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The impact of fatigue on patients with psoriatic arthritis: a multi-center study of the TLAR-network

  • Observational Research
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Abstract

Fatigue is a substantial problem in patients with psoriatic arthritis (PsA) that needs to be considered in the core set of domains. This study aimed to evaluate fatigue and its relationship with disease parameters, functional disability, anxiety, depression, quality of life, and correlation with disease activity as determined by various scales. A total of 1028 patients (677 females, 351 males) with PsA who met the CASPAR criteria were included [Turkish League Against Rheumatism (TLAR) Network multicenter study]. The demographic features and clinical conditions of the patients were recorded. Correlations between fatigue score and clinical parameters were evaluated using the Disease Activity Score 28 (DAS28), Disease Activity in Psoriatic Arthritis (DAPSA), Clinical DAPSA (cDAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Fibromyalgia Rapid Screening Tool (FiRST), minimal disease activity (MDA), and very low disease activity (VLDA). Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy (FACIT-F) and a 10-point VAS (VAS-F). The mean age of the patients was 47 (SD: 12.2) years, and the mean disease duration was 6.4 (SD: 7.3) years. The mean VAS-F score was 5.1 (SD: 2.7), with fatigue being absent or mild, moderate, and severe in 12.8%, 24.6%, and 62.5% of the patients, respectively. Fatigue scores were significantly better in patients with DAS28 remission, DAPSA remission, cDAPSA remission, MDA, and VLDA (p < 0.001). Fatigue scores significantly increased with increasing disease activity levels on the DAS28, DAPSA, and cDAPSA (p < 0.001). VAS-F scores showed correlations with the scores of the BASDAI, BASFI, PsAQoL, HAD-A, FiRST, pain VAS, and PtGA. FiRST scores showed fibromyalgia in 255 (24.8%) patients. FACIT-F and VAS-F scores were significantly higher in patients with fibromyalgia (p < 0.001). In regression analysis, VLDA, BASDAI score, FiRST score, high education level, HAD-Anxiety, and BMI showed independent associations with fatigue. Our findings showed that fatigue was a common symptom in PsA and disease activity was the most substantial predictor, with fatigue being less in patients in remission, MDA, and VLDA. Other correlates of fatigue were female gender, educational level, anxiety, quality of life, function, pain, and fibromyalgia.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey

    Mehmet Tuncay Duruöz, Halise Hande Gezer & Sevtap Acer Kasman

  2. Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey

    Kemal Nas, Ayhan Kamanlı & İbrahim Tekeoglu

  3. Kanuni Training and Research Hospital, Rheumatology Clinic, Trabzon, Turkey

    Erkan Kilic

  4. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey

    Betül Sargin

  5. Department of Physical Medicine and Rehabilitation, Pamukkale University School of Medicine, Denizli, Turkey

    Hakan Alkan

  6. Department of Physical Medicine and Rehabilitation, Balıkesir University School of Medicine, Balıkesir, Turkey

    Nilay Sahin

  7. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University School of Medicine, Kayseri, Turkey

    Gizem Cengiz & Mustafa Calis

  8. Van Training and Research Hospital, Rheumatology Clinic, Van, Turkey

    Gizem Cengiz

  9. Şanlıurfa Training and Research Hospital, Rheumatology Clinic, Şanlıurfa, Turkey

    Nihan Cuzdan

  10. Department of Physical Medicine and Rehabilitation, Selçuk University School of Medicine, Konya, Turkey

    İlknur Albayrak Gezer

  11. Department of Physical Medicine and Rehabilitation, Kırıkkale University School of Medicine, Kırıkkale, Turkey

    Dilek Keskin

  12. Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey

    Cevriye Mulkoglu & Fikriye Figen Ayhan

  13. Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey

    Hatice Resorlu

  14. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Ankara University School of Medicine, Ankara, Turkey

    Sebnem Ataman

  15. Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Dışkapı Yıldırım Beyazıt Trainig and Research Hospital, Ankara, Turkey

    Ajda Bal

  16. Department of Physical Medicine and Rehabilitation, Bezmiâlem Foundation University, İstanbul, Turkey

    Okan Kucukakkas, Ozan Volkan Yurdakul & Yaşar Keskin

  17. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Atatürk University School of Medicine, Erzurum, Turkey

    Meltem Alkan Melikoglu

  18. Department of Physical Medicine and Rehabilitation, Uşak University High School of Health Sciences, Uşak, Turkey

    Fikriye Figen Ayhan

  19. Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey

    Merve Baykul

  20. Department of Physical Medicine and Rehabilitation, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey

    Hatice Bodur

  21. Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey

    Erhan Capkin

  22. Department of Physical Medicine and Rehabilitation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey

    Gul Devrimsel

  23. Ankara City Hospital, Rheumatology Clinic, Ankara, Turkey

    Kevser Gök

  24. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Cumhuriyet University School of Medicine, Sivas, Turkey

    Sami Hizmetli

  25. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey

    Hilal Ecesoy

  26. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey

    Öznur Kutluk & Tiraje Tuncer

  27. Kartal Dr. Lutfi Kirdar Training and Research Hospital, Rheumatology Clinic, İstanbul, Turkey

    Nesrin Sen

  28. Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey

    Ömer Faruk Sendur

  29. Department of Physical Medicine and Rehabilitation, Medipol University School of Medicine, İstanbul, Turkey

    Sena Tolu

  30. Department of Physical Medicine and Rehabilitation, Yuzuncu Yıl University School of Medicine, Van, Turkey

    Murat Toprak

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  1. Mehmet Tuncay Duruöz
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  2. Halise Hande Gezer
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  3. Kemal Nas
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  4. Erkan Kilic
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  5. Betül Sargin
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  6. Sevtap Acer Kasman
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  7. Hakan Alkan
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  8. Nilay Sahin
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  9. Gizem Cengiz
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  10. Nihan Cuzdan
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  11. İlknur Albayrak Gezer
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  12. Dilek Keskin
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  13. Cevriye Mulkoglu
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  14. Hatice Resorlu
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  15. Sebnem Ataman
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  16. Ajda Bal
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  17. Okan Kucukakkas
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  18. Ozan Volkan Yurdakul
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  19. Meltem Alkan Melikoglu
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  20. Fikriye Figen Ayhan
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  21. Merve Baykul
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  22. Hatice Bodur
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  23. Mustafa Calis
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  24. Erhan Capkin
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  25. Gul Devrimsel
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  26. Kevser Gök
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Contributions

All authors contributed to the study conception, design and data collection. Material preparation and analysis were performed by MTD, HHG, and KN. The first draft of the manuscript was written by MTD and HHG and all authors commented on previous versions of the manuscript. All co-authors are fully responsible for all aspects of the study and the final manuscript in line with the IJME four criteria.

Corresponding author

Correspondence to Halise Hande Gezer.

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Conflict of interest

The authors declare that there is no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was taken from the Sakarya University Ethics Committee on 25.01.2018. The protocol number was 42. The protocol for the research project has been approved by the relevant Ethics Committee and conducted in accordance with the Helsinki Declaration.

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Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Duruöz, M.T., Gezer, H.H., Nas, K. et al. The impact of fatigue on patients with psoriatic arthritis: a multi-center study of the TLAR-network. Rheumatol Int 40, 1803–1815 (2020). https://doi.org/10.1007/s00296-020-04628-y

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  • DOI: https://doi.org/10.1007/s00296-020-04628-y

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