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Background
Psoriatic arthritis is associated with psychosocial morbidity and decrease in quality of life. Psychiatric comorbidity also plays an important role in the impairment of quality of life and onset of fatigue.
Objectives
This study aimed to assess the prevalence of fatigue in psoriatic arthritis patients and to correlate it to quality of l...
Contexts in source publication
Context 1
... articular disease was clinically and/or radiologically diagnosed and showed the distribution presented in Table 1. ...
Context 2
... CDAI designed for RA may therefore be used in PA and other arthritis models. 39 At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) meetings, 44 the possibility of using an already existing measure to evaluate PA or the need to create a new one specific to the disease was discussed 0 3 0 1st quartile 2nd quartile 3rd quartile 4th quartile 42 47 ...
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Citations
... Little is known about the factors underlying PsA-associated fatigue. In two Canadian studies involving approximately 400 patients with PsA from a single center, 9,76 54% of the variability in fatigue can be explained mainly by physical disability, pain, and psychological stress. 77 A recent study of 246 patients with PsA from 13 countries demonstrated that high fatigue was mainly explained by disease-related factors (skin psoriasis, number of tender joints, and enthesitis), but also by patient-related characteristics (level of education and female gender), indicating that fatigue in PsA has a multifactorial nature. ...
... Fatigue is often cited by patients in qualitative research, and it has complex meanings covering both the physical and mental aspects. 76 In a qualitative study preceding the development of the updated PsA Core GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis)/OMERACT, fatigue was considered a critical component of the impact on the life of PsA patients. 79 In a study by Gossec et al which involved 474 patients with PsA, the participants ranked fatigue as the second most important domain after pain. ...
It is well known that fatigue is a highly disabling symptom commonly observed in inflammatory rheumatic diseases (IRDs). Fatigue is strongly associated with a poor quality of life and seems to be an independent predictor of job loss and disability in patients with different rheumatic diseases. Although the pathogenesis of fatigue remains unclear, indirect data suggest the cooperation of the immune system, the central and autonomic nervous system, and the neuroendocrine system in the induction and sustainment of fatigue in chronic diseases. Fatigue does not correspond with disease activity and its mechanism in IRDs. It is suggested that it may change over time and vary between individuals. Abnormal production of pro-inflammatory cytokines such as interleukin-6 (IL-6), interferons (IFNs), granulocyte-macrophage colony-stimulating factor (GM-CSF), TNF, IL-15, IL-17 play a role in both IRDs and subsequent fatigue development. Some of these cytokines such as IL-6, IFNs, GM-CSF, and common gamma-chain cytokines (IL-15, IL-2, and IL-7) activate the Janus Kinases (JAKs) family of intracellular tyrosine kinases. Therapy blocking JAKs (JAK inhibitors – JAKi) has been recently proven to be an effective approach for IRDs treatment, more efficient in pain reduction than anti-TNF. Therefore, the administration of JAKi to IRDs patients experiencing fatigue may find rational implications as a therapeutic modulator not only of disease inflammatory symptoms but also fatigue with its components like pain and neuropsychiatric features as well. In this review, we demonstrate the latest information on the mechanisms of fatigue in rheumatic diseases and the potential effect of JAKi on fatigue reduction.
... PsA is inflammatory arthritis associated with psoriasis [13]. Psoriasis can result in negative impacts on the affected individuals, such as reduced productivity, embarrassment, stress, and lower self-esteem [14]. A previous study from Turkey showed that PsA affected the QoL of patients compared to psoriasis [13]. ...
Background:
Psoriatic arthritis (PsA) has a detrimental influence on the quality of life (QoL). The goal of this study was to evaluate the QoL of patients with PsA and its determinants at the King Abdulaziz University Hospital in Jeddah, Saudi Arabia.
Methods:
A cross-sectional study was conducted on 60 PsA patients. A questionnaire was used to collect data about their demographics. Assessment of health-related quality of life (HRQOL) was done by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue and the FACIT-General (FACIT-G) scales were used to assess fatigue. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to assess disease activity.
