Fatigue in rheumatic diseases

Association Between Wearable Device Use and Quality of Life in Patients With Idiopathic Inflammatory Myopathies and Primary Systemic Vasculitis

Background Despite the increasing use of wearable devices worldwide, concise data on these instruments in patients with systemic autoimmune rheumatic diseases, including idiopathic inflammatory myopathies (IIM) and primary systemic vasculitis (PSV), are lacking. Objectives The aim of this study is to investigate the knowledge and use of wearable devices and to assess their impact on the general quality of life of patients with IIM and PSV. Moreover, we compared these characteristics between patients with IIM and PSV users and non-users of wearable devices. Methods This single-center, cross-sectional study was conducted between January 2023 and June 2023. We included adult patients with IIM and PSV and a control group (CTR) and evaluated their use of cell phones and wearables, level of physical activity, and quality of life. Results A total of 132 patients with IIM, 82 with PSV, and 178 in the CTR were evaluated. Overall, 169 patients and 144 in the CTR were aware of wearable devices, of whom 50 (29.6%) and 47 (32.6%), respectively, had already used this technology. In addition, the IPAQ-Mets and EQ-5D scores were lower in the IIM and PSV groups than in the CTR, and the fatigue severity scale (FSS) scores were higher in the IIM and PSV groups than in the CTR. Patients who used the devices showed FSS scores of 29 (18-40) points, with higher levels of IPAQ-Mets among device users, indicating greater physical activity than among nonusers. Conclusion Based on the results, the use of wearable devices is associated with better fatigue and IPAQ scores. Possibly, the use of such devices can have an impact on better lifestyle habits among these patients.

Risk of Fibromyalgia in Patients with Primary Muscle Tension Dysphonia: A Prospective Pilot Study

OBJECTIVE

To investigate the risk of fibromyalgia in patients with primary muscle tension dysphonia (MTD) in comparison to subjects with no dysphonia.

STUDY DESIGN

Prospective cohort study.

METHODS

The medical records and video recordings of all patients presenting to the Voice and Swallowing unit at a tertiary referral center between October 2022 and October 2023 and who were diagnosed with primary MTD were prospectively reviewed. The risk of fibromyalgia was assessed using the "Fibromyalgia Rapid Screening Tool" (FiRST). Demographic data included age, gender, history of smoking, and history of high vocal load. The impact of dysphonia on quality of life was also analyzed using the Voice Handicap Index-10 (VHI-10).

RESULTS

A total of 42 patients who had filled the FiRST questionnaire were enrolled in this study. These included 20 patients diagnosed with primary MTD and 22 healthy subjects with no history of dysphonia and normal laryngeal examination. Forty percent of the study group tested positive using the FiRST questionnaire as compared to only 9.1% in the control group. The difference between the two groups was statistically significant (P = 0.03). The risk of having fibromyalgia was 6.67 times among patients with primary MTD in comparison to controls (RR=6.67; 95% CI [1.21-36.74]).

CONCLUSION

The results of this investigation indicate that the risk of fibromyalgia is significantly higher in patients with primary MTD vs controls. A holistic approach in the diagnosis and treatment of MTD is advocated.

Photobiomodulation therapy combined with static magnetic field is better than placebo in patients with fibromyalgia: a randomized placebo-controlled trial

BACKGROUND

Fibromyalgia is a syndrome characterized by generalized chronic pain and tenderness in specific areas. Photobiomodulation therapy (PBMT) using low-level laser therapy and/or light emitting diode therapy is an electrophysical agent that can be used alone or together with a static magnetic field (PBMT-sMF) to promote analgesia in several health conditions. Little evidence exists regarding the effects of using PBMT and PBMT-sMF in patients with fibromyalgia; this evidence is conflicting.

AIM

We aimed to investigate the effects of using PBMT-sMF versus a placebo on reduction of the degree-of-pain rating, impact of fibromyalgia, pain intensity, and satisfaction with treatment in patients with fibromyalgia.

