Longitudinal Analysis of Fatigue in Psoriatic Arthritis

Objective. To describe the longitudinal course of fatigue in psoriatic arthritis (PsA). Methods. Our study included 390 patients who attended the University of Toronto Psoriatic Arthritis Clinic between 1998 and 2006 and who completed 2 or more administrations of the modified Fatigue Severity Scale (mFSS) at yearly intervals. Clinical data were used that corresponded to visits in which mFSS was administered. We used linear mixed effects models to examine the relationships of disease-related and nondisease-related variables with mFSS scores across multiple clinic visits, and linear regression models to investigate the association between change in mFSS scores (Delta mFSS) and changes in covariates between visits. Results. Clinical measures of disease activity were related to fatigue over time; however, these relationships disappeared in the context of patient-reported physical disability and pain. Patient-reported measures of physical disability, pain, and psychological distress were most closely related to higher mFSS scores (greater fatigue) across clinic assessments. Fatigue was found to vary over time, at least when assessed at yearly intervals. In general, measures of clinical and functional status at the current visit were more predictive of Delta mFSS in between previous and current visits than change scores in these measures between visits. Comorbid fibromyalgia or hypertension were also associated with greater fatigue across multiple visits and with change in fatigue between visits. Conclusion. A combination of factors is associated with fatigue in PsA. The full effect of comorbidities on fatigue warrants further study to better understand the effective management of fatigue in PsA. (First Release July 1 2010; J Rheumatol 2010;37:1878-84; doi:10.3899/jrheum.100179)