Assessment of fatigue in rheumatoid arthritis and its relation to pain and disease activity measures

Background Fatigue is a serious outcome of rheumatoid arthritis (RA). Inflammatory synovitis is potentially an important causal factor for RA fatigue. Other factors include psychosocial factors, health beliefs, illness perceptions, and poor social support. Fatigue also has strong relationships to pain and depression. Objective The aim of the study was to define the amount of fatigue experienced by RA patients, and determine the relative contribution of RA disease activity to fatigue in comparison with factors such as pain and treatment in established RA cases using different instruments to assess fatigue [visual analog scale (VAS) fatigue and the vitality subscale of the Medical Outcomes Study Short Form 36 (SF-36) questionnaire]. Patients and methods A total of 50 adult patients diagnosed with RA according to the 1987 Revised American College of Rheumatology - 42 of them being female and the remaining eight being male, with a mean age of 45.36 ± 9.6 years and a mean disease duration of 7.78 ± 4.1 years - were included in the study. Fatigue was measured using a 100 mm VAS and the SF-36 vitality scores. We measured pain using 100 mm VAS, Disease Activity Score for 28 joint counts (DAS28), early morning stiffness, the modified Health Assessment Questionnaire score, and the physician global assessment score. Results Fatigue was common in RA patients. Out of 50 patients, 42 patients had fatigue (VAS ≥ 20 mm), and at the same time 26 had high fatigue scores (VAS΃50 mm). The mean SF-36 energy and vitality score was 60.5 ± 23.1. The VAS fatigue scores and the SF-36 vitality scores were significantly correlated with disease activity measures, including duration of morning stiffness (P = 0.001), articular index (P < 0.0001), VAS pain (P < 0.0001), DAS28 (P < 0.0001), C reactive protein (CRP) (P = 0.04 and 0.001, respectively), erythrocyte sedimentation rate (ESR) (P = 0.04), and rheumatoid factor positivity (P = 0.04 and 0.01, respectively). Pain had the strongest association with fatigue, followed by articular index, duration of morning stiffness, ESR, DAS28, and finally CRP in that order. Conclusion High fatigue levels are common in RA and are mainly linked to pain. VAS fatigue scores are simple measurements that can be used for assessment of fatigue in patients with RA

Use of the SS Scale, FIQR, and FIQ VASs for assessment of symptom severity in Egyptian fibromyalgia patients

Background Fibromyalgia (FM) is a complex syndrome associated with significant impairment in the quality of life and function. The ability to evaluate and measure the severity of FM is likely to provide several benefits. Objective This study aimed to assess symptom severity in Egyptian FM patients using the Symptom Severity Scale (SS Scale), Revised Fibromyalgia Impact Questionnaire (FIQR), and Fibromyalgia Impact Questionnaire Visual Analog Scales (FIQ VASs). Patients and methods Twenty-four female patients who fulfilled the ACR-2010 criteria of FM were included in the present study. The SS Scale, FIQR, and FIQ VASs were used to assess symptom severity of FM. Results The respective mean of the SS Scale, FIQR, and FIQ VASs were 7.3 ± 2.4, 52.9 ± 22.1, and 39.3 ± 14.2, and they were positively correlated with measure of pain distribution [widespread pain index (WPI)] in our patients. The SS Scale, WPI, FIQR, and FIQ VASs scores were positively correlated with many regional pain distribution sites (upper arm pain and jaw pain at most) and somatic pain symptoms (central nervous system symptoms, musculoskeletal symptoms, otological and hypersensitivity symptoms). The high scores of the SS Scale, FIQR, and FIQ VASs and their positive correlations with most of the regional pain sites and distribution and somatic symptoms indicate the severity of symptoms in the studied population. The FIQ VAS was the only significant independent determinant of FM severity (P < 0.001) in backward/stepwise multiple linear regression models. Conclusion The SS Scale of the ACR-2010 criteria, FIQR, and FIQ VASs were excellent methods for assessment of symptom severity in our Egyptian FM patients

Relationship between serum 25-hydroxy vitamin D levels, knee pain, radiological osteoarthritis, and the Western Ontario and McMaster Universities Osteoarthritis Index in patients with primary osteoarthritis

Objective This study aims to detect the relationship between serum 25-hydroxy vitamin D (25-OHD) levels in patients with primary osteoarthritis (OA) of the knees and with other disease parameters of OA, mainly radiological findings, functional assessment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and pain [numerical rating scale (NRS)]. Patients and methods We studied 140 consecutive patients with primary knee OA, 110 female patients and 30 male patients. They were clinically, radiologically, and also functionally evaluated regarding OA; pain was also assessed using NRS, and serum 25-OHD, serum parathormone, serum calcium, phosphorus, and alkaline phosphatase were measured. Results In our patient sample, we found that 90 (64.3%) patients had lower 25-OHD levels. The mean serum 25-OHD was 35.77 ± 14.6 (range 10.62-71.82) ng/ml; 25-OHD was negatively significantly correlated with patients′ age (P = 0.013, r = −0.236), radiological degree of OA (P = 0.036, r = −0.20), WOMAC (P < 0.0001, r = −0.337), and NRS for pain (P < 0.0001, r = −0.580). When comparing between patients with hypovitaminosis, 25-OHD less than 40 ng/ml, and patients with desirable 25-OHD levels, we found that radiographic grading of OA was significantly higher in the hypovitaminosis group (t = 2.024, P = 0.045); WOMAC was also significantly higher in the hypovitaminosis group (t = 3.226, P = 0.002) and NRS was also higher in the hypovitaminosis group (t = 4.468, P < 0.0001). Conclusion 25-OHD deficiency is prevalent in our patients suffering from OA; in addition, 25-OHD may play a role in patients suffering from OA