Skip to main content

Advertisement

SpringerLink
Log in

Fatigue in Rheumatoid Arthritis

  • Rheumatoid Arthritis (L Moreland, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this study was to review the current information on fatigue in rheumatoid arthritis (RA).

Recent Findings

Severe fatigue is common among individuals with RA and has a significant impact on quality of life (QOL). RA-related factors (e.g., inflammation, pain) are associated with greater fatigue, but other factors, such as obesity, physical inactivity, sleep disturbance, and depression, explain the majority of variation in fatigue. Medications targeting RA have little effect on fatigue. Instead, the most effective interventions seem to address non-RA-specific factors such as physical inactivity or use cognitive behavioral approaches. No recommendations have been made for tools to measure fatigue in RA, leading to potential difficulty comparing studies.

Summary

Although fatigue has great impact on patients’ QOL, effective interventions that are feasible for broad dissemination remain elusive. Additional multi-faceted research is needed to identify modifiable sources of fatigue. Such research would be enhanced by harmonization of fatigue measurement across studies.

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

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Carr A, Hewlett S, Hughes R, Mitchell H, Ryan S, Carr M, et al. Rheumatology outcomes: the patient’s perspective. J Rheumatol. 2003;30:880–3.

    PubMed  Google Scholar 

  2. Kirwan J, Heiberg T, Hewlett S, Hughes R, Kvien T, Ahlmen M, et al. Outcomes from the patient perspective workship at OMERACT 8. J Rheumatol. 2003;30:868–72.

    PubMed  Google Scholar 

  3. Kirwan JR, Minnock P, Adebajo A, Bresnihan B, Choy E, de Wit M, et al. Patient perspective: fatigue as a recommended patient centered outcome measure in rheumatoid arthritis. J Rheumatol. 2007;34(5):1174–7.

    PubMed  Google Scholar 

  4. Hewlett S, Chalder T, Choy E, Cramp F, Davis B, Dures E, et al. Fatigue in rheumatoid arthritis: time for a conceptual model. Rheumatology. 2011;50:1004–6.

    Article  PubMed  Google Scholar 

  5. Overman C, Kool M, Da Silva J, Geenen R. The prevalence of severe fatigue in rheumatic disease: an international study. Clin Rheumatol. 2016;35:409–15.

    Article  PubMed  Google Scholar 

  6. •• Nikolaus S, Bode C, Taal E, van de Laar M. Fatigue and factors related to fatigue in rheumatoid arthritis: a systematic review. Arthritis Care Res. 2013;65:1128–46. Systematic review of factors related to RA fatigue.

    Article  Google Scholar 

  7. Belza B, Dewing K. Fatigue. In: Bartlett S, editor. Clinical care in the rheumatic diseases. 3rd ed. Atlanta: Association of Rheumatology Health Professions; 2006. p. 285–8.

    Google Scholar 

  8. • Minnock P, Ringnér A, Bresnihan B, Veale D, FitzGerald O, McKee G. Perceptions of the cause, impact, and management of presistent fatigue in patients with rheumatoid arthritis following tumour necrosing actor inhibition therapy. Musculoskeletal Care. 2016 [epub ahead of print]. Provides a good overview of the patient’s perspective on fatigue.

  9. • van Tuyl L, Sadlonova M, Hewlett S, Davis B, Flurey C, Goel N, et al. The patient perspective on absence of disease activity in rheumatoid arthritis: a survey to identify key domains of patient-peceived remission. Ann Rheum Dis. 2016 [epub ahead of print 2016 Nov 30]. Multi-country data on patient perspectives on RA remission, including the role of fatigue.

  10. Felson D, Smolen J, Wells G, Zhang B, van Tuyl L, Funovits J, et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthrits Rheum. 2011;63:573–86.

    Article  Google Scholar 

  11. Strand V, Wright G, Bergman M, Tambiah J, Taylor P. Patient expectations and perceptions of goal-setting strategies for disease management in rheumatoid arthritis. J Rheumatol. 2015;42:2046–54.

