Avaliação da fadiga em pacientes com artrite reumatoide e sua relação com qualidade de vida, capacidade funcional, sintomas de ansiedade e depressão e atividade de doença

Abstract

Fatigue is a highly subjective symptom that is, difficult to characterize and define. Fatigue is extremely common among rheumatoid arthritis (RA) patients. The aim of this study was to assess fatigue in a cohort of Brazilian patients with RA and to analyze the relationship between fatigue and disease-specific variables. A common protocol of investigation was prospectively applied to 371 Brazilian patients diagnosed with RA according to the 1987 American College of Rheumatology (ACR) RA classification criteria. Clinical, demographic and laboratorial data were obtained. The laboratory data included the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The number of painful joints was evaluated using the third item of the Disease Activity Index 28 (DAS 28). Age, gender, bone mass index (BMI), disease duration, quality of life (QoL) assessed by the physical and mental domains of the Medical Outcomes Study Short-Form 36-item Health Survey (SF-36P and SF-36M) and the functional capacity (FC) assessed by the Health Assessment Questionnaire - Disability Index (HAQ DI) were recorded. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HAD a/d). Fatigue was evaluated using the subscale of Fatigue Assessment of Chronic Illness Therapy who only scores fatigue complaints (FACIT-Fatigue). A confidence interval of 95% were applied as a measure of precision. The mean FACIT-Fatigue score was 39.88 ± 8.64. The fatigue scores were correlated with FC as measured by the HAQ DI (-0.507; p < 0.0000), anxiety and depression as measured by the HAD a/d (-0.542 and -0.545; p < 0.0000 respectively) and with QoL as measured by the both domains of SF-36 correlated predominantly with physical domain (SF-36P: 0.584; p < 0.0000 and 0.405; p < 0,05 respectively).The scores were not associated with the ESR (-0.118; p < 0.05), CRP (-0.089), the disease activity measured by the DAS 28 (-0.250; p < 0.0000) or the number of painful joints (-0.135; p < 0.009). In this series of Brazilian patients with RA, we suggest a new significance for fatigue complaints as an independent parameter that is not related to inflammatory activity or the number of painful joints. Anxiety and functional impairment appears to be more related to fatigue, but additional studies and an inclusion of standard measures for monitoring and clinical management are required. Fatigue is an important complaint in at least 1/3 of this Brazilian patients.