Most patients who reach disease remission following anti-TNF therapy continue to report fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Katie L. Druce, Yagnaseni Bhattacharya, Gareth T. Jones, Gary J. Macfarlane, Neil Basu

Research output: Contribution to journalArticlepeer-review

72 Citations (Scopus)
9 Downloads (Pure)

Abstract

Objectives. RA-related fatigue is common and debilitating, but does not always respond to immunotherapy. In the context of anti-TNF therapy, we aimed to examine whether patients achieving disease remission experienced remission of fatigue. Methods. Data from the British Society for Rheumatology Biologics Register for RA were used. In participants with severe baseline fatigue [36-item Short Form Health Survey (SF-36) vitality score ⩽12.5], we identified those in disease remission [28-joint DAS (DAS28) <2.6] by 6 months. Fatigue response was evaluated according to partial (SF-36 vitality score >12.5) and complete remission (SF-36 vitality score >50) at follow-up. Demographic (e.g. sex, age), clinical (e.g. inflammation, joint erosion and co-morbidities) and psychosocial (e.g. SF-36 domains and HAQ) characteristics were compared between responder and non-responder groups. Results. Severe baseline fatigue was reported by 2652 participants, of whom 271 (10%) achieved a DAS28 <2.6 by 6 months. In total, 225 participants (83%) reported partial remission and were distinguished from those who did not by better health status on all psychosocial domains. Far fewer [n = 101 (37.3%)] reported full fatigue remission. In addition to reporting clinically poorer health status, they were distinguished on the basis of a history of hypertension, depression and stroke as well as baseline treatment use of steroids and antidepressants. Conclusion. Despite achieving clinical remission, many RA patients do not achieve complete remission of their fatigue. Therefore, despite being important in overall disease control, reductions in disease activity are not always sufficient to ameliorate fatigue, so other symptom-specific management approaches must be considered for those for whom fatigue does not resolve.
Original languageEnglish
Pages (from-to)1786-1790
Number of pages5
JournalRheumatology
Volume55
Issue number10
Early online date21 Jun 2016
DOIs
Publication statusPublished - Oct 2016

Bibliographical note

Acknowledgements
K.L.D. was funded by a studentship from the Institute of Applied Health Sciences, University of Aberdeen. Y.B. was funded by a studentship from the Aberdeen Summer Research Studentship Programme, University of Aberdeen.

The BSR commissioned the BSRBR-RA as a UK-wide national
project to investigate the safety of biologic agents in routine medical practice. BSR receives restricted income from UK pharmaceutical companies, including Abbott Laboratories, Merck, Pfizer, Roche, UCB and SOBI. This income finances a wholly separate contract between the BSR and the University of Manchester, who provide and oversee the BSRBR-RA data collection, management and analysis service. The principal investigators and their team have full academic freedom and are able to work independently of pharmaceutical industry influence. All decisions concerning analyses, interpretation and publication
are made autonomously of any industry contributions.

Funding: No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article.

Disclosure statement: The authors have declared no conflicts of interest.

Keywords

  • fatigue
  • disease activity
  • remission

Fingerprint

Dive into the research topics of 'Most patients who reach disease remission following anti-TNF therapy continue to report fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis'. Together they form a unique fingerprint.

Cite this