Psoriatic Arthritis Linked to High Fatigue

Fatigue ranks second only to pain in perceived importance.

Almost 50% of patients with psoriatic arthritis (PsA) report high levels of fatigue, according to a study published in the April issue of Joint Bone Spine.1

Investigators led by Tania Gudu, MD, from Sorbonne University in Paris, France, found that 44.7% of PsA patients reported fatigue levels of 5 or higher on a 10-point numerical rating scale (NRS).

The relative importance of fatigue was also high: of 9 health domains assessed, fatigue was ranked second — after pain, and before skin problems.

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The findings suggest that clinicians should address fatigue at each patient visit, in addition to disease activity and therapeutic management.

Fatigue is an important issue for patients who suffer from rheumatic diseases, and this is one of the first studies to assess its priority from a patient perspective, Dr Gudu and colleague Laure Gossec, MD, PhD, told Clinical Pain Advisor.

“Clinicians should keep in mind that no matter the causes, fatigue is a very important aspect of the disease from PsA patients’ perspective. These patients report high levels of fatigue and consider it a high-priority problem, more important than skin problems, work/leisure activities, or functional capacity,” Dr Gossec pointed out.

“In clinical practice, clinicians should consider the importance of fatigue for PsA patients and try to address it [using methods such as an] NRS question at each assessment. This could strengthen the relationship between doctors and their patients and might improve patients’ adherence to treatment,” Dr Gossec added.

One in 3 patients develop psoriatic arthritis

The National Psoriasis Foundation estimates that about 30% of patients with psoriasis also develop psoriatic arthritis2, which causes stiffness, pain, and swelling in and around the joints. Psoriatic arthritis most commonly develops between the ages of 30 and 50 years.

Michael Siegel, PhD, the Foundation’s director of research programs, told Clinical Pain Advisor that not much is known about the relationship between fatigue and PsA, and that the current study is a step in the right direction.

“Understanding that fatigue is an element of the spectrum of symptoms of PsA, even though we may not know where it is in the chain of causation, will help doctors treat their patients in the most complete way possible,” Dr Siegel said.

Fatigue is Multifactorial

The current research was an ancillary analysis of the cross-sectional Psoriatic Arthritis Impact of Disease (PsAID) study, designed to evaluate the effect of PsA on domains of health from the patient’s perspective.

Data was obtained from 246 PsA patients in 13 European countries, with a mean disease duration of 9.9 ± 10.1 y. Disease activity was moderate on average, and 34.4% of participants were receiving biologic therapy. The majority (84.2%) had current psoriatic skin lesions affecting more than 5% of the body surface.