    Article  CAS  PubMed  Google Scholar 

  12. •• Ward M, Guthrie L, Dasgupta A. Direct and indirect determinants of the patient global assessment in rheumatoid arthritis: differences by level of disease activity. Arthritis Care Res. 2016 [epub ahead of print 2016 Jun 6]. Important information on the determinants of patient global assessments, which are used to determine treatment response.

  13. Aletaha D, Landewe R, Karonitsch T, Bathon J, Boers M, Bombardier C, et al. Reporting disease activity in clinical trials of patients with rheumatoid arthritis: EULAR/ACR collaborative recommendations. Arthritis Rheum. 2008;59(10):1371–7.

    Article  CAS  PubMed  Google Scholar 

  14. Hewlett S, Hehir M, Kirwan JR. Measuring fatigue in rheumatoid arthritis: a systematic review of scales in use. Arthritis Rheum. 2007;57(3):429–39.

    Article  CAS  PubMed  Google Scholar 

  15. Hewlett S, Dures E, Almeida C. Measures of fatigue. Arthritis Care Res. 2011;63(11 Suppl):S263–S86.

    Article  Google Scholar 

  16. PROMIS Measure development and research [Available from: http://www.healthmeasures.net/explore-measurement-systems/promis/measure-development-research.

  17. Bartlett S, Orbai A, Duncan T, DeLeon E, Ruffing V, Clegg-Smith K, et al. Reliability and validity of selected PROMIS measures in people with rheumatoid arthritis. PLoS One. 2015;10:e0138543.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Katz P, Pedro S, Michaud K. Performance of the PROMIS 29-item profile in rheumatoid arthritis, osteoarthritis, fibromyalgia, and systemic lupus erythematosus. Arthritis Care Res. epub ahead of print, 2016.

  19. Hegarty R, Conner T, Stebbings S, Treharne G. Feel the fatigue and be active anyway: physical activity on high-fatigue days protects adults with arthritis from decrements in same-day positive mood. Arthritis Care Res. 2015;67:1230–6.

    Article  Google Scholar 

  20. Surowiec I, Gjesdal C, Jonsson G, Norheim K, Lundstedt T, Trygg J, et al. Metabolomics study of fatigue in patients with rheumatoid arthritis naïve to biological treatment. Rheumatol Int. 2016;36:703–11.

    Article  CAS  PubMed  Google Scholar 

  21. • van Steenbergen H, Tsonaka R, Huizinga T, Boonen A, van der Helm-van Mil A. Fatigue in rheumatoid arthritis; a persistent problem: a large longitudinal study. RMD Open. 2015;4:e000041. Longitudinal study of RA fatigue over 8 years of follow-up.

    Article  Google Scholar 

  22. Castrejon I, Nikiphorou E, Jain R, Huang A, Block J, Pincus T. Assessment of fatigue in routine care on a Multidimensional Health Assessment Questionnaire [MDHAQ]: a cross-sectional study of associations with RAPID3 and other variables in different rheumatic diseases. Clin Exp Rheumatol. 2016;34:901–9.

    PubMed  Google Scholar 

  23. Lee Y, Frits M, Iannaccone C, Weinblatt M, Shadick N, Williams D, et al. Subgrouping of patients with rheumatoid arthritis based on pain, fatigue, inflammation, and psychosocial factors. Arthritis Rheum. 2014;66:2006–14.

  24. • Olsen C, Lie E, Kvien T, Zangi H. Predictors of fatigue in rheumatoid arthritis patients in remission or in low disease activity state. Arthritis Care Res. 2016;68:1043–8. Longitudinal study of fatigue after reaching low disease activity or remission.

    Article  CAS  Google Scholar 

  25. Camacho E, Verstappen S, Chipping J, Symmons D. Learned helplessness predicts functional disability, pain, and fatigue in patients with recent-onset inflammatory polyarthritis. Rheumatology. 2013;52:1233–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Druce K, Jones G, Macfarlane G, Verstappen S, Basu N. The longitudinal course of fatigue in rheumatoid arthritis: results from the Norfolk Arthritis Register. J Rheumatol. 2015;42:2059–65.