DESIGN

A prospectively registered, monocentric, randomized placebo-controlled trial, with blinding of patients, therapists, and assessors, was performed.

SETTING

The study was conducted at the Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT) in Brazil, between March and October 2020.

POPULATION

Ninety female patients with fibromyalgia were randomized to undergo either PBMT-sMF (N.=45) or placebo (N.=45) treatment.

METHODS

Patients from both groups received nine treatment sessions, three times a week, for 3 weeks. Clinical outcomes were collected at baseline, the end of treatment, and at the follow-up appointment 4 weeks post-treatment. The primary outcome was the degree-of-pain rating, measured by the reduction of the tender point count.

RESULTS

A decrease in the degree-of-pain rating was observed in patients allocated to the PBMT-sMF group, decreasing the number of tender points when compared to placebo group at the end of treatment (P<0.0001) and at the follow-up assessment (P<0.0001). Patients did not report any adverse events.

CONCLUSIONS

PBMT-sMF is superior to placebo, supporting its use in patients with fibromyalgia.

CLINICAL REHABILITATION IMPACT

PBMT-sMF might be considered an important adjuvant to the treatment regimens of patients with fibromyalgia.

Efficacy of cupping therapy in individuals with fibromyalgia. A systematic review of randomized clinical trials

BACKGROUND

Fibromyalgia is a chronic and idiopathic condition and is among the most common causes of generalized chronic pain, even affecting psychological and cognitive aspects.

AIM

To evaluate the efficacy of cupping therapy on pain, quality of life, sleep disorders, and the impact of the disease in subjects with fibromyalgia.

METHODS

We searched the Pubmed, CINAHL, Epistemonikos, Scopus, and Web of Science databases. Randomized controlled trials involving adults with fibromyalgia undergoing cupping were included. Pain intensity, quality of life, sleep disturbances, and the impact of fibromyalgia were assessed. We have reported the results using descriptive statistics and narrative synthesis.

RESULTS

Two articles with a total of 155 participants were included. Large effect sizes were found for pain intensity, moderate for quality of life, and low for the impact of fibromyalgia and sleep disorders. However, the certainty of the evidence is low for most outcomes except for sleep disorders.

CONCLUSIONS

There is a discrepancy in the efficacy of cupping therapy in improving pain intensity, quality of life, sleep disturbances, and disease impact in people with fibromyalgia. Future high-quality randomized clinical trials are required.

Profile and quality of life of the adult population in good health according to the level of vitality: European NHWS cross sectional analysis

BACKGROUND

The World Health Organization's definition of health highlights the importance of mental and physical wellbeing and not only disease state. However, lack of awareness on the burden of impaired vitality and its impact on the quality of life of the general healthy population prevents healthcare providers from delivering appropriate solutions and advice. This study aims to better characterize this population in Europe and identify the profile and the health reported outcomes associated with impaired vitality.

METHODS

This retrospective observational study included National Health and Wellness Survey (NHWS) data collected in healthy participants aged 18-65 years from five European Union countries in 2018. Socio-demographic and lifestyle characteristics, comorbidities, attitudes towards healthcare systems, Patient Activation Measure, health-related quality of life outcomes (EQ-5D), and work productivity and activity impairment were analysed according to SF-12 vitality score subgroups (≥ 60, 50- < 60, 40- < 50, < 40).

RESULTS

A total of 24,295 participants were enrolled in the main analysis. Being a female, younger, having a lower income and being obese or having sleep and mental disorders was associated with an increased risk of impaired vitality. This was associated with a higher consumption of healthcare resources along with having a weak patient-physician relationship. Participants who were disengaged in the self-management of their health were 2.6 times more likely to have a low level of vitality. For participants in the lowest vitality group, odds of mobility problems increased by 3.4, impairment of usual activity by 5.8, increased of pain and discomfort by 5.6 and depression and anxiety by 10.3, compared with participants in the highest vitality group. Also, odds of presenteeism increased by 3.7, overall work impairment by 3.4 and daily activity losses by 7.1.

