gms | German Medical Science

Rheumatoid arthritis (RA) is the most common chronic inflammatory disease affecting about 1% of the population, it is characterised by joint swelling, joint tenderness and joint destruction, leading to severe disability and premature mortality.

Gradual destruction of the joints and surrounding tissues leads to functional impairments, to decreased ROM, loss of muscle strength and endurance, to altered movement patterns and deficits in cardio-pulmonary capacity. RA has a major effect on perceived health. Patients do not only suffer of pain, but also of lack of energy and drive – fatigue – sleep disturbances, and depressive mood. Fatigue is really common in RA-patients, it is their most important symptom after pain. However, there has not been paid much attention to fatigue. The 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for RA include joint involvement, serology, and duration of symptoms, but not fatigue. However, the ACR/EULAR provisional definitions of remission in RA published this year indirectly include the sensation of fatigue; the fact that fatigue was not assessed in most trials published over the last decade is criticised.

Evidence on the causality of fatigue in RA is conflicting but a model which suggests interactions between three factors has been proposed: 1. disease process, 2. thoughts, feelings, and behaviours, and 3. personal life issues. RA factors that might drive fatigue include deconditioning and actual or perceived increased muscle effort resulting from joint damage and disability. Anaemia, medication, and sleep disturbances may be involved in the causality of fatigue. Beliefs that RA has serious consequences as well as low mood predict future RA fatigue. Of course, personal factors like the ability or inability to work, the presence or absence of social support, and potential comorbidities also potentially influence RA fatigue.

As treatment options for fatigue the cognitive behaviour therapy as well as therapeutic exercise have been proposed. They are supposed to decrease pain and fatigue.