    Article  CAS  PubMed  Google Scholar 

  27. Putrik P, Ramiro S, Hifinger M, Keszei A, Hmamouchi I, Dougados M, et al. In wealthier countries, patients perceive worse impact of the disease, although they have lower objectively assessed disease activity: results from the cross-sectional COMORA study. Ann Rheum Dis. 2016;75:715–20.

    Article  CAS  PubMed  Google Scholar 

  28. Nicklin J, Cramp F, Kirwan J, Greenwood R, Urban M, Hewlett S. Measuring fatigue in RA: a cross-sectional study to evaluate the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire, Visual Analog Scales, and Numerical Rating Scales. Arthritis Care & Research. 2010;62:1559–68.

    Article  Google Scholar 

  29. Feldthusen C, Grimby-Ekman A, Florsblad-d’Ella H, Jacobsson L, Mannerkorpi K. Explanatory factors and predictors of fatigue in persons with rheumatoid arthritis: a longitudinal study. J Rehabil Med. 2016;48:469–76.

    Article  PubMed  Google Scholar 

  30. Feldthusen C, Dean E, Forsblad-d’Elia H, Mannerkorpi K. Effects of person-centered physical therapy on fatigue-related variables in persons with rheumatoid arthritis: a randomized controlled trial. Arch Phys Med Rehabil. 2016;97:26–36.

    Article  PubMed  Google Scholar 

  31. Van Hoogmoed D, Fransen J, Bleijenberg G, van Piel P. How to assess fatigue in rheumatoid arthritis: validity and reliability of the Checklist Individual Strength. Arthritis Rheum. 2008;58(Suppl):S868.

    Google Scholar 

  32. Vercoulen J, Swanink C, Fennis J, Galama J, van der Meer J, Bleijenberg G. Dimensional assessment of chronic fatigue syndrome. J Psychosom Res. 1994;38:383–92.

    Article  CAS  PubMed  Google Scholar 

  33. • van Dartel S, Repping-Wuts J, van Hoogmoed D, Bleijenberg G, van Riel P, Fransen J. Association between fatigue and pain in rheumatoid arthritis: does pain precede fatigue or does fatigue precede pain? Arthritis Care Res. 2013;65:862–9. Longitudinal study examining the time-ordering of pain and fatigue.

    Article  Google Scholar 

  34. Rongen-van Dartel S, Repping-Wuts J, van Hoogmoed D, Knoop H, Bleijenberg G, van Riel P, et al. Relationship between objectively assessed physical activity and fatigue in patients with rheumatoid arthritis: inverse correlation of activity and fatigue. Arthritis Care Res. 2014;66:852–60.

    Article  CAS  Google Scholar 

  35. Rongen-van Dartel S, Repping-Wuts H, Donders R, van Hoogmoed D, Knoop H, Bleijenberg G, et al. A multidimensional “path analysis” model of factors explaining fatigue in rheumatoid arthritis. Clin Exp Rheumatol. 2016;34:200–6.

    PubMed  Google Scholar 

  36. Hann DM, Denniston MM, Baker F. Measurement of fatigue in cancer patients: further validation of the Fatigue Symptom Inventory. Qual Life Res. 2000;9(7):847–54.

    Article  CAS  PubMed  Google Scholar 

  37. •• Katz P, Margaretten M, Trupin L, Schmajuk G, Yazdany J, Yelin E. Role of sleep disturbance, depression, obesity, and physical inactivity in fatigue in rheumatoid arthritis. Arthritis Care & Research. 2016;68:81–90. Included the broadest range of potential predictors of RA fatigue of any study to date.

    Article  Google Scholar 

  38. Krupp L, LaRocca N, Muir-Nash J, Steinberg A. The Fatigue Severity Scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46:1121–3.