CONCLUSION

Evidence-based trends facilitate the identification of a healthy population with impaired vitality in real-world practice. This study highlights the actual burden of low vitality on daily life activities, particularly on mental health and reduced work productivity. Additionally, our results underline the importance of self-engagement in the management of vitality impairment and highlights the need to implement strategies to address this public health concern in the affected population (HCP-patient communication, supplements, meditation).

High prevalence of fatigue in patients with Takayasu arteritis: a case-control study in a Brazilian centre

Objectives

Several studies have shown not only a high prevalence of fatigue but also a reduction in health-related quality of life (HRQoL) in patients with rheumatic diseases. Owing to insufficient research in this area, we aimed to assess the prevalence of fatigue and its contribution to impairment of HRQoL in patients with Takayasu arteritis (TAK).

Methods

This single-centre case-control study included 53 TAK patients who were matched by age, BMI and sex with 100 healthy individuals. Aside from the patients' general data, the following information was collected: disease activity, level of activities of daily living (HAQ), physical activity levels and chronic fatigue.

Results

The TAK patients and healthy individuals were comparable in terms of current age, BMI and sex distribution. The median disease duration of TAK was 13.0 (7.0-20.0) years, and 11 (20.8%) patients had active disease. Compared with healthy individuals, patients with TAK had a higher prevalence of fatigue and lower HAQ score, physical activity level and intensity, and physical and psychosocial domains of the modified fatigue impact scale (P < 0.01). Moreover, TAK patients had increased fatigue rates compared with the healthy individuals (fatigue severity scale: odds ratio = 2.6; 95% CI = 1.2, 5.4; modified fatigue impact scale: odds ratio = 2.6; 95% CI = 1.2, 5.5). Fatigue was positively correlated with worsening HAQ, CRP levels, daily prednisone dose and disease activity, and negatively correlated with disease duration.

Conclusion

TAK patients have a higher prevalence of fatigue, which affects different aspects of the disease, including physical function. Thus, fatigue-focused treatments should also be considered in clinical practice.

Trial registration

The Brazilian Clinical Trials Registry (ReBEC), https://ensaiosclinicos.gov.br/, RBR-9n4z2hh.

The pathway and characteristics of patients with non-specific symptoms of cancer: a systematic review

BACKGROUND

Non-specific symptoms are  common and often sign of a non-serious disease. Because of this, patients with non-specific symptoms of cancer (NSSC) present a challenge for general practitioners (GP). Studies describing characteristics of patients with NSSC have been done after fast-track pathways were created to diagnose and treat patients with NSSC. This study reviews characteristics of patients with NSSC and their patient pathways.

MATERIALS AND METHODS

Database searches of Embase, Cochrane, PubMed, Cinahl and Web of Science were performed. Search terms used were cancer, patient pathway, and NSSC with their synonyms. The flow diagram Preferring Reporting Items for Systematic Review was applied to the systematic search. The Newcastle-Ottawa Assessment Scale (NOS) was used to compare the quality of the included studies.

RESULTS

Twelve studies met the inclusion criterias. All studies were considered to be of high methodological quality. Patient Pathway: 11-35% of patients were diagnosed with cancer. Median number of days through diagnostic process was 7-10.

PATIENT CHARACTERISTICS

The most prevalent cancers included hematological-(14-30%), gastrointestinal-(13-23%) and lung cancers (13%). Rheumatological, musculoskeletal and gastrointestinal diseases were among the most common non-malignant diseases diagnosed. Weight loss, fatigue, pain and loss of appetite were the most common symptoms. Cardiovascular diseases, lung diseases, diabetes and previous diagnosed cancer were the most common comorbidities. Mean age of included patients was 60-72 years.

CONCLUSION

Limited number of studies were found and they lacked sufficient heterogenic data to conduct a metaanalysis. Symptoms, diagnoses, age and gender were described with some heterogenic results. Further studies should be conducted to gather broader knowledge about patients with NSSC.