Results:
The mean age of the patients was 50.33 ± 11.15 years and 78.3% were females. The mean HRQOL, FACIT-G, FACIT, and BASDAI scores were 59.99 ± 34.67, 28.18 ± 5.95, 20.01 ± 9.68, and 4.05 ± 2.54, respectively. The HRQOL scores were found to have a highly significant negative correlation with both the FACIT and BASDAI scores, as well as the patients' age and BMI. The FACIT-G scores and the BASDAI scores, as well as the BASDAI scores and the FACIT scores, were found to have a strong positive correlation with age and BMI.
Conclusion:
PsA has a significant detrimental influence on QoL, with a link between QoL and disease activity and fatigue. A greater understanding of QoL issues will help improve the quality of care.
... It is however noteworthy that the questions on fatigue for patients and physicians were not symmetrical, Other studies have found that the relationship between fatigue and anxiety/depression is highly correlated 8,9,28 . A multidisciplinary European working group concluded that the interdependence of fatigue and anxiety, together with pain, may form a "vicious cycle" with negative effects on PsA symptoms 39 . ...
Objective
To evaluate fatigue frequency and severity among patients with psoriatic arthritis (PsA) and assess the impact of fatigue severity on patient-reported outcome measures (PROMs) assessing quality of life, function, and work productivity.
Methods
Data were derived from the Adelphi Disease Specific Programme, a cross-sectional survey conducted in 2018 in the United States and Europe. Patients had physician-confirmed PsA. Fatigue was collected as a binary variable and through its severity (0-10 scale, using the Psoriatic Arthritis Impact of Disease (PsAID) fatigue question) from patients; physicians also reported patient fatigue (yes/no). Other PROMs included EQ-5D-5L for health-related quality of life (HRQoL), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Work Productivity and Activity Impairment (WPAI). Multivariate linear regression was used to evaluate the association between fatigue severity and other PROMs.
Results
Among the 831 included patients (mean age 47.5 years, mean disease duration 5.3 years, 46.9% female, 48.1% receiving a biologic), fatigue was reported by 78.3% of patients. Patients with greater fatigue severity had greater disease duration, PsA severity, pain levels, body surface area affected by psoriasis, and swollen and tender joint counts (all p<0.05). In multivariate analyses, patients with greater fatigue severity experienced worse physical functioning, HRQoL, and work productivity (all p<0.001). Presence of fatigue was under-reported by physicians (reported in only 32.0% of patients who self-reported fatigue).
Conclusion
Prevalence of patient-reported fatigue was high among PsA patients and under-recognized by physicians. Fatigue severity was associated with altered physical functioning, work productivity, and HRQoL.
... In order to assess fatigue in our study population, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale was used. This scale was originally developed in order to assess fatigue in cancer patients with or without anemia, compared to the general US population (53) and it has been validated in the general population (54) and has been also largely used and validated in patients with inflammatory (55)(56)(57) and autoimmune diseases, including primary SS (58)(59)(60)(61). The score of the FACIT-F scale ranges from 0 to 52, higher values reflect lower fatigue levels and a cutoff score of <30 indicates severe fatigue (62). ...
Background/Purpose
Primary Sjögren’s Syndrome (SS) is characterized by B lymphocyte hyperactivity with B cell activating factor (BAFF) acting as an important regulator. Single Nucleotide Polymorphisms (SNPs) of the BAFF gene have been implicated in the pathogenesis of several autoimmune diseases characterized by heightened fatigue levels, including primary SS. We aimed to explore potential associations between BAFF SNPs and fatigue status of primary SS patients.