    Article  CAS  PubMed  Google Scholar 

  39. Durcan L, Wilson F, Cunnane G. The effect of exercise on sleep and fatigue in rheumatoid arthritis: a randomized controlled study. J Rheumatol. 2014;41:1966–73.

    Article  PubMed  Google Scholar 

  40. Cella D, Yount S, Sorensen M, Chartash E, Sengupta N, Grober J. Validation of the Functional Assessment of Chronic Illness therapy Fatigue Scale relative to other instrumentation in patients with rheumatoid arthritis. J Rheumatol. 2005;32:811–9.

    PubMed  Google Scholar 

  41. Singh H, Arya S, Talapatra P, Lather K, Mathur R, Singhania A, et al. Assessment of fatigue in rheumatoid arthritis [by Functional Assessment of Chronic Illness Therapy-Fatigue score] and its relation to disease activity and anemia. J Clin Rheumatol. 2014;20:87–90.

    Article  PubMed  Google Scholar 

  42. Smolen J, Kremer J, Gaich C, DeLozier A, Schlichting D, Xie L, et al. Patient-reported outcomes from a randomised phae III study of baricitinib in patients with rheumatoid arthritis and an inadequate response to biological agents [RA-BEACON]. Ann Rheum Dis. 2016 [epub ahead of print].

  43. Belza BL. Comparison of self-reported fatigue in rheumatoid arthritis and controls. J Rheumatol. 1995;22(4):639–43.

    CAS  PubMed  Google Scholar 

  44. Nicassio P, Ormseth S, Custodio M, Irwin M, Olmstead R, Weisman M. A multidimensional model of fatigue in patients with rheumatoid arthritis. J Rheumatol. 2012;39:1807–13.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Inanc N, Yilmaz-Oner S, Can M, Sokka T, Direskeneli H. The role of depression, anxiety, fatigue, and fibromyalgia in the evaluation of remission status in patients with rheumatoid arthritis. J Rheumatol. 2014;41:1755–60.

    Article  PubMed  Google Scholar 

  46. Smets E, Garssen B, Cull A, De Haes J. The Multidimensional Fatigue Inventory [MFI]: psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39:315–25.

    Article  CAS  PubMed  Google Scholar 

  47. Løppenthin K, Esbensen B, Østergaard M, Jennum P, Tolver A, Aadahl M, et al. Physical activity and the association with fatigue and sleep in Danish patients with rheumatoid arthritis. Rheumatol Int. 2015;35:1655–64.

    Article  PubMed  Google Scholar 

  48. McNair D, Lorr M, Droppleman L. Profile of mood states manual. New York: Multi-health Systems, Inc; 1992.

    Google Scholar 

  49. Minnock P, Veale D, Bresnihan B, FitzGerald O, McKee G. Factors that influence fatigue status in patients with severe rheumatoid arthritis [RA] and good disease outcome following 6 months of TNF inhibitor therapy: a comparative analysis. Clin Rheumatol. 2015;34:1857–65.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Ware J, Kosinski M, Dewey J. How to score version 2 of the SF-36 ® Health Survey. QualityMetric Incorporated: Lincoln; 2002.

    Google Scholar 

  51. •• Druce K, Jones G, Macfarlane G, Basu N. Determining pathways to improvements in fatigue in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Arthritis Rheum. 2015;67:2303–10. Empirical model of changes in RA fatigue, including both disease- and non-disease-specific factors.

    Article  CAS  Google Scholar 

  52. • Druce K, Bhattacharya Y, Jones G, Macfarlane G, Basu N. Most patients who reach disease remission following anti-TNF therapy continue to report fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Rheumatology. 2016;55:1786–90. Longitudinal study of RA fatigue following anti-TNF therapy.

    Article  PubMed  Google Scholar 

  53. Druce K, Jones G, Macfarlane G, Basu N. Examining changes in central and peripheral pain as mediates of fatigue improvements: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Arthritis Care Res. 2016;68:922–6.

