Mean fatigue on the NRS scale was 5.0 ± 3.0, with 44.7% of patients reporting high fatigue (> 5); age and disease duration were not significant factors.
Multivariate analysis revealed that independent factors accounting for 73% of high-fatigue cases included skin psoriasis > 5% of body surface area (odds ratio [OR] = 4.67 (95% CI, 1.05 – 20.72); tender joints count (OR per 5 extra joints = 1.30; 95% CI, 1.01 – 1.68); and years of education (OR for each year less = 1.09; 95% CI, 1.02-1.23). Female gender did not reach statistical significance (P=.06).
In multiple linear regression, 79% of fatigue was explained by skin psoriasis (β = 2.62; 95% CI, 1.17 – 4.06), tender joints (β = 0.07; 95% CI, 0.02 – 0.13), enthesitis (β = 0.99; 95% CI, 0.11 – 1.89), female gender (β = 1.66; 95% CI, 0.90 – 2.42), and years of education (β = –0.10; 95% CI, –0.20 to –0.08).
More Research Needed
“Fatigue is very important for PsA patients because it interferes with daily activities, work and leisure, and social participation. Moreover, fatigue is very difficult to manage [because] conventional treatments, including biologic drugs, have a small, non-significant effect,” Dr Gudu pointed out.
“Clinicians should not only acknowledge the presence and importance of fatigue, but they should also try to find a therapeutic approach,” Dr Gudu added, noting that behavioral approaches have shown efficacy in patients with rheumatoid arthritis (RA).
More research is needed to identify the exact mechanism that causes fatigue in PsA.
“Patients with more active disease report higher levels of fatigue, suggesting that disease activity may be an important cause. However, in RA it has been shown that the high priority attributed to fatigue by patients is not related to high levels of fatigue, and that patients in remission may still experience fatigue,” Dr Gudu said.
Patient characteristics — demographic, psychological, and social factors — may also play a role, as well as comorbidities.
Despite an increasing interest in qualitative studies to evaluate the impact of fatigue in RA, studies in PsA patients remain limited and their experience might be quite different, Dr. Gudu said.
Dr Siegel concurred, stating a need for similar studies that include a more comprehensive evaluation of PsA fatigue-related factors, as well as clinical assessments of patient-reported outcomes.
The PsAID study and analysis were supported by the European League Against Rheumatism (EULAR).
1. Gudu T, Etcheto A, de Wit M, et al. Fatigue in psoriatic arthritis – a cross-sectional study of 246 patients from 13 countries. Joint Bone Spine 2016 Apr 4. pii: S1297-319X(16)00030-0. doi: 10.1016/j.jbspin.2015.07.017. [Epub ahead of print]
2. The National Psoriasis Foundation. About Psoriatic Arthritis. The National Psoriasis Foundation. https://www.psoriasis.org/about-psoriatic-arthritis. Accessed April 11, 2016.