Methods
Fatigue status was assessed in 199 consecutive primary SS patients (Greek cohort) using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale. Clinical, histological, laboratory, psychometric and personality data were also collected. DNA extracted from peripheral blood of all patients underwent evaluation for the presence of five BAFF SNPs (rs9514827, rs1041569, rs9514828, rs1224141, rs12583006) by PCR. To confirm our findings, an independent replicative cohort of 62 primary SS patients (Dutch cohort) was implemented. Finally, 52 multiple sclerosis (MS) patients were served as disease controls (MS cohort). Analysis of BAFF SNPs in association with fatigue levels was performed by the online platforms SNPStats and SHEsis and the SPSS 26 and Graph Pad Prism 8.00 software.
Results
TT genotype of the rs9514828 BAFF polymorphism was significantly less frequent in the fatigued primary SS patients of the Greek cohort compared to the non-fatigued (14.1% vs 33.3%). The corresponding ORs [95%CI] in the dominant and overdominant models were 0.33 [0.15-0.72], p=0.003 and 0.42 [0.23-0.78], p=0.005 respectively. The association remained significant after adjustment for the variables contributing to fatigue in the univariate analysis (OR [95% CI]: 0.3 [0.1-0.9], p=0.026). Accordingly, in the Dutch cohort, there was a trend of lower mental fatigue among patients carrying the TT rs9514828 BAFF genotype compared to their CC counterparts (4.1 ± 2.4 vs 6.0 ± 2.2 respectively, p=0.06). The rs9514828 BAFF SNP was not significantly associated with fatigue in the MS cohort.
Conclusions
We report a novel association between genetic makeup and primary SS-associated fatigue with the rs9514828 TT genotype decreasing the likelihood of fatigue development among these patients. These findings need validation in multi-center studies.
... Treating physicians prioritize reduction in joint pain, swelling and stiffness (8), while patients often rank pain, cutaneous manifestations, and fatigue as their priority symptoms of focus (9,10). Several studies investigating decreased HRQoL in PsA patients are conducted in cross-sectional setups to assess associations with individual clinical manifestations (11)(12)(13)(14), while studies including follow up examining the relationship between changes in individual PsA manifestations and change in QoL have been sparse (15,16). ...
OBJECTIVES
The objective was to investigate interplay between change (Δ) in health-related quality of life (HRQoL) quantified by physical component score (PCS) and mental component score (MCS) retrieved from short-form health survey (SF-36), change in disease activity (ΔDAS28CRP) and manifestations of Psoriatic Arthritis (PsA).
METHODS
PsA patients initiating new medical therapy were enrolled. Independent disease measures evaluating disease activity, enthesitis, psoriasis, pain and fatigue were collected at treatment initiation and after 4 months. Interplay between independent disease measures and dependent outcome measures; ΔPCS and ΔMCS was described with univariate regression analyses. Multivariate regression analyses were applied to assess impact of independent variables e.g. individual disease outcome measures versus ΔDAS28CRP on ΔPCS and ΔMCS.
RESULTS
108 PsA patients were included. In the univariate regression analyses, improvement in fatigue, pain, and disability were associated with improvement in ΔPCS (β; -2.08, -0.18, -13.00, respectively, all; p < 0.001) and ΔMCS (β; -1.59, -0.12, -6.07, respectively, and p < 0.001, p < 0.001, p = 0.003, respectively). When PROs were included in the final multivariate models, improvements in ΔPCS and ΔMCS were associated with improvements in pain, fatigue and disability (p < 0.001). Improvement in enthesitis positively impacted ΔPCS (β -0.31, p < 0.001). No association was found between change in skin psoriasis, ΔPCS and ΔMCS (β 0.15, p = 0.056 and β 0.05, p = 0.561, respectively).
CONCLUSION
In this PsA patient cohort, diminishing pain, disability and fatigue improved PCS and MCS significantly. Changes in enthesitis and psoriasis, did not grossly impact HRQoL compared to DAS28CRP. Individual PsA manifestations influence HRQoL differently which is clinically important when targeting treatment.
... The effects of osteoarticular disease showed that people affected by this pathology and who are more physically active obtained higher well-being values. This could be the most visible part of the emotional and social disease implications, which determines the quality of life perception and well-being, and not only the physical and functional aspects of the pathology [56]. ...