    Article  CAS  Google Scholar 

  54. PROMIS Assessment Center [Available from: https://www.assessmentcenter.net/.

  55. Christodoulou C, Junghaenel D, DeWalt D, Rothrock N, Stone A. Cognitive interviewing in the evaluation of fatigue items: results from the patient-reported outcomes measurement information system [PROMIS]. Qual LifeRes. 2008;17:1239–46.

    Article  Google Scholar 

  56. Cella D, Lai J, Stone A. Self-reported fatigue: one dimension or more? Lessons from the Functional Assessment of Chronic Illness Therapy—Fatigue [FACIT-F] questionnaire. Support Care Cancer. 2011;19:1441–50.

    Article  PubMed  Google Scholar 

  57. Lai J, Cook K, Stone A, Beaumont J, Cella D. Classical test theory and item response theory/Rasch model to assess differences between patient-reported fatigue using 7-day and 4-week recall periods. J Clin Epidemiol. 2009;62:991–7.

    Article  PubMed  PubMed Central  Google Scholar 

  58. •• Louati K, Berenbaum F. Fatigue in chronic inflammation—a link to pain pathways. Arthritis Res Ther. 2015;17:254. Review of potential pathways that may lead to fatigue in rheumatic diseases. Strong focus on biological factors.

    Article  PubMed  PubMed Central  Google Scholar 

  59. • Matcham F, Ali S, Hotopf M, Chalder T. Psychological correlates of fatigue in rheumatoid arthritis: a systematic review. Clin Psychol Rev. 2015;39:16–29. Systematic review of psychological and cognitive factors associated with fatigue in RA.

    Article  CAS  PubMed  Google Scholar 

  60. •• Karshidoff B, Sundelin T, Lasselin J. Role of inflammation in human fatigue: relevance of multidimensional assessments and potential neuronal mechanisms. Front Immunol. 2017:8–21. Describes multiple factors that may affect fatigue in inflammatory conditions, including systemic inflammation and specific neuronal processes.

  61. Madsen S, Danneskiold-Samsøe B, Stockmarr A, Bartels E. Correlations between fatigue and disease duration, disease activity, and pain in patients with rheumatoid arthritis: a systemaic review. Scand J Rheumatol. 2016;45:255–61.

    Article  PubMed  Google Scholar 

  62. Evers A, Verhoeven E, van Middendorp H, Sweep F, Kraaimaat F, Donders A, et al. Does stress affect the joints? Daily stressors, stress vulnerability, immune and HPA axis activity, and short-term disease and symptom fluctuations in rheumatoid arthritis. Ann Rheum Dis. 2014;73:1683–8.

    Article  CAS  PubMed  Google Scholar 

  63. Irwin M, Olmstead R, Carroll J. Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol Psychiatry. 2016;80:40–52.

    Article  PubMed  Google Scholar 

  64. Chauffier K, Salliot C, Berenbaum F. J S. Effect of biotherapies on fatigue in rheumatoid arthritis: a systematic review of the literature and meta-analysis. Rheumatology. 2012;51:60–8.

    Article  CAS  PubMed  Google Scholar 

  65. Walsh D, McWilliams D. Mechanisms, impact and management of pain in rheumatoid arthritis. Nature Rev Rheumatol. 2014;10:581–92.

    Article  CAS  Google Scholar 

  66. Grøn K, Ornbjerg L, Heftland M, Aslam F, Khan N, Jacobs J, et al. The association fo fatigue, comorbidity burden, disease activity, disability and gross domestic product in patients with rheumatoid arthritis. Results from 34 countries participating in the Quest-RA program. Clin Exp Rheumatol. 2014;32:869–77.

    PubMed  Google Scholar 

  67. Hewlett S, Cockshott Z, Byron M, Kitchen K, Tipler S, Pope D, et al. Patients’ perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Arthritis Rheum. 2005;53(5):697–702.

