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Prevalence and variables associated with fatigue in psoriatic arthritis: a cross-sectional study

  • Observational Research
  • Published:
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Abstract

Objective

To describe the prevalence of and evaluate the factors associated with fatigue patients with psoriatic arthritis (PsA) in an Asian population.

Methods

We used baseline data from a registry of patients with PsA attending an outpatient clinic of a tertiary hospital in Singapore. Demographic data and disease characteristics were evaluated. Fatigue was assessed by question one of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI-F) and the vitality domain of the Medical Outcome Survey, Short-Form 36 (SF-36 VT). We evaluated clusters of variables, and individual variables in association with fatigue.

Results

We included 131 patients (50.4% men, 63.4% Chinese, median PsA duration 21.0 months) with completed data for fatigue. Forty-five patients (34%) experienced severe fatigue (defined by BASDAI-F > 5/10). We used principal component analysis and identified five clusters of variables that explained 62.9% of the variance of all factors. Of these, disease activity and impact, and disease chronicity were significantly associated with BASDAI-F and SF-36 VT. In multivariable analyses, back pain, peripheral joint pain and patient global assessment were associated with BASDAI-F, whereas peripheral joint pain and mental health were associated with SF-36 VT.

Conclusion

PsA-associated fatigue is prevalent in this Asian PsA cohort and is associated with disease activity, impact and chronicity.

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References

  1. Gossec L, de Wit M, Kiltz U, Braun J, Kalyoncu U, Scrivo R, Maccarone M, Carton L, Otsa K, Sooaar I, Heiberg T, Bertheussen H, Canete JD, Sanchez Lombarte A, Balanescu A, Dinte A, de Vlam K, Smolen JS, Stamm T, Niedermayer D, Bekes G, Veale D, Helliwell P, Parkinson A, Luger T, Kvien TK, Taskforce EP (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(6):1012–1019. https://doi.org/10.1136/annrheumdis-2014-205207

    Article  PubMed  Google Scholar 

  2. Tillett W, Dures E, Hewlett S, Helliwell PS, FitzGerald O, Brooke M, James J, Lord J, Bowen C, de Wit M, Orbai AM, McHugh N (2017) A multicenter nominal group study to rank outcomes important to patients, and their representation in existing composite outcome measures for psoriatic arthritis. J Rheumatol 44(10):1445–1452. https://doi.org/10.3899/jrheum.161459

    Article  PubMed  Google Scholar 

  3. Orbai AM, de Wit M, Mease P, Shea JA, Gossec L, Leung YY, Tillett W, Elmamoun M, Callis Duffin K, Campbell W, Christensen R, Coates L, Dures E, Eder L, FitzGerald O, Gladman D, Goel N, Grieb SD, Hewlett S, Hoejgaard P, Kalyoncu U, Lindsay C, McHugh N, Shea B, Steinkoenig I, Strand V, Ogdie A (2017) International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials. Ann Rheum Dis 76(4):673–680. https://doi.org/10.1136/annrheumdis-2016-210242

    Article  PubMed  Google Scholar 

  4. Betteridge N, Boehncke W-H, Bundy C, Gossec L, Gratacós J, Augustin M (2016) Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience. J Eur Acad Dermatol Venereol 30(4):576–585. https://doi.org/10.1111/jdv.13306

    Article  CAS  PubMed  Google Scholar 

  5. Merola JF, Shrom D, Eaton J, Dworkin C, Krebsbach C, Shah-Manek B, Birt J (2019) Patient perspective on the burden of skin and joint symptoms of psoriatic arthritis: results of a multi-national patient survey. Rheumatol Ther 6(1):33–45. https://doi.org/10.1007/s40744-018-0135-1

    Article  PubMed  PubMed Central  Google Scholar 

  6. Minnock P, Kirwan J, Veale D, Fitzgerald O, Bresnihan B (2010) Fatigue is an independent outcome measure and is sensitive to change in patients with psoriatic arthritis. Clin Exp Rheumatol 28(3):401–404

