Skip to main content

Advertisement

SpringerLink
Log in

Bristol rheumatoid arthritis fatigue scale is valid in patients with psoriatic arthritis and is associated with overall severe disease and higher comorbidities

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Aims

To (1) determine the reliability and validity of the Bristol Rheumatoid Arthritis Fatigue scale (BRAF-NRS) in patients with psoriatic arthritis (PsA) and (2) examine possible clinical associations of worse fatigue in PsA.

Methods

Study phase 1: BRAF-NRS scale validation cohort. A consecutive cohort of 70 PsA patients was recruited to complete the 3-item BRAF-NRS and the 13-item Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaires, alongside disease activity assessment. All patients also completed the BRAF-NRS questionnaire, 1 day later. Study phase 2: Identifying the potential clinical associations of fatigue by using BRAF-NRS (n = 283). A second cohort of 283 PsA patients underwent detailed skin and rheumatologic assessments including disease activity measures. Comorbidities were measured using the Charlson comorbidity index (CCI). Factors predicting worse fatigue as measured by BRAF-NRS were determined using regression analysis.

Results

In phase 1, 67 out of 70 patients from the first cohort had complete assessments. The internal consistency of BRAF-NRS as measured by Cronbach’s alpha was 0.92. Test–retest reliability as measured by the intra-class correlation coefficient was 0.97. There was excellent correlation between the BRAF-NRS and FACIT-F score(r = − 0.83) (p = <0.001, 95% CI – 0.74 to − 0.91). In phase 2, using data from the second cohort of 283 PsA patients, possible clinical associations of worse fatigue were examined. On multiple linear regression analyses, the model predicted significant association of worse fatigue scores with low education status (p = 0.03), number of deformed joints (p = 0.01), not achieving minimal disease activity state (p < 0.001), higher CCI scores, and worse health assessment questionnaire score (p < 0.001).

Conclusions

BRAF-NRS is a reliable, reproducible, and valid instrument for measuring fatigue in PsA. Fatigue in PsA is associated with low education status and overall more severe disease.

Key Points

• Fatigue is increasingly recognized as an important measure to examine among patients with PsA, but the available valid fatigue scores in PsA are relatively long and time-consuming especially when other core domains also need to be measured

• BRAF-NRS is a short, easily readable, only 3-item tool to measure fatigue, and this is the first study which has examined its performance among the patients with PsA. Our results show that it is a reliable, reproducible, and valid (construct validity) instrument for measuring fatigue in PsA

• This study also clearly showed a significant positive relationship between fatigue and comorbidities, and it was also found that comorbidities play the largest role in the multivariate model

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hewlett S, Nicklin J, Treharne GJ (2008) Fatigue in musculoskeletal conditions.Topical reviews series 6: no 1. Arthritis Research UK. http://www.arthritisresearchuk.org/files/6641_25022010173830.pdf

  2. Hewlett S, Cockshott Z, Byron M, Kitchen K, Tipler S, Pope D, Hehir M (2005) Patients’ perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Arthritis Rheum 53:697–702

    Article  Google Scholar 

  3. Repping-Wuts H, Uitterhoeve R, van Riel P, van Achterberg T (2008) Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study. Int J Nurs Stud 45:995–1002

    Article  Google Scholar 

  4. Power JD, Badley EM, French MR, Wall AJ, Hawker GA (2008) Fatigue in osteoarthritis: a qualitative study. BMC Musculoskelet Disord 9:63

    Article  Google Scholar 

  5. Franklin AL, Harrell TH (2013) Impact of fatigue on psychological outcomes in adults living with rheumatoid arthritis. Impact of fatigue on psychological outcomes in adults living with rheumatoid arthritis. Nurs Res 62:203–209

    Article  Google Scholar 

  6. Rupp I, Boshuizen HC, Jacobi CE, Dinant HJ, van den Bos GA (2004) Impact of fatigue on health-related quality of life in rheumatoid arthritis. Arthritis Rheum 51:578–585

    Article  Google Scholar 

  7. Suurmeijer TP, Waltz M, Moum T, Guillemin F, van Sonderen FL, Briançon S, Sanderman R et al (2001) Quality of life profiles in the first years of rheumatoid arthritis: results from the EURIDISS longitudinal study. Arthritis Rheum 45:111–121

    Article  CAS  Google Scholar 

  8. Gossec L, de Wit M, Kiltz U, Braun J, Kalyoncu U, Scrivo R, Maccarone M et al (2014) A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis 73:1012–1019