    Article  PubMed  Google Scholar 

  68. Sturgeon J, Finan P, Zautra A. Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways. Nature Rev Rheumatol. 2016;12:532–42.

    Article  Google Scholar 

  69. Haapakoski R, Mathieu J, Ebmeier K, Alenius H, Kivimäki M. Cumulative meta-analysis of interleukines 6 and 1b, tumor crosis factor a and C-reactive protein in patients with major depressive disorder. Brain Behav Immun. 2015;49:206–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Miller A, Raison C. The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol. 2016;16:22–34.

    Article  CAS  PubMed  Google Scholar 

  71. Capuron L, Lasselin J, Castanon N. Role of adiposity-driven inflammation in depressive morbidity. Neuropsychophamacol Rev. 2017;42:115–28.

    Article  CAS  Google Scholar 

  72. Abad VC, Sarinas PS, Guilleminault C. Sleep and rheumatologic disorders. Sleep Med Rev. 2008;12(3):211–28.

    Article  PubMed  Google Scholar 

  73. Bjurström M, Olmstead R, Irwin M. Reciprocal relationship between sleep macrostructure and evening and morning cellular inflammation in rheumatoid arthritis. Psychosom Med. 2017;79:24–33.

    Article  PubMed  Google Scholar 

  74. Irwin M, Olmstead R, Carrillo C, Sadeghi N, Fitzgerald J, Ranganath V, et al. Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. Sleep. 2012;35:537–43.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Westhovens R, Van der Elst K, Matthys A, Tran M, Gilloteau I. Sleep problems in patients with rheumatoid arthritis. J Rheumatol. 2014;40:31–40.

    Article  Google Scholar 

  76. Løppenthin K, Esbensen B, Jennum P, Østergaard M, Tolver A, Thomsen T, et al. Sleep quality and correlates of poor sleep in patients with rheumatoid arthritis. Clin Rheumatol. 2015;2029–39.

  77. Lee Y, Lu B, Edwards R, Wasan A, Nassikas N, Clauw D, et al. The role of sleep problems in central pain processing in rheumatoid arthritis. Arthritis Rheum. 2013;65:59–68.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Katz P, Yazdany J, Trupin L, Schmajuk G, Margaretten M, Criswell L, et al. Sex differences in assessment of obesity in rheumatoid arthritis. Arthritis Care & Research. 2013;65:62–70.

    Article  Google Scholar 

  79. Mancuso P. The role of adipokines in chronic inflammation. Immunotargets Ther. 2016;5:47–56.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Mancuso C, Rincon M, Sayles W, Paget S. Comparison of energy expenditure from lifestyle physical activities between patients with rheumatoid arthritis and healthy controls. Arthritis Rheum (Arthritis Care Res). 2007;57:672–8.

    Article  Google Scholar 

  81. Metsios G, Koutedakis Y, Veldhjuijzen van Zanten J, Stavropoulos-Kalinoglou A, Vitalis P, Duda J, et al. Cardiorespiratory fitness levels and their association with cardiovascular profile in patients with rheumatoid arthritis: a cross-sectional study. Rheumatology. 2015;54:2215–25.

    PubMed  Google Scholar 

  82. Hood V, Granat M, Maxwell D, Hasler J. A new method of using heart rate to represent energy expenditure: the total heart beat index. Arch Phys Med Rehabil. 2002;83:1266–73.

    Article  PubMed  Google Scholar 

  83. Brondel L, Mourey F, Mischis-Troussard C, d’Athis P, Pfitzenmeyer P. Energy cost and cardiorespiratory adaptation in the “get-up-and-go” test in frail elderly women with postural abnormalities and in controls. J Gerontol A Biol Sci Med Sci. 2005;60A:98–103.

    Article  Google Scholar 

  84. Edwards M, Loprinzi P. Systemic inflammation as a function of the individual and combined associations of sedentary behaviour, physical activity and cardiorespiratory fitness. Clin Physiol Funct Imaging. 2016 [epub ahead of print].

