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THURSDAY, 13 JUNE 2019
Osteoarthritis: Research in motion
My joints hurt and I’m overwhelmingly tired – fatigue in rheumatoid arthritis
OP0201 FATIGUE IN JUVENILE IDIOPATIC ARTHRITIS AFTER 18 YEARS OF FOLLOW-UP
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  1. Ellen Dalen Arnstad1,2,
  2. Mia Glerup3,
  3. Veronika Rypdal4,5,
  4. Suvi Peltoniemi6,
  5. Maria Ekelund7,8,
  6. Lillemor Berntson8,
  7. Anders Fasth9,
  8. Susan Nielsen10,
  9. Marek Zak11,
  10. Kristiina Aalto6,
  11. Ellen Nordal4,5,
  12. Troels Herlin3,
  13. Pål Richard Romundstad12,
  14. Marite Rygg2,13
  1. 1Levanger Hospital, Dept. of Pediatrics, Levanger, Norway
  2. 2NTNU – Norwegian University of Science and Technology, Dept. of Clin. and Molecular Med., Trondheim, Norway
  3. 3Aarhus University Hospital, Dept. of Pediatrics, Aarhus, Denmark
  4. 4University Hospital of North Norway, Dept. of Pediatrics, Tromsø, Norway
  5. 5UiT The Arctic University of Norway, Dept. of Clin. Med., Tromsø, Norway
  6. 6University of Helsinki, Helsinki, Finland
  7. 7Ryhov County Hospital, Dept. of Pediatrics, Jonkoping, Sweden
  8. 8Uppsala University, Dept. of Women’s and Children’s Health, Uppsala, Sweden
  9. 9Institute of Clin. Sciences, Sahlgrenska Academy, University of Gothenburg, Dept. of Pediatrics, Gothenburg, Sweden
  10. 10Rigshospitalet Copenhagen University Hospital, Dept. of Pediatrics, Copenhagen, Denmark
  11. 11Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
  12. 12NTNU – Norwegian University of Science and Technology, Dept. of Public Health and Nursing, Trondheim, Norway
  13. 13St. Olavs Hospital, Dept. of Pediatrics, Trondheim, Norway

Abstract

Background Fatigue is common in adults with rheumatic disease and has also been shown in adolescents with juvenile idiopathic arthritis (JIA). Knowledge on fatigue in JIA in long-term follow-up is limited.

Objectives To study the prevalence and severity of fatigue 18 years after onset of JIA.

Methods In this close to population-based cohort study from defined geographical areas of Norway, Sweden, Denmark and Finland, consecutive cases of JIA with disease onset in 1997 to 2000 were prospectively enrolled (1). At 18-year follow-up, fatigue was measured using Fatigue Severity Scale (FSS, range 0-7) (2), and severe fatigue was defined as FSS ≥4. General health status was measured with Health Assessment Questionnaire (HAQ) and 36-Item Short Form Health Survey (SF-36). Reduced health was defined as HAQ >0, and SF-36 <40 (according to the physical component summary score/mental component summary score (PCS/MCS)). Pain was measured with 10 cm visual analogue scale (VAS), 0 = no pain, >0 = pain. Remission was defined according to the preliminary criteria described by Wallace. A Norwegian healthy cohort was used for comparison. Multivariable logistic regression analyses were performed.

Results Among 434 eligible JIA participants 377 completed a Fatigue Severity Scale (FSS) measurement at the 18-year follow-up and were included. Of these 72% were girls, 53% had oligoarticular disease six months after onset, median age at onset was 5.6 (IQR 2.6-9.7) years, and age at the 18-year visit was 23.1 (IQR 20.3-27.2). Mean total FSS (±SD) was 3.2 (±1.5), and participants with active disease scored 3.6 (±1.6) compared to 2.9 (±1.4) for those in remission off medication. The highest total FSS was found in those with SF-36 PCS and/or MCS <40 (4.7 (±1.6) and 4.6 (±1.6), respectively). Severe fatigue was considerably more frequent in participants with active disease (36%, odds ratio (OR) 2.5) compared to those in remission off medication (19%), HAQ score >0 (47%, OR 4.1) compared to HAQ score =0 (18%), SF-36 PCS/MCS <40 (64/61%, OR 7.1/6.9) compared to SF-36 PCS/MCS ≥40 (20/19%), and VAS pain >0 (36%, OR 3.8) compared to VAS pain =0 (13%). The proportion of severe fatigue in a healthy Norwegian control cohort was 12%.

Conclusion At 18-year follow-up fatigue was a prominent symptom in JIA, and we found consistently higher fatigue burden and considerably more severe fatigue among participants with active disease, pain and self-reported health problems, compared to those without. We suggest fatigue to be measured at long-term follow-up both in clinical and research settings.

References [1] Nordal E, et al. Arthritis Rheum 2011;63:2809-18

[2] Krupp LB, et al. Arch Neurol 1989;46:1121-23

Disclosure of Interests Ellen Dalen Arnstad: None declared, Mia Glerup: None declared, Veronika Rypdal: None declared, Suvi Peltoniemi: None declared, Maria Ekelund: None declared, Lillemor Berntson Consultant for: AbbVie, Speakers bureau: AbbVie, Anders Fasth: None declared, Susan Nielsen: None declared, Marek Zak: None declared, Kristiina Aalto: None declared, Ellen Nordal: None declared, Troels Herlin: None declared, Pål Richard Romundstad: None declared, Marite Rygg: None declared

https://doi.org/10.1136/annrheumdis-2019-eular.4006

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