Telephone-delivered exercise and cognitive behavioral interventions improve fatigue severity and impact versus usual care in people with inflammatory rheumatic diseases, LIFT study data show.

Fatigue may follow one of four trajectories in people with early rheumatoid arthritis but overall is associated with increased pain, poor mental health, and poor sleep quality, irrespective of disease activity, Belgian researchers report.

We aimed to characterise fatigue from the patients’ perspective and develop a conceptual model of fatigue based on qualitative interviews.

Fatigue among patients with early rheumatoid arthritis improves significantly following the initiation of DMARDs, but maximal improvements may not occur until 6 months after remission, research shows.

Findings from the RAFT trial support the use of cognitive behavioral therapy delivered by rheumatology teams to reduce the impact of fatigue among patients with rheumatoid arthritis.

Provision of pedometers could improve activity levels and reduce fatigue among patients with rheumatoid arthritis, results of a randomized trial suggest.

The purpose of this study was to comprehensively examine the relationships between lifestyle physical activity with multiple outcome domains in women with fibromyalgia [ read more ]. Merriwether EN et al. Arthritis Res Ther 2018; 20: 199. doi: 10.1186/s13075-018-1671-3

This paper reviews potential biologic mechanisms for the cognitive impairment, depression and fatigue associated with systemic lupus erythematosus (SLE). Summary Patients with SLE frequently report cognitive impairment, fatigue and depression, which have a substantial impact on their quality of life. The immune system and the brain are interlinked via several pathways: within the central nervous system (CNS) between neurons and between neurons and microglia, within the vasculature in various brain regions and within neuroendocrine pathways. Data exists to support a role for adaptive immunity in normal brain function. The choroid plexus, a specialized interface between the brain and the peripheral circulation, acts as a mediator for neuroimmune interactions – an abundance of T cells in this area has been associated with worsening CNS and peripheral disease manifestations in mouse models. Increased levels of peripheral circulating inflammatory cytokines are thought to mediate changes in central cytokine expression, leading to transient alterations in cognitive processes. This may occur in chronic inflammatory states such as in SLE, where organ damage related to immune dysregulation is mediated partly by peripheral circulating cytokines. Idiopathic major depression has been associated with increased circulating levels of cytokines, and increased SLE activity has been linked to increased vulnerability to depression. Central mechanisms that may play a role in the complex interplay between the immune system and cognition involve the cytokines, chemokines and neurotransmitters, with impaired adult neurogenesis also playing a possible role. Autoantibodies present in SLE have also been implicated in cognitive disturbances and mood disorders. Cerebrospinal fluid autoantibody levels have been shown to correlate significantly with neuropsychiatric manifestations. Evidence suggests that the chronic inflammation present in SLE, along with episodes of acute escalation, lead to altered CNS processing, with resultant effects on cognition and mood. Mackay M. Immunol Res  2015;63:26–37. doi:10.1007/s12026-015-8716-3

By contrast, patient-reported outcomes, including ESSPRI score, improved to a similar degree in the two treatment groups and there was no differentiation between the two treatments in terms of the ESSPRI subdomains of dryness, pain, and fatigue.

In favor of treating people with subclinical RA, speaking together with V Michael Holers (University of Colorado, Boulder, Denver, USA), Kevin Deane (University of Colorado) believes “we should try and prevent or ameliorate clinical RA by treating in a stage-specific manner pre-RA autoimmune processes that may have their own symptoms and tissue injury,” adding that treating at a stage even when inflammatory arthritis is not present could still provide benefits such as reduced pain or fatigue.

There were no between-group differences at either timepoint for health-related quality of life, depression or fatigue.

None of the patients included in the study required hospital admission, and the most common symptoms – low-grade fever, fatigue, myalgia, and cough – resolved within a few days.

The team also observed sustained reductions in inflammation, spinal pain, fatigue, stiffness, as well as improvements in physical function.

Notably sarilumab treatment was associated with significant improvements in general quality of life, short form-36 mental and physical components, and fatigue, as well as changes on the HAQ-DI (borderline significance), pain on the visual analog scale, and PMR activity scores.

Compared with the baseline parameters, after 3-month and 12-month treatments disease activities were improved significantly, including Patient Global Assessment (PTGA), overall back pain, nocturnal pain, fatigue, Ankylosing Spondylitis Disease Activity Score–C-Reactive Protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI). (2) Only 59.3% used ETN biosimilars with full dose (3.5 days’ interval) in the first 3 months.

However, they say that having moderate or severe depression at 0, 6, and 12 months was significantly associated with average fatigue scores at these timepoints, while severe anxiety was associated with pain, and illness belief scores were associated with both pain and fatigue.