Self-reported fatigue in patients with rheumatoid arthritis compared to patients with cancer: results from two large-scale studies

Fatigue is a common symptom in patients with rheumatoid arthritis (RA) and in patients with cancer (CA). The aim was to investigate the degree of fatigue in RA patients as compared to CA patients as well as potential influencing factors on RA-related fatigue. This was a retrospective analyses of two prospective cohort studies that used the EORTC QLQ-FA12 as a common instrument to assess fatigue. The cohort of RA patients was based on a nationwide survey in Germany. The cohort of CA patients was recruited in the context of an international validation field study. Multivariable ANCOVAs compared levels of fatigue between the two cohorts, also including various subgroup analyses. Regression analyses explored influencing factors on RA patients’ fatigue. Data of n = 705 RA patients and of n = 943 CA patients were available for analyses. RA patients reported significantly higher Physical Fatigue (mean difference = 7.0, 95% CI 4.2–9.7, p < 0.001) and Social Sequelae (mean difference = 7.5, 95% CI 4.7–10.2, p < 0.001). CA patients reported higher Cognitive Fatigue (mean difference = 3.5, 95% CI 1.4–5.6, p = 0.001). No differences in Emotional Fatigue (p = 0.678) and Interference with Daily Life (p = 0.098) were found. In RA patients, mental health and pain were associated with fatigue (p values < 0.001). RA patients showed a considerable level of fatigue that is comparable to and in certain cases even higher than that of CA patients. The implementation of standardized diagnostic procedures and interventions to reduce fatigue in RA patients are recommended.

Fatigue assessment by FACIT-F scale in Pakistani cohort with Rheumatoid Arthritis (FAF-RA) study

Objective:

To fine out fatigue frequency and severity by FACIT-F scale in Pakistani cohort with rheumatoid arthritis.

Methods:

This study was conducted at department of Medicine division of rheumatology CPMC Lahore. After the approval of IRB, 192 patients of RA were recruited. Written, informed consent was taken, demographic details were noted, patients filled the URDU version of FACIT-F (fatigue severity scale). 5-ml of blood was taken for fasting blood sugar, viral markers and ESR by a trained phlebotomist. Each individual’s disease activity was assessed by DAS-28 and FACIT-F score was calculated.

Results:

The Mean age (39.9±10.5) years, (71.9%) were females. Fatigue frequency was 62% (n=126), age, education, hypertension, DAS-28, exercise levels and HCV gives significant association with fatigue score. Linear regression analysis, results showed one unit increase in DAS-28 will gives 2.71 unit increases in fatigue scores(P <0.05).

Conclusions:

We have very high frequency of fatigue in RA, increases with disease activity & associated conditions.

Effects of 12-week whole-body vibration exercise on fatigue, functional ability and quality of life in women with systemic lupus erythematosus: A randomized controlled trial

BACKGROUND

Systemic lupus erythematosus (SLE) is a complex rheumatic autoimmune disease characterized by periods of exacerbations that can present damage in organs with important clinical manifestations.

OBJECTIVE

The aim of this study was to evaluate the effect of 12-week whole-body vibration exercise (WBVE) on the fatigue, functional ability and quality of life of women with systemic lupus erythematosus (SLE) in chronic glucocorticoids use (CGU).

METHODS

Twenty-one women were allocated randomly in the WBVE group or isometry group. The participants of WBVE group were positioned on the vibrating platform with 130° knee flexion and received the intervention twice a week for 12 weeks. The isometry group performed the same position and time, but without the stimulus of mechanical vibration. Fatigue, functional ability and the quality of life were evaluated at weeks 0, 6, and 12.

RESULTS

From a sample of seventy-seven individuals, seventeen participants completed the study, 8 in WBVE group and 9 in isometry group. Fatigue reduced in the WBVE group at 6 and 12 weeks of intervention (p = 0.04) and (p = 0.03) respectively. There was a significant improvement in the functional ability evaluated by the Health Assessment Questionnaire in the WBVE group compared to the isometry group (p = 0.03).