    Article  Google Scholar 

  9. Gladman DD, Mease PJ, Strand V, Healy P, Helliwell PS, Fitzgerald O, Gottlieb AB, Krueger GG, Nash P, Ritchlin CT, Taylor W, Adebajo A, Braun J, Cauli A, Carneiro S, Choy E, Dijkmans B, Espinoza L, van der Heijde D, Husni E, Lubrano E, McGonagle D, Qureshi A, Soriano ER, Zochling J (2007) Consensus on a core set of domains for psoriatic arthritis. J Rheumatol 34:1167–1170

    PubMed  Google Scholar 

  10. Orbai AM, de Wit M, Mease PJ, Callis Duffin K, Elmamoun M, Tillett W, Campbell W, FitzGerald O, Gladman DD, Goel N, Gossec L, Hoejgaard P, Leung YY, Lindsay C, Strand V, van der Heijde D, Shea B, Christensen R, Coates L, Eder L, McHugh N, Kalyoncu U, Steinkoenig I, Ogdie A (2017) Updating the psoriatic arthritis (PsA) core domain set: a report from the PsA workshop at OMERACT 2016. J Rheumatol 44:1522–1528

    Article  Google Scholar 

  11. Belza BL, Henke CJ, Yelin EH, Epstein WV, Gilliss CL (1993) Correlates of fatigue in older adults with rheumatoid arthritis. Nurs Res 42:93–99

    Article  CAS  Google Scholar 

  12. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  Google Scholar 

  13. Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, Huber SL (1999) The rapid assessment of fatigue severity in cancer patients: use of the brief fatigue inventory. Cancer 85:1186–1196

    Article  CAS  Google Scholar 

  14. Wolfe F, Hawley DJ, Wilson K (1996) The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol 23:1407–1417

    CAS  PubMed  Google Scholar 

  15. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46:1121–1123

    Article  CAS  Google Scholar 

  16. Chandran V, Bhella S, Schentag C, Gladman DD (2007) Functional assessment of chronic illness therapy-fatigue scale is valid in patients with psoriatic arthritis. Ann Rheum Dis 66:936–939

    Article  Google Scholar 

  17. Mease PJ, Gladman DD, Ritchlin CT, Ruderman EM, Steinfeld SD, Choy EH, Sharp JT, Ory PA, Perdok RJ, Weinberg MA, Adalimumab Effectiveness in Psoriatic Arthritis Trial Study Group (2005) Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial. Arthritis Rheum 52:3279–3289

    Article  CAS  Google Scholar 

  18. Tyring S, Gottlieb A, Papp K, Gordon K, Leonardi C, Wang A, Lalla D, Woolley M, Jahreis A, Zitnik R, Cella D, Krishnan R (2006) Etanercept and clinical outcomes, fatigue, and depression in psoriasis: double-blind placebo-controlled randomised phase III trial. Lancet 367:29–35

    Article  CAS  Google Scholar 

  19. Dures EK, Hewlett SE, Cramp FA, Greenwood R, Nicklin JK, Urban M, Kirwan JR (2013) Reliability and sensitivity to change of the Bristol rheumatoid arthritis fatigue scales. Rheumatology (Oxford) 52:1832–1839

    Article  CAS  Google Scholar 

  20. Gladman DD, Shuckett R, Russell ML, Thorne JC, Schachter RK (1987) Psoriatic arthritis (PSA) — an analysis of 220 patients. Q J Med 62:127–141

    CAS  PubMed  Google Scholar 

  21. Gladman DD, Cook RJ, Schentag C, Feletar M, Inman RD, Hitchon C et al (2004) The clinical assessment of patients with psoriatic arthritis: results of a reliability study of the spondyloarthritis research consortium of Canada. J Rheumatol 31:1126–1131

    PubMed  Google Scholar 

  22. Coates LC, Fransen J, Helliwell PS (2010) Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 69(1):48–53

    Article  CAS  Google Scholar 

  23. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  Google Scholar 

  24. Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E (1997) Measuring fatigue and other anemia-related symptoms with the functional assessment of Cancer therapy (FACT) measurement system. J Pain Symptom Manag 13:63–74

    Article  CAS  Google Scholar 

  25. Husted JA, Tom BD, Schentag CT, Farewell VT, Gladman DD (2009) Occurrence and correlates of fatigue in psoriatic arthritis. Ann Rheum Dis 68:1553–1558

    Article  CAS  Google Scholar 

  26. Tobin AM, Sadlier M, Collins P, Rogers S, FitzGerald O, Kirby B (2017) Fatigue as a symptom in psoriasis and psoriatic arthritis: an observational study. Br J Dermatol 176:827–828

