Fatigue in patients with Crohn's disease in remission: The influence of medical history and psychological factors

Objectives. - Fatigue is a common complaint in IBD disease. Medical factors (anemia, medicinal side effects, activity of the disease) partially explain IBD-related fatigue. Research has shown that fatigue is persistent even if the disease is in remission. Other factors need to be considered in order to understand this phenomenon. Fatigue could be considered as a consequence of disease history. But it also appears necessary to consider patients' causal attribution of the disease, the perceived gravity of their trouble and the presence of psychological suffering. Methods. - Seventy-seven patients with Crohn's Disease in remission were enrolled. They answered questionnaires assessing fatigue (MFI), depression (HADS), anxiety (HADS, STAI YA/B), perceived severity (CGI1), pain EVS and a causal attribution scale. Information about disease history was collected from the MICISTA database for the 10-year period preceding the assessments (the number and severity of clinical relapses, the number of hospitalizations due to a major degradation of the clinical condition, the number of intestinal surgeries, the severity of bowel resection evaluated by the Post Surgical Handicap Index, type of medical treatment taken at the time of evaluation). Patients were compared using the CGI1 median (ANOVA) and the General Fatigue median (t-test). Then MFI scores were analyzed with a multiple regression. Results. - The results showed only one significant relation between perceived severity of the disease and pain. Dichotomization of patients according to the median level of general fatigue showed that patients were significantly more tired, more depressed, anxious, and in pain than less tired patients. They also had a more serious bowel resection and a significantly worse perception of the severity of their current troubles. The analysis of correlation showed that none of the medical disease-related history was linked in fatigue scores. In contrast, intensity of depression and anxiety-related variables (more particularly trait-anxiety) were the most involved in fatigue scores intensity. Only the perceived severity and the internal-external dimension of causal attributions respectively were linked to the severity of general fatigue and reduced activity. Conclusion. - These results confirm that if fatigue is associated with medical factors including the period of clinical activity (as was demonstrated elsewhere), this medical reality would not play a role when the disease is in remission. The influence of anxiety and depression is consistent with that observed in other studies. Trait-anxiety would increase the vulnerability to the onset of fatigue. This could partially explain why some patients remain tired even in remission. Fatigue could be also understood as a manifestation of the work of the disease which can be conceived as the totality of psychic operations involved in the subject's relation to his illness. This psychic work is particularly difficult because it requires both development and a waiver of certain aspects. of the self. This difficulty is reflected in the appearance of depression, but may also occur to a lesser extent by the complaint of being tired. In the context of chronic disease, it is then possible to hypothesize that fatigue could be a manifestation of the work of the disease in individuals already vulnerable because of an anxious dimension of personality. Understanding and management of fatigue in patients with Crohn's disease requires the transition to a more personal understanding of the meaning attributed to each patient's illness and fatigue. In any case, it seems essential to reconsider the weight of the patient's objective medical history in fatigue and the physicians' attributions linking it to the disease. (C) 2011 Elsevier Masson SAS. All rights reserved.