    PubMed  Google Scholar 

  7. Moverley AR, Vinall-Collier KA, Helliwell PS (2015) It’s not just the joints, it's the whole thing: qualitative analysis of patients' experience of flare in psoriatic arthritis. Rheumatology (Oxford) 54(8):1448–1453. https://doi.org/10.1093/rheumatology/kev009

    Article  Google Scholar 

  8. Wang CTM, Kwan YH, Fong W, Xiong SQ, Leung YY (2019) Factors associated with patient-physician discordance in a prospective cohort of patients with psoriatic arthritis: an Asian perspective. Int J Rheum Dis. https://doi.org/10.1111/1756-185x.13568

    Article  PubMed  PubMed Central  Google Scholar 

  9. Eder L, Thavaneswaran A, Chandran V, Cook R, Gladman DD (2015) Factors explaining the discrepancy between physician and patient global assessment of joint and skin disease activity in psoriatic arthritis patients. Arthritis Care Res (Hoboken) 67(2):264–272. https://doi.org/10.1002/acr.22401

    Article  Google Scholar 

  10. Rosen J, Landriscina A, Friedman AJ (2016) Psoriasis-associated fatigue: pathogenesis, metrics, and treatment. Cutis 97(2):125–132

    PubMed  Google Scholar 

  11. Carneiro C, Chaves M, Verardino G, Drummond A, Ramos-e-Silva M, Carneiro S (2011) Fatigue in psoriasis with arthritis. Skinmed 9(1):34–37

    PubMed  Google Scholar 

  12. Gudu T, Etcheto A, de Wit M, Heiberg T, Maccarone M, Balanescu A, Balint PV, Niedermayer DS, Canete 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(4):439–443. https://doi.org/10.1016/j.jbspin.2015.07.017

    Article  PubMed  Google Scholar 

  13. Mease PJ, Karki C, Palmer JB, Etzel CJ, Kavanaugh A, Ritchlin CT, Malley W, Herrera V, Tran M, Greenberg JD (2017) Clinical and patient-reported outcomes in patients with psoriatic arthritis (PsA) by body surface area affected by psoriasis: results from the Corrona PsA/spondyloarthritis registry. J Rheumatol 44(8):1151–1158. https://doi.org/10.3899/jrheum.160963

    Article  PubMed  Google Scholar 

  14. Leung YY, Fong W, Lui NL, Thumboo J (2017) Effect of ethnicity on disease activity and physical function in psoriatic arthritis in a multiethnic Asian population. Clin Rheumatol 36(1):125–131. https://doi.org/10.1007/s10067-016-3460-1

    Article  PubMed  Google Scholar 

  15. Roussou E, Chopra S, Ngandu DL (2013) Phenotypic and clinical differences between Caucasian and South Asian patients with psoriatic arthritis living in North East London. Clin Rheumatol 32(5):591–599. https://doi.org/10.1007/s10067-012-2139-5

    Article  PubMed  Google Scholar 

  16. Hifinger M, Putrik P, Ramiro S, Keszei AP, Hmamouchi I, Dougados M, Gossec L, Boonen A (2015) In rheumatoid arthritis, country of residence has an important influence on fatigue: results from the multinational COMORA study. Rheumatology 55(4):735–744. https://doi.org/10.1093/rheumatology/kev395

    Article  PubMed  Google Scholar 

  17. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54(8):2665–2673. https://doi.org/10.1002/art.21972

    Article  Google Scholar 

  18. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing spondylitis disease activity index. J Rheumatol 21(12):2286–2291

    CAS  Google Scholar 

  19. Coates LC, Fransen J, Helliwell PS (2010) Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 69(01):48–53. https://doi.org/10.1136/ard.2008.102053

