TY - JOUR
T1 - Multimorbidity and Fatigue in Rheumatoid Arthritis
T2 - A Cross-Sectional Study of a Population-Based Cohort
AU - Davis, John M.
AU - Myasoedova, Elena
AU - Gunderson, Tina M.
AU - Crowson, Cynthia S.
N1 - Funding Information:
We thank the participants of the study. This work was funded by a grant from the National Institutes of Health, NIAMS (R01 AR46849) and made possible by the Rochester Epidemiology Project (R01 AG034676 from the National Institute on Aging). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. No Rapid Service Fee was received by the journal for the publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. The findings of this study have been reported in part at the 2019 American College of Rheumatology annual scientific meeting in Atlanta, Georgia. John M. Davis III reports a grant from National Institutes of Health, during the conduct of the study, and has received grants from Pfizer and Genentech and served on advisory boards sponsored by AbbVie and Sanofi-Genzyme, outside the submitted work. Cynthia S. Crowson reports a grant from National Institutes of Health, during the conduct of the study, and has received grants from Pfizer and personal fees from Crescendo Biosciences, outside the submitted work. John M. Davis III is a member of the journal’s Editorial Board. Elena Myasoedova and Tina M. Gunderson have nothing to disclose. The Mayo Clinic (IRB number 06-005445) and Olmsted Medical Center (IRB number 039-omc-06) institutional review boards approved this research study. The study was conducted in accordance with the Helsinki Declaration of 1964 and its later amendments. All participants provided written informed consent. No protected health information of research participants is disclosed in this manuscript. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Publisher Copyright:
© 2020, The Author(s).
PY - 2020/12
Y1 - 2020/12
N2 - Introduction: The objective was to evaluate the relationships between multimorbidity and overall fatigue as well as fatigue subdomains in patients with rheumatoid arthritis (RA). Methods: A cross-sectional study of a population-based cohort of patients with RA was performed. Fatigue was assessed using the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ). Patients’ medical records were reviewed for 25 chronic comorbidities prior to the BRAF-MDQ. Linear and logistic regression models were used to estimate the differences in BRAF-MDQ total and subdomain (physical, living, cognitive, and emotional) scores associated with multimorbidity, adjusting for age, sex, disease duration, obesity, smoking, C-reactive protein, and RA autoantibodies. Higher BRAF-MDQ scores indicate greater fatigue severity. Results: The cohort included 192 patients, median age 62 years, and median RA duration 13 years. Multimorbidity was common with 93 (48%) having ≥ 2 comorbidities, and 27 (14%) having ≥ 4 comorbidities. The median BRAF-MDQ total score was 9 (interquartile range 3–18), with higher scores indicating greater fatigue. Patients with ≥ 4 comorbidities had higher total BRAF-MDQ scores (median 16.5, interquartile range: 6.8–24.8) than patients with < 4 comorbidities (7.5, 2.8–16.0; p = 0.014). Each additional comorbidity was associated with a 2.33 (95% confidence interval [CI] 1.10–3.56) unit increase in total BRAF-MDQ score (p < 0.001), and the presence of ≥ 4 comorbidities was associated with a 9.33 (95% CI 3.92–14.7) unit increase in total BRAF-MDQ score. Multimorbidity was significantly associated with all four fatigue subdomains in adjusted models. Conclusions: Multimorbidity is associated with increased fatigue in patients with RA. The findings suggest that interventions targeting multimorbidity could help alleviate treatment-refractory fatigue in patients with RA and other rheumatic diseases.
AB - Introduction: The objective was to evaluate the relationships between multimorbidity and overall fatigue as well as fatigue subdomains in patients with rheumatoid arthritis (RA). Methods: A cross-sectional study of a population-based cohort of patients with RA was performed. Fatigue was assessed using the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ). Patients’ medical records were reviewed for 25 chronic comorbidities prior to the BRAF-MDQ. Linear and logistic regression models were used to estimate the differences in BRAF-MDQ total and subdomain (physical, living, cognitive, and emotional) scores associated with multimorbidity, adjusting for age, sex, disease duration, obesity, smoking, C-reactive protein, and RA autoantibodies. Higher BRAF-MDQ scores indicate greater fatigue severity. Results: The cohort included 192 patients, median age 62 years, and median RA duration 13 years. Multimorbidity was common with 93 (48%) having ≥ 2 comorbidities, and 27 (14%) having ≥ 4 comorbidities. The median BRAF-MDQ total score was 9 (interquartile range 3–18), with higher scores indicating greater fatigue. Patients with ≥ 4 comorbidities had higher total BRAF-MDQ scores (median 16.5, interquartile range: 6.8–24.8) than patients with < 4 comorbidities (7.5, 2.8–16.0; p = 0.014). Each additional comorbidity was associated with a 2.33 (95% confidence interval [CI] 1.10–3.56) unit increase in total BRAF-MDQ score (p < 0.001), and the presence of ≥ 4 comorbidities was associated with a 9.33 (95% CI 3.92–14.7) unit increase in total BRAF-MDQ score. Multimorbidity was significantly associated with all four fatigue subdomains in adjusted models. Conclusions: Multimorbidity is associated with increased fatigue in patients with RA. The findings suggest that interventions targeting multimorbidity could help alleviate treatment-refractory fatigue in patients with RA and other rheumatic diseases.
KW - Autoimmune disease
KW - Comorbidity
KW - Fatigue subdomains
KW - Health care burden
KW - Multimorbidity
KW - Rheumatic disease
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U2 - 10.1007/s40744-020-00247-y
DO - 10.1007/s40744-020-00247-y
M3 - Article
AN - SCOPUS:85111353483
SN - 2198-6576
VL - 7
SP - 979
EP - 991
JO - Rheumatology and Therapy
JF - Rheumatology and Therapy
IS - 4
ER -