Artikel
Self-reported fatigue in patients with rheumatoid arthritis compared to patients with cancer – results from two large scale studies
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Autoren
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Karolina Müller
- Zentrum für Klinische Studien, Universitätsklinikum Regensburg, Regensburg, Deutschland
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Jens Gert Kuipers
- Klinik für internistische Rheumatologie, Rotes Kreuz Krankenhaus Bremen, Bremen, Deutschland
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Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung , Universitätsklinikum Freiburg, Freiburg im Breisgau, Deutschland
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Jens Ulrich Rüffer
- German Fatigue Society, Cologne, Germany
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Irene Fischer
- Dr. Fischer Institut für Tumor-Fatigue-Forschung, Emskirchen, Deutschland
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Tobias Pukrop
- Klinik für Innere Medizin III, Universitätsklinikum Regensburg, Regensburg, Deutschland
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Michael Koller
- Zentrum für Klinische Studien, Universitätsklinikum Regensburg, Regensburg, Deutschland
| Veröffentlicht: | 27. September 2021 |
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Gliederung
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Background and status of (inter)national research: Fatigue, defined as a condition of unusual tiredness, weakness and exhaustion, is a common symptom in patients with rheumatoid arthritis (RA) as well as in patients with cancer. To our knowledge, this is the first study to directly compare fatigue in these two patient populations.
Question and objective: The present project investigated the severity of fatigue in RA patients as compared to cancer patients as well as potential influencing factors of fatigue.
Method: The RA study was based on a survey involving a representative, nationwide sample of German physicians specialized in RA and their patients. Cancer patients were included in an international EORTC validation study. The patient questionnaire included the EORTC QLQ-FA12 measure of fatigue, assessing five components: Physical, Emotional, Cognitive, Interference with Daily Life, and Social Sequelae.
Results: Data of 705 RA patients and 943 cancer patients were available for analyses. RA patients reported significantly higher Physical Fatigue (mean difference=7.0, 95% CI=4.2–9.7, p<.001) and Social Sequelae (mean difference=7.5, 95% CI=4.7–10.2, p<.001) than cancer patients. Cancer patients reported higher Cognitive Fatigue impairments than RA patients (mean difference=3.5, 95% CI=1.4–5.6, p=.001). No differences in Emotional Fatigue (p=.678) and Interference with Daily Life (p=.098) were found. All analysis were adjusted for sex and age.
In RA patients, lower levels of Mental Health and higher levels of pain (SF-12) were associated with fatigue, p<.001. Patients taking glucocorticoids reported on average 4.6 (95% CI=1.6 to 7.7) higher Emotional Fatigue than patients not taking glucocorticoids (p=.003).
Internal consistencies of the EORTC QLQ-FA12 multi-item scales were comparably high for RA and for cancer patients (Cronbach’s alphas=.74–.92). Moreover, the scaling structure was confirmed in the sample of RA patients (convergent and discriminant validity, no scaling errors).
Discussion: This study showed that RA patients suffer from a considerable level of fatigue that is comparable to and in certain cases even higher than cancer patients.
Practical implications: More knowledge on RA fatigue should be generated for a better care. The implementation of standardized diagnostic procedures and interventions to reduce fatigue in RA patients are recommended.
Appeal for practice (science and/or care) in one sentence: RA patients’ level of fatigue should be regarded as alarming and call for close monitoring in clinical practice.
