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Fatigue in Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: Analysis from a Longitudinal Observation Cohort.
J Rheumatol. 2015 Dec; 42(12):2354-60.JR

Abstract

OBJECTIVE

In this study, we aimed to address the prevalence of fatigue, its associated factors, and the effect of tumor necrosis factor inhibitors (TNFi) on this subgroup of patients in a large axial spondyloarthritis (axSpA) cohort.

METHODS

The study included 681 patients [ankylosing spondylitis (AS) and nonradiographic axSpA (nr-axSpA)]. The Fatigue Severity Scale (FSS) and the Bath AS Disease Activity Index question 1 (BASDAI Q1) indices were used for fatigue assessment. Severe fatigue was defined as an FSS ≥ 4 or a BASDAI Q1 ≥ 5. Disease activity, function, and quality of life (QoL) measures were recorded. Patients who had been treated with TNFi were identified, and baseline and followup data were analyzed.

RESULTS

Of the cohort, 67.3% had severe fatigue, and the prevalence was similar between AS (67.2%) and nr-axSpA (68.2%). Severely fatigued patients tended to have higher disease activity scores, increased acute-phase proteins, and decreased QoL measures. TNFi therapy was associated with improvement in disease activity, and although this treatment led to significantly decreased fatigue scores, this reduction was not optimal in the majority of patients with 80% continuing to have severe fatigue according to their posttreatment scores. Health Assessment Questionnaire, mean scores of BASDAI Q5 and Q6, and BASDAI enthesitis were independent predictors of fatigue severity.

CONCLUSION

Fatigue is a common symptom in axSpA, and the burden of fatigue among patients with nr-axSpA is similar to that seen in AS. While biologics are effective in improving disease activity, their effect on fatigue is more limited. In axSpA, fatigue remains unresponsive to TNFi in nearly 80% of patients.

Authors+Show Affiliations

From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto.From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto.From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto.From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto.From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto.From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto. dr.mkbedaiwi@gmail.com.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

26523020

Citation

Bedaiwi, Mohamed, et al. "Fatigue in Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: Analysis From a Longitudinal Observation Cohort." The Journal of Rheumatology, vol. 42, no. 12, 2015, pp. 2354-60.
Bedaiwi M, Sari I, Thavaneswaran A, et al. Fatigue in Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: Analysis from a Longitudinal Observation Cohort. J Rheumatol. 2015;42(12):2354-60.
Bedaiwi, M., Sari, I., Thavaneswaran, A., Ayearst, R., Haroon, N., & Inman, R. D. (2015). Fatigue in Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: Analysis from a Longitudinal Observation Cohort. The Journal of Rheumatology, 42(12), 2354-60. https://doi.org/10.3899/jrheum.150463
Bedaiwi M, et al. Fatigue in Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: Analysis From a Longitudinal Observation Cohort. J Rheumatol. 2015;42(12):2354-60. PubMed PMID: 26523020.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fatigue in Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: Analysis from a Longitudinal Observation Cohort. AU - Bedaiwi,Mohamed, AU - Sari,Ismail, AU - Thavaneswaran,Arane, AU - Ayearst,Renise, AU - Haroon,Nigil, AU - Inman,Robert D, Y1 - 2015/11/01/ PY - 2015/08/13/accepted PY - 2015/11/3/entrez PY - 2015/11/3/pubmed PY - 2016/9/16/medline KW - ANKYLOSING SPONDYLITIS KW - FATIGUE KW - INFLAMMATION KW - QUALITY OF LIFE KW - SPONDYLOARTHROPATHIES KW - TUMOR NECROSIS FACTOR-α SP - 2354 EP - 60 JF - The Journal of rheumatology JO - J. Rheumatol. VL - 42 IS - 12 N2 - OBJECTIVE: In this study, we aimed to address the prevalence of fatigue, its associated factors, and the effect of tumor necrosis factor inhibitors (TNFi) on this subgroup of patients in a large axial spondyloarthritis (axSpA) cohort. METHODS: The study included 681 patients [ankylosing spondylitis (AS) and nonradiographic axSpA (nr-axSpA)]. The Fatigue Severity Scale (FSS) and the Bath AS Disease Activity Index question 1 (BASDAI Q1) indices were used for fatigue assessment. Severe fatigue was defined as an FSS ≥ 4 or a BASDAI Q1 ≥ 5. Disease activity, function, and quality of life (QoL) measures were recorded. Patients who had been treated with TNFi were identified, and baseline and followup data were analyzed. RESULTS: Of the cohort, 67.3% had severe fatigue, and the prevalence was similar between AS (67.2%) and nr-axSpA (68.2%). Severely fatigued patients tended to have higher disease activity scores, increased acute-phase proteins, and decreased QoL measures. TNFi therapy was associated with improvement in disease activity, and although this treatment led to significantly decreased fatigue scores, this reduction was not optimal in the majority of patients with 80% continuing to have severe fatigue according to their posttreatment scores. Health Assessment Questionnaire, mean scores of BASDAI Q5 and Q6, and BASDAI enthesitis were independent predictors of fatigue severity. CONCLUSION: Fatigue is a common symptom in axSpA, and the burden of fatigue among patients with nr-axSpA is similar to that seen in AS. While biologics are effective in improving disease activity, their effect on fatigue is more limited. In axSpA, fatigue remains unresponsive to TNFi in nearly 80% of patients. SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/26523020/Fatigue_in_Ankylosing_Spondylitis_and_Nonradiographic_Axial_Spondyloarthritis:_Analysis_from_a_Longitudinal_Observation_Cohort_ L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=26523020 DB - PRIME DP - Unbound Medicine ER -