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

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15 Citations (Scopus)
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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

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Biological Products
Fatigue
Rheumatoid Arthritis
amsonic acid
Joints
ametantrone
Therapeutics
Health Status
Health Surveys
Immunotherapy
Antidepressive Agents
Stroke
Steroids
Demography
Hypertension
Inflammation
Morbidity

Keywords

  • fatigue
  • disease activity
  • remission

Cite this

@article{330b8d6b717843ec8ffd2dcddf1e5109,
title = "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",
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.",
keywords = "fatigue, disease activity, remission",
author = "Druce, {Katie L.} and Yagnaseni Bhattacharya and Jones, {Gareth T.} and Macfarlane, {Gary J.} and Neil Basu",
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.",
year = "2016",
month = "10",
doi = "10.1093/rheumatology/kew241",
language = "English",
volume = "55",
pages = "1786--1790",
journal = "Rheumatology",
issn = "1462-0324",
publisher = "OXFORD UNIV PRESS INC",
number = "10",

}

TY - JOUR

T1 - Most patients who reach disease remission following anti-TNF therapy continue to report fatigue

T2 - results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

AU - Druce, Katie L.

AU - Bhattacharya, Yagnaseni

AU - Jones, Gareth T.

AU - Macfarlane, Gary J.

AU - Basu, Neil

N1 - 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.

PY - 2016/10

Y1 - 2016/10

N2 - 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.

AB - 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.

KW - fatigue

KW - disease activity

KW - remission

U2 - 10.1093/rheumatology/kew241

DO - 10.1093/rheumatology/kew241

M3 - Article

VL - 55

SP - 1786

EP - 1790

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 10

ER -