    Article  CAS  PubMed  Google Scholar 

  20. Walsh JA, McFadden ML, Morgan MD, Sawitzke AD, Duffin KC, Krueger GG, Clegg DO (2014) Work productivity loss and fatigue in psoriatic arthritis. J Rheumatol 41(8):1670–1674. https://doi.org/10.3899/jrheum.140259

    Article  PubMed  Google Scholar 

  21. Nas K, Capkin E, Dagli AZ, Cevik R, Kilic E, Kilic G, Karkucak M, Durmus B, Ozgocmen S (2017) Gender specific differences in patients with psoriatic arthritis. Mod Rheumatol 27(2):345–349. https://doi.org/10.1080/14397595.2016.1193105

    Article  PubMed  Google Scholar 

  22. Kalyoncu U, Bayindir O, Ferhat Oksuz M, Dogru A, Kimyon G, Tarhan EF, Erden A, Yavuz S, Can M, Cetin GY, Kilic L, Kucuksahin O, Omma A, Ozisler C, Solmaz D, Bozkirli ED, Akyol L, Pehlevan SM, Gunal EK, Arslan F, Yilmazer B, Atakan N, Aydin SZ (2017) The Psoriatic Arthritis Registry of Turkey: results of a multicentre registry on 1081 patients. Rheumatology (Oxford) 56(2):279–286. https://doi.org/10.1093/rheumatology/kew375

    Article  Google Scholar 

  23. 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(3):827–828. https://doi.org/10.1111/bjd.15258

    Article  CAS  PubMed  Google Scholar 

  24. Husted JA, Tom BD, Schentag CT, Farewell VT, Gladman DD (2009) Occurrence and correlates of fatigue in psoriatic arthritis. Ann Rheum Dis 68(10):1553–1558. https://doi.org/10.1136/ard.2008.098202

    Article  CAS  PubMed  Google Scholar 

  25. Klingberg E, Bilberg A, Bjorkman S, Hedberg M, Jacobsson L, Forsblad-d'Elia H, Carlsten H, Eliasson B, Larsson I (2019) Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Res Ther 21(1):17. https://doi.org/10.1186/s13075-019-1810-5

    Article  PubMed  PubMed Central  Google Scholar 

  26. Skougaard M, Jorgensen TS, Rifbjerg-Madsen S, Coates LC, Egeberg A, Amris K, Dreyer L, Hojgaard P, Guldberg-Moller J, Merola JF, Frederiksen P, Gudbergsen H, Kristensen LE (2019) In psoriatic arthritis fatigue is driven by inflammation, disease duration, and chronic pain: An observational DANBIO registry study. J Rheumatol. https://doi.org/10.3899/jrheum.181412

    Article  PubMed  Google Scholar 

  27. Mease PJ, Karki C, Palmer JB, Etzel CJ, Kavanaugh A, Ritchlin CT, Malley W, Herrera V, Tran M, Greenberg JD (2017) Clinical characteristics, disease activity, and patient-reported outcomes in psoriatic arthritis patients with dactylitis or enthesitis: results from the Corrona psoriatic arthritis/spondyloarthritis registry. Arthritis Care Res (Hoboken) 69(11):1692–1699. https://doi.org/10.1002/acr.23249

    Article  CAS  Google Scholar 

  28. Mease PJ, Palmer JB, Liu M, Kavanaugh A, Pandurengan R, Ritchlin CT, Karki C, Greenberg JD (2018) Influence of axial involvement on clinical characteristics of psoriatic arthritis: analysis from the corrona psoriatic arthritis/spondyloarthritis registry. J Rheumatol 45(10):1389–1396. https://doi.org/10.3899/jrheum.171094

    Article  PubMed  Google Scholar 

  29. 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(5):887–896. https://doi.org/10.3899/jrheum.130797

    Article  PubMed  Google Scholar 

  30. Pilgaard T, Hagelund L, Stallknecht SE, Jensen HH, Esbensen BA (2019) Severity of fatigue in people with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis - results of a cross-sectional study. PLoS ONE 14(6):e0218831. https://doi.org/10.1371/journal.pone.0218831

