30% of RA Patients Don’t See Fatigue Improve After Starting Treatment

30% of RA Patients Don’t See Fatigue Improve After Starting Treatment

And a few factors seemed to be responsible, including being obese and also having fibromyalgia.

When most people think about rheumatoid arthritis (RA), they focus on joint pain, swelling, and stiffness. While those issues are certainly common, they tend to co-exist with another symptom — overwhelming fatigue — that can be harder for friends and family to understand.

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Fatigue is more than being a little tired. Earlier this year, a Chronicwoman/Chronicillness poll found that 89 percent of people with arthritis (including but not limited to RA) said that fatigue interfered with their ability to go about their everyday activities. An important question for treating RA, then, is this: Does severe fatigue resolve when patients receive proper RA treatment?

Fortunately, a new study says yes: 70 percent of newly diagnosed patients who initially presented with high levels of fatigue “reported significant improvements in fatigue” within a year.

These findings, which were presented at the 2019 American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting in Atlanta, focused on more than 1,000 Canadian patients who had been recently diagnosed with RA and started on a disease-modifying antirheumatic drug (DMARD), such as methotrexate or sulfasalazine. They suggest that treating RA with these drugs also leads to less fatigue, though whether the medication is directly responsible is unclear. It’s equally likely that patients become more energized as a result of their joint pain and stiffness improving.

Although this is mostly good news, the researchers, led by Susan J. Barlett, PhD, from McGill University in Montreal, found that a substantial portion of participants — 30 percent — did not experience a major improvement in their level of fatigue. Those in this camp were typically more likely to be obese or have fibromyalgia in addition to RA. Some had simply reported less fatigue to begin with, so there was less room for improvement.

“Debilitating fatigue is common around the time of RA diagnosis and is associated with more active disease, worse pain and disability, and [osteoarthritis]/back pain, obesity, depression, poor sleep, and major stressors in the previous year,” the authors wrote. “Early [methotrexate] use and optimizing weight, sleep, and mood may help address persistent fatigue when RA inflammation is well controlled.”

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