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Depression, disability and sleep disturbance are the main explanatory factors of fatigue in rheumatoid arthritis: a path analysis model
C.F. Silva1, C. Duarte2, R.J. Ferreira3, E. Santos4, J.A.P. Da Silva5
- Faculty of Medicine, University of Coimbra, Portugal.
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, and Coimbra Institute of Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal.
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, and Escola Superior de Enfermagem de Coimbra, Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal.
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE; Escola Superior de Enfermagem de Coimbra, Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra; and Escola Superior de Enfermagem do Porto, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal.
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, and Coimbra Institute of Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal. jdasilva@chuc.min-saude.pt
CER12030
2020 Vol.38, N°2
PI 0314, PF 0321
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PMID: 31365331 [PubMed]
Received: 30/12/2018
Accepted : 10/06/2019
In Press: 19/07/2019
Published: 26/03/2020
Abstract
OBJECTIVES:
Fatigue is one of the most prevalent and disabling symptoms among patients with rheumatoid arthritis (RA), however, it is frequently neglected by health professionals. This study aimed to develop a multidimensional explanatory model of fatigue in patients with RA as a basis for better understanding and intervention.
METHODS:
This was an ancillary analysis of an observational, cross-sectional, single centre study. Patients completed a questionnaire including demographic data and measures of pain, sleep, disability, anxiety, depression, and personality. Fatigue was assessed by the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F). Disease activity and haemoglobin levels were assessed. Path analysis was performed to test and improve a hypothesised model for fatigue.
RESULTS:
This analysis included 142 patients, with a mean (SD) age of 61.1 (11.7) years. The final path analysis model presented acceptable fit and explained 60.0% of the variance of fatigue. The predominant direct explanatory factors identified were disability (46.5%) and depression (41.2%), the latter having an additional indirect influence of 19% through disability. Age (-16.2%) and sleep disturbance (15.7%) were also directly linked to fatigue. Personality trait extroversion (-22.4%), pain (20.0%), and disease activity (14.9%) are only indirectly related to fatigue.
CONCLUSIONS:
Depression, disability and sleep disturbance appear to be the main factors explaining fatigue in patients with RA. Disease activity, pain, and personality seem to play only a secondary role, extroversion being the only personality trait associated with fatigue. These findings foster a shift in the paradigm of care towards a more holistic management of fatigue, integrating adjunctive therapies beyond measures targeted solely at disease remission.
