New research published in Arthritis Care & Research suggests that fatigue in inflammatory arthritis (IA) is “poorly and inconsistently explained” by the American College of Rheumatology’s core set outcomes and recommends updating the guidelines to “truly assess disease impact on patients,” according to the study’s lead author.1
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“The ACR core set does not capture the symptom of fatigue,” writes study author Patricia Minnock, PhD, a registered advanced nurse practitioner in rheumatology at Our Lady’s Hospice & Care Services in Dublin, Ireland, in an e-mail interview with The Rheumatologist. “Fatigue is a symptom in its own right and so warrants assessment in its own right. Updating the [ACR] core set to include fatigue would address this.”
The longitudinal study, conducted within the rheumatology department of a large academic medical center in Ireland, followed 125 patients who met the ACR diagnostic criteria for rheumatoid arthritis or psoriatic arthritis over six months. Researchers found the relationship between fatigue and the core set measures changed at different stages of the disease, particularly during disease flares.
“When patients’ inflammatory arthritis was flared, fatigue was related to poor function and raised blood measures of inflammation,” Dr. Minnock writes. “As the disease flare settled, fatigue was more related to pain, for example. This suggests that fatigue cannot be explained away by any of these other symptoms only.”
Increasingly recognized by clinicians as a major symptom in IA, fatigue can be difficult to manage effectively. “In order to best manage fatigue, more needs to be learnt about its many faces or dimensions,” she writes. “For this reason, fatigue should be measured routinely in clinical studies and routine practice.”
Dr. Minnock says more research into fatigue should be done, namely studies that examine “what biological/organic processes cause this symptom that perhaps are as yet an unidentified component of inflammation,” she writes. (posted 11/26/14)
Richard Quinn is a freelance writer in New Jersey.