    Article  CAS  Google Scholar 

  27. Gudu T, Etcheto A, de Wit M, Heiberg T, Maccarone M, Balanescu A, Balint PV, Niedermayer DS, Cañete JD, Helliwell P, Kalyoncu U, Kiltz U, Otsa K, Veale DJ, de Vlam K, Scrivo R, Stamm T, Kvien TK, Gossec L (2016) Fatigue in psoriatic arthritis – a cross-sectional study of 246 patients from 13 countries. Joint Bone Spine 83:439–443

    Article  Google Scholar 

  28. Schentag C, Gladman DD (2002) Changes in fatigue in psoriatic arthritis: disease activity or fibromyalgia [abstract]. Arthritis Rheum 46(Suppl 9):S424

    Google Scholar 

  29. Skoie IM, Dalen I, Ternowitz T, Jonsson G, Kvivik I, Norheim K, Omdal R (2017) Fatigue in psoriasis – a controlled study. Br J Dermatol 177:505–512

    Article  CAS  Google Scholar 

  30. Eder L, Polachek A, Rosen CF, Chandran V, Cook R, Gladman DD (2017) The development of PsA in patients with psoriasis is preceded by a period of non-specific musculoskeletal symptoms: a prospective cohort study. Arthritis Rheum 69:622–629

    Article  Google Scholar 

  31. Husted JA, Tom BD, Farewell VT, Gladman DD (2010) Longitudinal analysis of fatigue in psoriatic arthritis. J Rheumatol 37:1878–1884

    Article  Google Scholar 

  32. McDonough E, Ayearst R, Eder L, Chandran V, Rosen CF, Thavaneswaran A, Gladman DD (2014) Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol 41:887–896

    Article  Google Scholar 

  33. Hewlett S, Chalder T, Choy E, Cramp F, Davis B, Dures E, Nicholls C, Kirwan J (2011) Fatigue in rheumatoid arthritis: time for a conceptual model. Rheumatology (Oxford) 50:1004–1006

    Article  Google Scholar 

  34. Guidance for Industry Patient-Reported Outcome Measures. (2009) Use in Medical Product Development to Support Labeling Claims. US Department of Health and Human Services Food and Drug Administration; Center for Drug Evaluation and Research (CDER); Center for Biologics Evaluation and Research (CBER); Center for Devices and Radiological Health (CDRH). www.fda.gov/downloads/Drugs/Guidance ComplianceRegulatoryInformation/Guidances/UCM193282.pdf. Accessed 1 Feb 2011

  35. Minnock P, Kirwan J, Bresnihan B (2009) Fatigue is a reliable, sensitive and unique outcome measure in rheumatoid arthritis. Rheumatology (Oxford) 48:1533–1536

    Article  Google Scholar 

  36. Finlayson M, Preissner K, Cho C (2013) Impact of comorbidity on fatigue management intervention outcomes among people with multiple sclerosis: an exploratory investigation. Int J MS Care 15:21–26

    Article  Google Scholar 

  37. Nicklin J, Cramp F, Kirwan J, Urban M, Hewlett S (2010) Collaboration with patients in the design of patient-reported outcome measures: capturing the experience of fatigue in rheumatoid arthritis. Arthritis Care Res 62:1552–1558

    Article  Google Scholar 

  38. Paiva CE, Barroso EM, Carneseca EC et al (2014) A critical analysis of test-retest reliability in instrument validation studies of cancer patients under palliative care: a systematic review. BMC Med Res Methodol 14:8

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, University Hospital Kerry, Tralee, Ireland

    Muhammad Haroon & Mohsin Ashraf

  2. Department of Rheumatology, Fatima Memorial Hospital & FMH College of Medicine and Dentistry, Lahore, Pakistan

    Muhammad Haroon

  3. Department of Rheumatology, St. Vincent’s University Hospital, Dublin, Ireland

    Agnes Szentpetery, Phil Gallagher & Oliver FitzGerald

Authors
  1. Muhammad Haroon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Agnes Szentpetery
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohsin Ashraf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Phil Gallagher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Oliver FitzGerald
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muhammad Haroon.

Ethics declarations

Conflict of interest

Muhammad Haroon received educational grants from AbbVie and Pfizer and has been a member of advisory boards for AbbVie and Celgene.

Agnes Szenpetery: None.

Mohsin Ashraf: None.

Phil Gallagher: None.

Oliver FitzGerald has received honoraria and grant support and has been a member of advisory boards for Pfizer, Abbvie, MSD, Roche, UCB, Janssen and Cellgene.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haroon, M., Szentpetery, A., Ashraf, M. et al. Bristol rheumatoid arthritis fatigue scale is valid in patients with psoriatic arthritis and is associated with overall severe disease and higher comorbidities. Clin Rheumatol 39, 1851–1858 (2020). https://doi.org/10.1007/s10067-020-04945-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-020-04945-4

Keywords

Search

Navigation