Rheumatoid arthritis patients with mono-, oligo-arthritis, high PGA remain most fatigued

Rheumatoid arthritis (RA) patients with mono- or oligo-arthritis and high Patient Global Assessment (PGA) at diagnosis remain the most fatigued, according to a study published in the June issue of Rheumatology.

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Anna M.P. Boeren, from the Leiden University Medical Center in the Netherlands, and colleagues studied Disease Activity Score (DAS) components at diagnosis in relation to the course of fatigue over a five-year period in two early RA cohorts. Data were included for 1,560 RA patients in the Leiden Early Arthritis Cohort and 415 in the tREACH cohort. Swollen joint count, tender joint count, erythrocyte sedimentation rate, and PGA (on a visual analog scale) were assessed in relation to fatigue.

The researchers found that a more severe course of fatigue was seen in association with higher tender joint count and higher PGA at diagnosis. Mono- or oligo-arthritis at diagnosis was associated with patients remaining more fatigued. In contrast, there was an inverse association seen for the swollen joint count.

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Patients presenting with mono- or oligo-arthritis and PGA ≥50 mm remained the most fatigued over time (+20 mm versus polyarthritis with PGA <50 mm) on examination of combinations of characteristics, while no difference was seen for the DAS course over time. Fourteen percent of the early RA population were part of this subgroup. Similar findings were seen in the tREACH trial.

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“Future studies on the efficacy of additional nonpharmacological treatments, such as cognitive behavioral therapy, preferentially within this subgroup of RA patients, are needed, because these patients have the highest unmet need,” the authors write.

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