Osteoarticular diseases are one of the effects of aging, and they are related to physical, psychological, and social functions. Physical activity seems to slow the start and progression of these kinds of illnesses and presents benefits for psychosocial health. The main aim of the study was to investigate the possible effect of physical activity level (Yale Physical Activity Survey) on quality of life (SF-36 Health Questionnaire), subjective psychological well-being (Psychological Well-being Scale), and depression levels (Geriatric Depression Scale), depending on osteoarticular illness. The sample consisted of 263 Spanish adults aged 65 to 98 years who had high or low physical activity (assessed by YPAS Questionnaire) and osteoarticular disease. Results show that physical activity influences the perceived quality of life, depression levels, and subjective well-being in older adults regardless of osteoarticular disease. The present study suggests the need for promoting physical exercise due to its proven positive impact on older adults’ mental health, entailing a significant reduction in the risks of suffering from a variety of frequent diseases and disorders.
... 9 In addition, it is considered to be the comorbidity that has the greatest impact on the quality of life of these patients, thus requiring early diagnosis and treatment. 10 In Brazil, the prevalence of psoriatic arthritis exclusively in patients with plaque psoriasis ...
Background:
Psoriatic arthritis is the most frequent and impactful comorbidity among psoriatic patients and appears in most cases after skin disease. Dermatologists play a key role in its early diagnosis and treatment.
Objective:
To determine the prevalence of psoriatic arthritis and associated variables among patients with plaque psoriasis seen at a reference center for treating psoriasis.
Design and setting:
Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, MG, Brazil.
Methods:
Standardized records of 300 patients with plaque psoriasis were examined. Demographic data and medical variables relating to psoriasis (Psoriasis Area and Severity Index (PASI), family history, age at onset and disease progression) and psoriasis arthritis (CASPAR criteria) were evaluated. Laboratory and radiographic tests in the medical records were reviewed.
Results:
Seventy-three (24.3%) of these 300 patients with plaque psoriasis had psoriatic arthritis. Asymmetric oligoarthritis (58.9%) was the most common clinical form, followed by polyarthritis (20.5%), distal interphalangeal arthritis (15.2%) and spondyloarthritis (5.4%). Dactylitis was present in 21.9% and enthesitis in 35.6% of patients. Compared with patients without arthritis, patients with arthritis had higher average age, higher frequency of positive family history of psoriasis, longer duration of evolution and higher PASI rates.
Conclusion:
Psoriatic arthritis is often underdiagnosed. Since dermatologists perform the initial approach, these professionals need to be trained to diagnose this comorbidity and treat it, together with rheumatologists.
... Fatigue is related to pain, psychological distress, sleep quality, comorbidities, disability, fibromyalgia, and socio-demographic characteristics in rheumatic disorders [15][16][17][18]. As in other rheumatic diseases, fatigue levels are high in patients with PsA and are associated with emotional and social aspects of the disease beside disease related parameters [14,[19][20][21][22][23]. To date, little is known about the effect of the presence of FM on fatigue in patients with PsA. ...
... The number of studies on fatigue in PsA patients has increased recent years and fatigue was defined as a potential core domain in clinical trials in these patients [35]. In the literature, most researchers studied the severity of fatigue in patients with PsA, and reported that fatigue levels were high and moderate to severe in the majority of the patients [19][20][21][22]. However there is only one study comparing fatigue level in PsA patients with the controls. ...
... It was shown that fatigue has priority in PsA patients and has multifactorial aspects. Both the disease related factors and patient related characteristics play important role in the etiology of fatigue in patients with PsA [14,[19][20][21][22]. Coexisting FM was reported as one of the factors that contribute to fatigue in PsA [14,19,23]. ...
Background:
Coexisting fibromyalgia (FM) to psoriatic arthritis (PsA) has been identified and it has been associated with more severe symptoms, impaired function, and greater disability. It was aimed to explore the effect of the presence of FM on fatigue in patients with PsA comparing with controls.