CONCLUSION

WBVE would be a useful intervention for control of fatigue and improvement of the functional ability of women with SLE in CGU.

Using qualitative methods for a conceptual analysis of measures of health status and presenteeism prior to a mapping study

OBJECTIVES

The inclusion of productivity in economic evaluations is a contentious issue. Methods are currently being developed to assess how it may feasibly be included for specific interventions, such as workplace interventions (WPIs), where productivity is a key outcome. Mapping (also called cross-walking or prediction modelling) may offer a solution. Prior to producing a mapping algorithm, it is recommended that the conceptual validity between 'source' and 'target' measures be understood first. This study aimed to understand the conceptual validity of two existing measures of health status (EQ-5D; SF-6D) and presenteeism to inform the potential for a subsequent mapping algorithm.

METHODS

A purposive sample of individuals who were currently working and had either rheumatoid arthritis (RA), ankylosing spondylitis (AS) or psoriatic arthritis (PsA). Individuals were recruited through support groups. Semi-structured telephone interviews were conducted until data saturation (no new emerging themes) was reached. Deductive and inductive framework analysis methods were used to identify key aspects of the conditions (themes) that impact on presenteeism (working at reduced levels of health).

RESULTS

Twenty-two (RA = 10; AS = 9; PsA = 3) employed individuals were interviewed. Deductive analysis identified evidence which confirmed the domains included in the EQ-5D and SF-6D capture those key aspects of RA, AS and PsA that increase presenteeism. Inductive analysis identified an additional theme; mental clarity, not captured by the EQ-5D or SF-6D, was also found to have a direct impact on presenteeism.

CONCLUSIONS

The results of the study indicate conceptual validity of both health status measures to predict presenteeism. The next step is to develop a mapping algorithm for presenteeism.

Effect of biologics and targeted synthetic disease-modifying anti-rheumatic drugs on fatigue in rheumatoid arthritis

Fatigue is a common and debilitating symptom in patients with RA. Since 2007, fatigue has been included as one of the core outcome measures in RA. Clinical trials of biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) have included fatigue as a secondary endpoint. A Cochrane review in 2016 concluded that the bDMARDs have a moderate effect on improving fatigue in RA. More recent clinical trials of the new biologic agent sarilumab and the Janus kinase inhibitors tofacitinib and baricitinib showed similar benefits. It remains unclear whether the effect of bDMARDs and tsDMARDs on fatigue is mediated by direct effects or through a reduction in inflammation. As fatigue was a secondary endpoint, many analyses did not adjust for potential confounding factors, including pain, mood and anaemia, which is a significant limitation.

Impacts of Fatigue, Stress, and Perceived Health Status on Women With Rheumatic Diseases: A Comparison Study

BACKGROUND

Rheumatic conditions, which increase in prevalence as populations age, are a growing public health problem that disproportionately affects women. Understanding the influences of rheumatic diseases (RDs) on fatigue, stress, and perceived health status is deemed important to the improvement of physical and mental health for women with RDs.

PURPOSE

This study was designed to compare the fatigue, stress, and perceived physical and mental health status of women with RDs (RD group) with those of peers who did not have chronic illnesses (comparison group).

METHODS

A cross-sectional, purposive sample and comparative design was used. Four hundred forty-three women with a mean age of 46.2 years participated in this study. Those with physician-diagnosed RDs (n = 212) were enrolled in the RD group, and those without chronic disease were enrolled in the comparison group (n = 231). Measures used included a demographic datasheet, Fatigue Severity Scale, Perceived Stress Scale, and Short Form-12 Items Health Survey. Analysis of covariance was used to examine the intergroup differences for major variables based on demographic covariates.

