1228 - Fatigue and Morning Stiffness Are Correlated in Early Arthritis and Both Are Substantially Improved by Glucocorticoids

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Gisela Westhoff, German Rheumatism Research Center Berlin, Berlin, Germany, Angela Zink, Deutsches Rheumaforschungszentrum and Charité University Medicine, Berlin, Germany and Frank Buttgereit, Charité University Medicine, Berlin, Germany
Presentation Number: 1228

Background/Purpose: Morning stiffness (MS) in rheumatoid arthritis (RA) is considered to be causally related to the circadian rhythms of pro-inflammatory factors and is ameliorated by glucocorticoids (GC). In contrast, the pathophysiology of fatigue, a similarly frequent and debilitating RA symptom, is still not well understood. We therefore investigated the association between MS and fatigue in patients with early arthritis and delineated the effects of GC on both manifestations.

Method: Baseline data of 516 patients of an early arthritis inception cohort (disease duration <26 weeks, µ 13 ±8) were used. Morning stiffness was measured as duration (minutes) and severity (NRS 0-10). Dimensions of fatigue were assessed by the PROFAD items ‘need rest’, ‘poor starting’, ‘low stamina’, ‘weak muscles’ and ‘poor concentration’ (NRS 0-10). The patients with no GC, GC to be started and GC ≥1 week were compared with respect to the severity of MS and fatigue. The effects were adjusted for serological and immunological parameters, tender and swollen joint counts (0-28) and the duration under DMARDs (just started vs. ≥1 week).

Result: All patients were clinically diagnosed with either RA or undifferentiated arthritis (definite RA 56.1%, probable RA 36.1%, uA 7.8%) and 69.1% were classified as RA by the new ACR/EULAR RA classification criteria. 62% had just started a DMARD therapy with only 4% taking DMARDs for a week or more. 22% had oral GC (µ 16 mg/d, median 10) for at least one week (µ 2.7 ±3 weeks) and another 44% were designated to start GC. The patient-reported fatigue score (0-50) was significantly correlated with the physician-reported duration of MS (r = 0.246; P <0.001) and patient-reported severity of MS (r = 0.514, P <0.001) but was at the utmost weakly correlated with acute phase reactants and joint counts. Patients without GC yet and those designated to start GC were comparable in all measures considered, whereas patients taking GC for a week or more reported substantially less severe MS and fatigue, particularly less severe problems with “it is being hard to get going, things taking an effort or are a battle”. Multivariate logistic regression analysis with below average-fatigue (PROFAD score ≤12) as target variable revealed that patients with GC for at least one week reported twice as likely low fatigue severity (adjusted OR 2.10, 95% CI 1.30-3.40; P = 0.002). Age, sex, diagnoses, blood parameters, joint counts and duration under DMARDs were not associated with the binary fatigue severity score.

Morning stiffness and fatigue by glucocorticoid therapy at baseline

 

n

MS duration
minutes

MS severity
0-10 phys.

MS severity
0-10 pts.

 

Need
 rest

Poor
 starting

Low
 stamina

Weak
 muscles

Poor
concentration

No GC

174

58

4.1

5.2

 

3.6

3.6

2.9

3.4

2.4

GC to be started

226

77

4.8

6.1

 

3.9

4.2

3.0

3.6

2.5

GC >1 week

116

66

3.9

4.0

 

2.5

2.5

2.1

2.5

1.8

Total

516

68

4.4

5.3

 

3.5

3.6

2.9

3.3

2.3

P

 

0.011

0.007

<0.001

 

<0.001

<0.001

0.002

0.003

0.075

 Conclusion: Our data indicate an association between MS and several dimensions of patient-reported fatigue. Since both RA manifestations are inter-correlated and ameliorated by GC, a common pathophysiology is suggested that may contribute to the understanding and treatment of fatigue in inflammatory arthritis.


Keywords: fatigue, glucocorticoids and rheumatoid arthritis (RA)

Disclosure: G. Westhoff, None; A. Zink, None; F. Buttgereit, Mundipharma, 5, Horizon Pharma, 5, Merck Serono, 5, Horizon Pharma, 2, Merck Serono, 2 .