  85. Kramer H, Fontaine K, Bathon J, Giles J. Muscle density in rheumatoid arthritis: associations with disease features and functional outcomes. Arthritis Rheum. 2012;64:2438–50.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Baker J, Long J, Ibrahim S, Leonard M, Katz P. Men are at greater risk of lean mass deficits in rheumatoid arthritis. Arthritis Care Res. 2015;67:112–9.

    Article  Google Scholar 

  87. Engvall IL, Elkan AC, Tengstrand B, Cederholm T, Brismar K, Hafstrom I. Cachexia in rheumatoid arthritis is associated with inflammatory activity, physical disability, and low bioavailable insulin-like growth factor. Scand J Rheumatol. 2008;37(5):321–8.

    Article  CAS  PubMed  Google Scholar 

  88. Giles J, Bartlett S, Andersen R, Thompson R, Fontaine K, Bathon J. Association of body fat with C-reactive protein in rheumatoid arthrits. Arthritis Rheum. 2008;58:2632–41.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Powers S, Lynch G, Murphy K, Reid M, Zijdewind I. Disease-induced skeletal muscle atrophy and fatigue. Med Sci Sports Exerc. 2016;48:2307–19.

    Article  PubMed  Google Scholar 

  90. •• Morris G, Berk M, Galecki P, Walder K, Maes M. The neuro-immune pathophysiology of central and peripheral fatigue in systemic immune-inflammatory and neuro-immune diseases. Mol Neurobiol. 2016;53:1195–219. Review of pathways that may underlie fatigue in autoimmune and inflammatory conditions, with a focus on biological factors.

    Article  CAS  PubMed  Google Scholar 

  91. •• Almeida C, Choy E, Hewlett S, Kirwan J, Cramp F, Chalder T, et al. Biologic interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev. 2016 [6]. Systematic review of the impact of biologic therapy on RA fatigue.

  92. •• Cramp F, Hewlett S, Almeida C, Kirwan K, Choy E, Chalder T, et al. Non-pharmacological interventions for RA fatigue. Cochrane Database Syst Rev. 2013 [8]:CD008322. Systematic review of interventions for RA fatigue.

  93. •• Rongen-van Dartel S, Repping-Wuts H, Flendrie M, Bleijenberg G, Metsios G, van den Hout W, et al. Effect of aerobic exercise training on fatigue in rheumatoid arthritis: a meta-analysis. Arthritis Care Res. 2015;67:1054–62. Systematic review of exercise interventions on RA fatigue.

    Article  CAS  Google Scholar 

  94. Katz P, Margaretten M, Gergorich S, Kaplan S, Rush S, Trupin L. A randomized controlled trial for a physical activity intervention for RA fatigue. American College of Rheumatology; San Francisco, CA: Arthritis Rheum; 2015. p. abstract 2083.

  95. Dures E, Kitchen K, Almeida C, Ambler N, Cliss A, Hammond A, et al. “They didn’t tell us, they made us work it out ourselves”: patient perspectivies of a cognitive-behavioral program for rheumatoid arthritis fatigue. Arthritis Care Res. 2012;64:494–501.

    Article  CAS  Google Scholar 

  96. Repping-Wuts H, van Riel P, van Achterberg T. Rheumatologists’ knowledge, attitude and current management of fatigue in patients with rheumatoid arthritis [RA]. Clin Rheumatol. 2008.

Download references

Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, and Institute for Health Policy Studies, University of California San Francisco, 3333 California St, Suite 270, San Francisco, CA, 94143-0920, USA

    Patricia Katz

Authors
  1. Patricia Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patricia Katz.

Ethics declarations

Conflict of Interest

The author declares that she has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Topical Collection on Rheumatoid Arthritis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Katz, P. Fatigue in Rheumatoid Arthritis. Curr Rheumatol Rep 19, 25 (2017). https://doi.org/10.1007/s11926-017-0649-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-017-0649-5

Keywords

Search

Navigation