RESULTS

The RD group reported significantly more fatigue and stress than the comparison group. Moreover, the RD group reported significantly poorer perceived physical health status, significantly poorer physical functioning and general health, and greater bodily pain compared with the comparison group. Conversely, the RD group reported significantly better perceived mental health status, significantly lower vitality, and better role emotional status than the comparison group.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings support the theory that RDs have a negative impact on perceived stress and fatigue in women. Physical function, bodily pain, and general health may be the most significantly affected domains of perceived physical health in women with RDs. Of note, with the exception of the vitality subscale, RDs did not adversely affect the perceived mental health of participants with RD in this study. Healthcare professionals should cooperate with clinical rheumatologists, psychologists, and physiotherapists to provide comprehensive care that includes long-term education to help patients with RD self-manage stress, restore vitality, relieve pain, and increase physical function.

Fatigue severity in anti-nuclear antibody-positive individuals does not correlate with pro-inflammatory cytokine levels or predict imminent progression to symptomatic disease

Background

Fatigue is a common symptom of systemic autoimmune rheumatic disease (SARD). Patients with SARD have a protracted pre-clinical phase during which progressive immunologic derangements occur culminating in disease. In this study, we sought to determine when fatigue develops and whether its presence correlates with inflammatory factors or predicts disease progression.

Methods

Anti-nuclear antibody (ANA)-negative healthy controls (HCs) and ANA-positive participants with no criteria, at least one clinical criteria (undifferentiated connective tissue disease, UCTD), or meeting SARD classification criteria were recruited. Fatigue was assessed using a modified version of the FACIT-F questionnaire and the presence of fibromyalgia determined using a questionnaire based on the modified 2010 ACR criteria. Peripheral blood expression of five IFN-induced genes was quantified by NanoString and the levels of IL-1β, IL-6, or TNF-α by ELISA.

Results

Fatigue was as prevalent and severe in individuals lacking SARD criteria as it was in UCTD and SARD. Overall, ~ 1/3 of ANA⁺ subjects met fibromyalgia criteria, with no differences between sub-groups. Although fatigue was more severe in these individuals, those lacking fibromyalgia remained significantly more fatigued than ANA⁻ HC. However, even in these subjects, fatigue correlated with the widespread pain index and symptom severity scores on the fibromyalgia questionnaire. Fatigue was not associated with elevated cytokine levels in any of the ANA⁺ sub-groups and did not predict imminent disease progression.

Conclusions

Fatigue is common in ANA⁺ individuals lacking sufficient criteria for a SARD diagnosis, correlates with fibromyalgia-related symptoms, and is not associated with inflammation or predictive of disease progression.

Quality of Care in Rheumatoid Disease from the Clinician Perspective: A Modified Delphi Panel Approach

INTRODUCTION

To establish clinical consensus on important and relevant quality-of-care (QoC) attributes in rheumatic disease (RD) treatment that may improve treatment outcomes and guide best practices.

METHODS

Twenty-three QoC attributes were identified in a literature review. Fifteen European-based clinicians were selected based on their contributions to RD guidelines, publications, and patient care. A three-round (an interview round and two web-based rounds) modified Delphi panel was conducted to reach consensus and finalize a QoC attribute list.

RESULTS

In round 1 (clinician interviews), clinicians reported 52 unique QoC attributes across 14 themes, with the greatest number of attributes reported in the "treatment goals" (n = 7) and "remote monitoring" (n = 7) themes. During rounds 2 and 3, the critically important QoC attributes most frequently reported were access to care/treatment (n = 14, 93.3%), safety of treatment (round 2 n = 14, 93.3%, round 3 n = 13, 86.7%), and access to clinicians and specialists (round 2: n = 13, 86.7%, round 3: n = 14, 93.3%). The final list contained 53 QoC attributes.

CONCLUSION

The study demonstrates consensus across several themes of QoC. Quality of care is a complex, multidimensional, and fluid concept that can be improved by ensuring patients have access to care, open communication between patients and clinicians, and the use of novel strategies, such as remote monitoring. Utilization of the attribute list can potentially improve the lives of patients, provide clinicians with tools to provide greater QoC, and improve the healthcare system as a whole.

FUNDING

Merck & Co., Inc.