The association of fatigue, comorbidities and anti rheumatic drugs in rheumatoid arthritis: Results from the comedra study

Background: The mechanisms of fatigue in rheumatoid arthritis (RA) are still unclear and the effect of antirheumatic drugs on fatigue not fully established. Objectives: To analyse in a large cohort of RA the factors associated with fatigue focusing on social aspects, comorbidities and treatment intake. Methods: Cross sectional analyses were performed on RA patients from the French cohort study of comorbidities COMEDRA (1). Fatigue was assessed as a quantitative variable (RAID3 0-10 numeric scale) or by class (acceptable <3; moderate 3-4; severe ≥5 out of 10). Relationship with demographic, social, disease characteristics, treatments, comorbidities, physical activity, quality of life was investigated in univariate analyses (Table) and multivariate polynomial regression (Figure). Results: 962 patients were analysed (age 57.7 ± 11.1 years, disease duration 11.1 years [6.2-19.1], mean DAS28 3.1 ± 1.3), 763 (79%) were female. The mean fatigue score was 3.8± 2.7. Severe fatigue was more frequent in women, in patients not working, with less physical activity and more obesity. Fatigue was correlated with disease duration (p=0.05), all disease activity index (p<0.001), pain (p<0.001), mHAQ (p<0.001), sleep (p<0.001) and emotional well-being (p<0.001). Among comorbidities, hypertension, chronic obstructive pulmonary disease (COPD), fracture history and RA-related surgery were associated with fatigue. Fatigue was more severe in patients with current NSAID, steroid, biologic treatments. Methotrexate use and the type of biologic did not impact fatigue score. Conclusions: Beyond the expected association of fatigue with disease activity, female gender, pain, sleep and emotional well-being, comorbidities and less physical activity could contribute to the frequent fatigue noted in RA. Fatigue was associated with steroids, NSAIDs, biotherapies but not with methotrexate and did not depend of the type of biotherapy. (Figure Presented).