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Hensor EMA, McKeigue P, Ling SF, Colombo M, Barrett JH, Nam JL, Freeston J, Buch MH, Spiliopoulou A, Agakov F, Kelly S, Lewis MJ, Verstappen SMM, MacGregor AJ, Viatte S, Barton A, Pitzalis C, Emery P, Conaghan PG, Morgan AW (2019) Validity of a two-component imaging-derived disease activity score for improved assessment of synovitis in early rheumatoid arthritis. Rheumatology 58(8):1400–1409. https://doi.org/10.1093/rheumatology/kez049

    Article  Google Scholar 

  32. Carneiro C, Chaves M, Verardino G, Frade AP, Coscarelli PG, Bianchi WA, Ramos ESM, Carneiro S (2017) Evaluation of fatigue and its correlation with quality of life index, anxiety symptoms, depression and activity of disease in patients with psoriatic arthritis. Clin Cosmet Investig Dermatol 10:155–163. https://doi.org/10.2147/ccid.S124886

    Article  PubMed  PubMed Central  Google Scholar 

  33. Husted JA, Tom BD, Farewell VT, Gladman DD (2010) Longitudinal analysis of fatigue in psoriatic arthritis. J Rheumatol 37(9):1878–1884. https://doi.org/10.3899/jrheum.100179

    Article  PubMed  Google Scholar 

  34. Hinkle DE, Wiersma W, Jurs SG (2003) Applied statistics for the behavioral sciences. Houghton Mifflin College Division, Boston

    Google Scholar 

  35. Overman CL, Kool MB, Da Silva JA, Geenen R (2016) The prevalence of severe fatigue in rheumatic diseases: an international study. Clin Rheumatol 35(2):409–415. https://doi.org/10.1007/s10067-015-3035-6

    Article  PubMed  Google Scholar 

  36. 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(7):936–939. https://doi.org/10.1136/ard.2006.065763

    Article  PubMed  PubMed Central  Google Scholar 

  37. Reygaerts T, Mitrovic S, Fautrel B, Gossec L (2018) Effect of biologics on fatigue in psoriatic arthritis: a systematic literature review with meta-analysis. Joint Bone Spine 85(4):405–410. https://doi.org/10.1016/j.jbspin.2018.01.011

    Article  PubMed  Google Scholar 

  38. Krajewska-Wlodarczyk M, Owczarczyk-Saczonek A, Placek W (2017) Fatigue - an underestimated symptom in psoriatic arthritis. Reumatologia 55(3):125–130. https://doi.org/10.5114/reum.2017.68911

    Article  PubMed  PubMed Central  Google Scholar 

  39. Carmichael MD, Davis JM, Murphy EA, Brown AS, Carson JA, Mayer EP, Ghaffar A (2006) Role of brain IL-1β on fatigue after exercise-induced muscle damage. Am J Physiol Regul Int Compa Physiol 291(5):R1344–R1348. https://doi.org/10.1152/ajpregu.00141.2006

    Article  CAS  Google Scholar 

  40. Norden DM, Bicer S, Clark Y, Jing R, Henry CJ, Wold LE, Reiser PJ, Godbout JP, McCarthy DO (2015) Tumor growth increases neuroinflammation, fatigue and depressive-like behavior prior to alterations in muscle function. Brain Behav Immun 43:76–85. https://doi.org/10.1016/j.bbi.2014.07.013

    Article  CAS  PubMed  Google Scholar 

  41. Thumboo J, Fong KY, Machin D, Chan SP, Leong KH, Feng PH, Thio ST, Boey ML (2001) A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore. Qual Life Res 10(2):175–188. https://doi.org/10.1023/A:1016701514299

    Article  CAS  PubMed  Google Scholar 

  42. Chang DF, Chun C-A, Takeuchi DT, Shen H (2000) SF-36 Health survey: tests of data quality, scaling assumptions, and reliability in a community sample of Chinese Americans. Med Care 38(5):542–548

