Multimorbidity and Fatigue in Rheumatoid Arthritis: A Cross-Sectional Study of a Population-Based Cohort
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ORIGINAL RESEARCH
Multimorbidity and Fatigue in Rheumatoid Arthritis: A Cross-Sectional Study of a Population-Based Cohort John M. Davis III
. Elena Myasoedova . Tina M. Gunderson .
Cynthia S. Crowson
Received: August 13, 2020 / Accepted: October 14, 2020 Ó The Author(s) 2020
Electronic Supplementary Material The online version of this article (https://doi.org/10.1007/s40744020-00247-y) contains supplementary material, which is available to authorized users.
Results: The cohort included 192 patients, median age 62 years, and median RA duration 13 years. Multimorbidity was common with 93 (48%) having C 2 comorbidities, and 27 (14%) having C 4 comorbidities. The median BRAFMDQ total score was 9 (interquartile range 3–18), with higher scores indicating greater fatigue. Patients with C 4 comorbidities had higher total BRAF-MDQ scores (median 16.5, interquartile range: 6.8–24.8) than patients with \ 4 comorbidities (7.5, 2.8–16.0; p = 0.014). Each additional comorbidity was associated with a 2.33 (95% confidence interval [CI] 1.10–3.56) unit increase in total BRAF-MDQ score (p \ 0.001), and the presence of C 4 comorbidities was associated with a 9.33 (95% CI 3.92–14.7) unit increase in total BRAF-MDQ score. Multimorbidity was significantly associated with all four fatigue subdomains in adjusted models. Conclusions: Multimorbidity is associated with increased fatigue in patients with RA. The findings suggest that interventions targeting multimorbidity could help alleviate treatmentrefractory fatigue in patients with RA and other rheumatic diseases.
J. M. Davis III (&) E. Myasoedova C. S. Crowson Division of Rheumatology, Mayo Clinic, Rochester, MN, USA e-mail: [email protected]
Keywords: Autoimmune disease; Comorbidity; Fatigue subdomains; Health care burden; Multimorbidity; Rheumatic disease
ABSTRACT Introduction: The objective was to evaluate the relationships between multimorbidity and overall fatigue as well as fatigue subdomains in patients with rheumatoid arthritis (RA). Methods: A cross-sectional study of a population-based cohort of patients with RA was performed. Fatigue was assessed using the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ). Patients’ medical records were reviewed for 25 chronic comorbidities prior to the BRAF-MDQ. Linear and logistic regression models were used to estimate the differences in BRAF-MDQ total and subdomain (physical, living, cognitive, and emotional) scores associated with multimorbidity, adjusting for age, sex, disease duration, obesity, smoking, C-reactive protein, and RA autoantibodies. Higher BRAF-MDQ scores indicate greater fatigue severity.
T. M. Gunderson C. S. Crowson Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
Rheumatol Ther
Key Summary Points Why carry out this study? Previous studies have reported that multimorbidity is associated with the severity of fatigue as defined by visual or numeric scales. There is an unmet need to more deeply understand effects of multimorbidity on various facets
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