Methods:
Fifty patients with PsA and 34 sex-age matched controls were enrolled. In patients; pain was assessed by Visual Analogue Scale, disease activity by DAS-28, enthesitis by The Leeds Enthesitis Index. Fatigue level of all participants was evaluated by Multidimensional Assessment of Fatigue. In all participants, FM was determined according to 2010 American College of Rheumatology criteria.
Results:
Seventeen patients with PsA (34%) and 4 controls (11.8%) were diagnosed with FM and all of them were women. There was significant difference between the patients and controls in terms of presence of FM (p < 0.05). Patients' fatigue scores were significantly higher than controls' (p = 0.001). There were significant differences between the PsA patients with and without FM with regard to gender, enthesitis, DAS-28 and pain scores (p < 0.05); fatigue scores (p < 0.001). The significant effect of the presence of FM on fatigue was found by univariate analysis of variance in patients (p < 0.001).
Conclusion:
It was observed that FM presence and fatigue were more common in PsA patients than controls and comorbid FM had significant effect on fatigue in these patients. Physicians should be aware of the possibility of concomitant FM in patients with PsA.
... A recent study on the prevalence of fatigue in patients with psoriatic arthritis showed that the level of fatigue was moderate or intense in < 25% of patients (31). Fatigue seemed to be more related to the emotional and social aspects of the disease than to inflammatory aspects of the joints, confirming that the disease's visibility is the most disturbing aspect for the patient and that "skin pain" is more intense than joint pain. ...
The aim of this study was to examine the prevalence and nature of fatigue in patients with skin diseases by comparison with controls, using a survey of a large representative sample of the French population (n = 2,502). Of the respondents, 659 reported having a skin disease and 1,843 did not. Quality of life was decreased in people with skin diseases compared with controls, while levels of stress and sleep deprivation were higher in people with skin diseases. Level of fatigue was higher in people with skin diseases than in controls. The relative risk of fatigue was 4.71 (3.44-5.98, p < 0.001). Mediation analysis, adjusted according to sex, age and each skin disease, showed that the effects of skin diseases on fatigue were more commonly direct than indirect. To our knowledge, this is the first study to demonstrate that patients with skin diseases experience fatigue more frequently and more intensely. Hence, fatigue should be used as a new patient-related outcome in clinical trials.
... Although directionality has not been investigated, PsA disease activity is greater in patients with depression and/or anxiety. 78 Similar to AS, sleep and fatigue have been reported to be associated with poor quality of life and risk of depression in patients with PsA. 30, 79,80 Other PsA symptoms may further affect depression risk. For instance, psoriasis has been shown to impair body image. ...
Depression is a major neuropsychiatric disorder common in patients with rheumatological conditions including spondyloarthritis (SpA). It is associated with higher disease activity, functional impairment, poor treatment response and quality of life in patients with musculoskeletal disorders. Using ankylosing spondylitis (AS) and psoriatic arthritis (PsA) as examples, we have reviewed the evidence regarding the burden, risk factors, potential mechanisms and clinical management of depression in spondyloarthritis. The prevalence of depression is higher in patients with AS and PsA compared with the general population, with evidence of moderate/severe depression in about 15% of patients with AS or PsA. Mild depression is even more common and estimated to be present in about 40% of patients with AS. In addition to conventional risk factors such as stressful life events and socioeconomic deprivation, increased risk of depression in SpA may be associated with disease-related factors, such as disease activity, poor quality of life, fatigue, and sleep disturbances. Emerging evidence implicates inflammation in the aetiology of depression, which could also be a shared mechanism for depression and chronic inflammatory conditions such as AS and PsA. It is imperative for clinicians to actively assess and treat depression in SpA, as this could improve treatment adherence, quality of life, and overall long-term clinical and occupational outcomes. The use of validated tools can aid recognition and management of depression in rheumatology clinics. Management of depression in SpA, especially when to refer to specialist mental health services, are discussed.
