The Longitudinal Course of Fatigue in Rheumatoid Arthritis: Results from the Norfolk Arthritis Register

Katie L Druce, Gareth T Jones, Gary J Macfarlane, Suzanne M M Verstappen, Neil Basu

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OBJECTIVE: Fatigue is common and burdensome in rheumatoid arthritis (RA). Despite RA fatigue progression varying significantly between individuals in practice, existing longitudinal analyses only examine symptom advancement on a population level. This study aimed to determine fatigue trajectories at an individual level and to characterize those patients with the poorest prognosis, with a view to enabling earlier interventions.

METHODS: Patients with RA reporting clinically relevant baseline fatigue (≥ 20 mm on a 0-100 mm visual analog scale) were identified from a longterm inflammatory polyarthritis cohort (the Norfolk Arthritis Register). Fatigue changes from baseline to 1- and 4-year followups were calculated, and sex-stratified group-based trajectory modeling (GBTM) determined trajectories of the symptom between which baseline characteristics were compared.

RESULTS: Among 338 patients, only minimal average changes were observed between recruitment to 1 year (6.0 mm, SD 26.9) and 4 years (5.5 mm, SD 29.3). This was despite 45.6% and 40.7% of participants reporting clinically significant improvements (≥ 10 mm) at these respective followups. GBTM revealed varied trajectories of fatigue, which for both sexes consisted of Improved (men, n = 48 and women, n = 81) or persistent Moderate-high paths (n = 54, n = 105), and further included a persistent High trajectory in women (n = 50). Participants who followed persistent trajectories were best distinguished from improvers by patient-reported rather than demographic or clinical variables.

CONCLUSION: Among patients with RA presenting with clinically relevant fatigue, distinct longitudinal symptom trajectories were identified on an individual level despite nominal average changes in fatigue on a group level. It is possible to identify and characterize subgroups of participants who report persistent fatigue and should therefore be targeted to receive future fatigue-alleviating interventions.

Original languageEnglish
Pages (from-to)2059-2065
Number of pages7
JournalJournal of Rheumatology
Issue number11
Early online date15 Oct 2015
Publication statusPublished - Nov 2015

Bibliographical note

Acknowledgment: The authors would like to thank the University of Manchester for access to the Norfolk Arthritis Register data and Professor Deborah Symmons for comments on an earlier draft of the manuscript.

K.L.D. is funded by a studentship from the Institute of Applied Health Sciences, University of Aberdeen.


  • fatigue
  • rheumatoid arthritis
  • trajectory


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