Clinical Study Of Fatigue Status In Rheumatoid Arthritis

Objective:In this study,we collected data from patients with rheumatoid arthritis（RA）to investigate whether there was a difference between biologics and modifying anti-rheumatic drugs（DMARDs）therapy on the improvement of patients’ fatigue,and also analyzed the relationship between clinical indicators and fatigue status at baseline and the changes of fatigue after treatment.The study will be helpful to provide suggestions for clinicians to improve the fatigue status of RA patients.Methods:A total of 81 newly diagnosed RA patients were recruited in the First Hospital of Jilin University from July 2020 to December 2021 and their clinical data were recorded.The first fatigue assessment was performed before treatment by using the Bristol Rheumatoid Arthritis Multi-dimensional Questionnaire（BRAF-MDQ）.The second fatigue assessment would be performed three months later.The collected data on demography,clinical manifestations,immunological indicators,BRAF-MDQ scores and treatment of the patients were analyzed.Comparison was undertaken by using statistical methods such as independent sample t-test,chi-square test and Mann Whitney method,and differences were considered statistically significant at P<0.05.Results:（1）According to gender,age,education background,smoking history,drinking history,history of hypertension,history of diabetes mellitus,history of interstitial lung disease（ILD）,presence of osteoporosis,RF（Rheumatoid factor）positive,erythrocyte sedimentation rate（ESR）increased,C-reactive protein（CRP）increased,CCP（cyclic citrullinated peptide）antibodies positive,the 81 patients were divided to analyze whether there were differences in fatigue baseline between different groups,and the results of above all showed no difference（P>0.05）.（2）28-Joint Disease Activity Score-ESR（DAS28-ESR）and DAS28-CRP were used to classify the disease activity.The 81 patients were divided into the disease remission group,low disease activity group,medium disease activity group and high disease activity group,then we analyzed fatigue level among the different disease activity groups.There was no significant difference in fatigue among the groups at baseline（P>0.05）.（3）Comparing the remission of fatigue between the biologics group and the DMARDs group,the biologics group showed better fatigue improvement（P=0.018）.BRAF-MDQ scale has four sub-dimensions: physical,living,cognition and emotion,and the remission in fatigue in each sub-dimension was compared between the two treatment groups.In the dimension of living,cognition and emotion,the biologics group got more fatigue relief（P =0.034,P = 0.017,P = 0.034,respectively）.（4）In different treatment groups,according to the corresponding independent variables（gender,age,smoking history,history of hypertension,osteoporosis）,each group was divided into two parts.In the biologics groups,more fatigue relief was obtained in men on cognition and emotion subdimension and in elder patients on the emotion subdimension（P<0.05）.When treated with DMARDs,RA patients with osteoporosis had more relief in fatigue on the living subdimension（P< 0.05）.Conclusions:（1）No significant differences in fatigue were found between the different clinical indicator groups at baseline.（2）Biologics can improve the fatigue of RA patients better compared with DMARDs.（3）Men and the elderly are more likely to benefit from biologics to improve fatigue.