    Article  CAS  Google Scholar 

  43. Haroon M, Szentpetery A, Ashraf M, Gallagher P, FitzGerald O (2020) Bristol rheumatoid arthritis fatigue scale is valid in patients with psoriatic arthritis and is associated with overall severe disease and higher comorbidities. Clin Rheumatol. https://doi.org/10.1007/s10067-020-04945-4

    Article  PubMed  Google Scholar 

  44. Krajewska-Wlodarczyk M, Owczarczyk-Saczonek A, Placek W (2018) Sleep disorders in patients with psoriatic arthritis and psoriasis. Reumatologia 56(5):301–306. https://doi.org/10.5114/reum.2018.79501

    Article  PubMed  PubMed Central  Google Scholar 

  45. Wong ITY, Chandran V, Li S, Gladman DD (2017) Sleep disturbance in psoriatic disease: prevalence and associated factors. J Rheumatol 44(9):1369–1374. https://doi.org/10.3899/jrheum.161330

    Article  PubMed  Google Scholar 

  46. Sandikci SC, Colak S, Aydogan Baykara R, Oktem A, Cure E, Omma A, Kucuk A (2018) Evaluation of restless legs syndrome and sleep disorders in patients with psoriatic arthritis. Z Rheumatol. https://doi.org/10.1007/s00393-018-0562-y

    Article  Google Scholar 

  47. Mease PJ (2017) Fibromyalgia, a missed comorbidity in spondyloarthritis: prevalence and impact on assessment and treatment. Curr Opin Rheumatol 29(4):304–310. https://doi.org/10.1097/bor.0000000000000388

    Article  PubMed  Google Scholar 

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Acknowledgements

No external editing agencies were employed in writing or submitting the manuscript.

Funding

YYL was supported by the National Medical Research Council, Singapore (NMRC/CSA-INV/0022/2017). The funding sources had no role in the study design, data collection, analysis, interpretation of data, manuscript writing, or decision to submit.

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Authors and Affiliations

  1. Department of Rheumatology and Immunology, Singapore General Hospital, The Academia, Level 4, 20 College Road, Singapore, 169856, Singapore

    Joel Shi Quan Tan, Warren Fong & Ying Ying Leung

  2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Joel Shi Quan Tan, Warren Fong & Ying Ying Leung

  3. Duke-NUS Medical School, Singapore, Singapore

    Warren Fong, Yu Heng Kwan & Ying Ying Leung

Authors
  1. Joel Shi Quan Tan
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  2. Warren Fong
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  4. Ying Ying Leung
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Contributions

YYL and WF conceptualized the study design. YYL acquired the data. JSQT and YYL performed the data analysis. All authors performed the data interpretation. JSQT and YYL wrote the first draft of the manuscript and all authors revised it critically for important intellectual content. All authors approved the final version of the manuscript to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Ying Ying Leung.

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Conflicts of interest

YYL has received speaking fee from Novartis, Janssen, Eli Lilly and AbbVie (all under US$10,000).

Ethics approval

The SingHealth Centralized Institutional Review Board approved the study protocol (CIRB Ref: 2012/498/E).

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Informed consent was obtained from all individual participants included in the study.

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This work has previously been submitted for the eular congress 2020 with the following abstract publication (doi: 10.1136/annrheumdis-2020-eular.2068): Tan Jsq, Fong W, Kwan Yh, Leung Yy (2020) ab0836 prevalence and determinants of fatigue in psoriatic arthritis in an asian population. Annals of the Rheumatic Diseases 79 (suppl 1):1723

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Tan, J.S.Q., Fong, W., Kwan, Y.H. et al. Prevalence and variables associated with fatigue in psoriatic arthritis: a cross-sectional study. Rheumatol Int 40, 1825–1834 (2020). https://doi.org/10.1007/s00296-020-04678-2

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