data for the development of interventions to improve the quality of life of participants with rheumatoid arthritis.
Methods
Cross-sectional data collected using structured questionnaires and medical record reviews were analyzed for 246 rheumatoid arthritis outpatients from a university-affiliated hospital.
Results
Level of fatigue was an average of 4.4 out of 10, and 56.5% was evaluated as a remission level based on the disease activity score 28 (DAS28). Factors significantly affecting fatigue were pain and learned helplessness. Higher levels of pain and learned helplessness were associated with higher levels of fatigue. Conversely, there was no statistically significant difference in the fatigue levels of the participants according to the DAS28, objective disease activity index.
Conclusions
To reduce the fatigue levels of the participants with rheumatoid arthritis, learned helplessness, including pain control, should be lowered. The participant’s attitude towards the disease should be evaluated and the participants should be actively supported to obtain hope for remission, if clinically encountered with participants.

Keyword

Arthritis; rheumatoid; Fatigue; Helplessness; learned; Pain

Reference

1. Linde L, Sørensen J, Ostergaard M, Hørslev-Petersen K, Hetland ML. Health-related quality of life: validity, reliability, and responsiveness of SF-36, 15D, EQ-5D [corrected] RAQoL, and HAQ in patients with rheumatoid arthritis. J Rheumatol. 2008; 35(8):1528–37.

2. Aletaha D, Smolen JS. Diagnosis and management of rheumatoid arthritis: a review. JAMA. 2018; 320(13):1360–72.

3. Lee YH. Comparison of disease activity score-28 based on erythrocyte sedimentation rate and C-reactive protein level in rheumatoid arthritis. JRD. 2018; 25(1):1–2.

4. Salaffi F, Di Carlo M, Carotti M, Farah S, Ciapetti A, Gutierrez M. The impact of different rheumatic diseases on health-related quality of life: a comparison with a selected sample of healthy individuals using SF-36 questionnaire, EQ-5D and SF-6D utility values. Acta Biomed. 2019; 89(4):541–57.

5. Gong G, Mao J. Health-related quality of life among Chinese patients with rheumatoid arthritis: the predictive roles of fatigue, functional disability, self-efficacy, and social support. Nurs Res. 2016; 65(1):55–67.

6. Pollard LC, Choy EH, Gonzalez J, Khoshaba B, Scott DL. Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology (Oxford). 2006; 45(7):885–9.

7. Hewlett S, Cockshott Z, Byron M, Kitchen K, Tipler S, Pope D, et al. Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Arthritis Rheum. 2005; 53(5):697–702.

8. Boo S, Froelicher ES, Yun JH, Kim YW, Jung JY, Suh CH. Perceived and actual risk of cardiovascular disease in patients with rheumatoid arthritis in Korea: a cross-sectional study. Medicine (Baltimore). 2016; 95(40):e5117.

9. Suh CH, Jung JY, Oh H, Boo S. Evaluation of factors affecting the levels of physical activity in patients with rheumatoid arthritis: a cross-sectional study. Clin Rheumatol. 2019; 38(9):2483–91.

10. Boo S. Factors affecting medication adherence in patients with rheumatoid arthritis. Korean J Health Promot. 2020; 20(4):203–10.

11. Katz P. Fatigue in rheumatoid arthritis. Curr Rheumatol Rep. 2017; 19(5):25.

12. Madsen SG, Danneskiold-Samsøe B, Stockmarr A, Bartels EM. Correlations between fatigue and disease duration, disease activity, and pain in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol. 2016; 45(4):255–61.

13. Stein MJ, Wallston KA, Nicassio PM. Factor structure of the arthritis helplessness index. J Rheumatol. 1988; 15(3):427–32.

14. Camacho EM, Verstappen SM, Chipping J, Symmons DP. Learned helplessness predicts functional disability, pain and fatigue in patients with recent-onset inflammatory polyarthritis. Rheumatology (Oxford). 2013; 52(7):1233–8.

15. Englbrecht M, Gossec L, DeLongis A, Scholte-Voshaar M, Sokka T, Kvien TK, et al. The impact of coping strategies on mental and physical well-being in patients with rheumatoid arthritis. Semin Arthritis Rheum. 2012; 41(4):545–55.

16. Han JW, Park IH. Helplessness and health behavior of patients with rheumatoid arthritis. J Muscle Jt Health. 2008; 15(1):33–40.

17. Pincus T, Swearingen C, Wolfe F. Toward a multidimensional health assessment questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthritis Rheumatol. 1999; 42(10):2220–30.

18. Kim JS. Effects of aquatic exercise program on depression and helplessness in patients having rheumatoid arthritis. J Muscle Jt Health. 1995; 2(2):160–7.

19. Lee SS, Park MJ, Yoon HJ, Park YW, Park IH, Park KS. Evaluating the Korean version of the multidimensional health assessment questionnaire in patients with rheumatoid arthritis. Clin Rheumatol. 2006; 25(3):353–7.

20. Arts EE, Fransen J, Den Broeder AA, van Riel PLCM, Popa CD. Low disease activity (DAS28≤3.2) reduces the risk of first cardiovascular event in rheumatoid arthritis: a time-dependent Cox regression analysis in a large cohort study. Ann Rheum Dis. 2017; 76(10):1693–9.

21. Bae JM. Value-based medicine: concepts and application. Epidemiol health. 2015; 37:e2015014.

22. Cho SK, Sung YK, Choi CB, Bang SY, Cha HS, Choe JY, et al. What factors affect discordance between physicians and patients in the global assessment of disease activity in rheumatoid arthritis? Mod Rheumatol. 2017; 27(1):35–41.

23. Kvrgic Z, Asiedu GB, Crowson CS, Ridgeway JL, Davis JM 3rd. "Like no one is listening to me": a qualitative study of patient-provider discordance between global assessments of disease activity in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2018; 70(10):1439–47.

24. Repping-Wuts H, Uitterhoeve R, van Riel P, van Achterberg T. Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study. Int J Nurs Stud. 2008; 45(7):995–1002.

25. Covic T, Adamson B, Spencer D, Howe G. A biopsychosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study. Rheumatology (Oxford). 2003; 42(11):1287–94.

26. Verhoeven F, Tordi N, Prati C, Demougeot C, Mougin F, Wendling D. Physical activity in patients with rheumatoid arthritis. Joint Bone Spine. 2016; 83(3):265–70.

27. Nordgren B, Fridén C, Demmelmaier I, Bergström G, Opava CH. Long-term health-enhancing physical activity in rheumatoid arthritis--the PARA 2010 study. BMC Public Health. 2012; 12:397.

28. Myasoedova E, Crowson CS, Kremers HM, Therneau TM, Gabriel SE. Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007. Arthritis Rheum. 2010; 62:1576–82.

29. Rinke HS, Gjesdal CBG, Markussen H, Assmus J, Natvig GK. Patient-reported fatigue in patients with rheumatoid arthritis who commence biologic therapy: a longitudinal study. PeerJ. 2019; 7:e6771.

30. Olsen CL, Lie E, Kvien TK, Zangi HA. Predictors of fatigue in rheumatoid arthritis patients in remission or in a low disease activity state. Arthritis Care Res (Hoboken). 2016; 68(7):1043–8.