Fatigue in rheumatoid arthritis 'can be improved with successful treatment' (with a drug)

[Dolphin]

Fatigue in rheumatoid arthritis 'can be improved with successful treatment'

Published on 09 September 2015
A new study has indicated that successful treatment of rheumatoid arthritis can also help to alleviate the chronic fatigue often associated with the condition.

Published in the medical journal Clinical and Experimental Rheumatology, the French study from the Institut Pierre Louis d'Epidémiologie et de Santé Publique and the Pitié Salpêtrière Hospital aimed to assess fatigue levels over the first four months of tocilizumab treatment in rheumatoid arthritis patients, as well as the factors affecting tiredness.

The team performed a multicentre prospective study of 719 rheumatoid arthritis patients treated with intravenous tocilizumab, looking at the first five infusions over a four-month period. Fatigue was assessed alongside potentially influential variables, including other patient-reported outcomes, depression and anxiety, and disease activity.

At baseline, it was shown that fatigue levels were high, with 73 per cent of patients having unacceptable levels of fatigue. However, at four months, 62 per cent achieved a minimal clinically important difference in terms of improvement for fatigue, with reductions shown to be rapid - often seen as early as after two weeks.

Fatigue was mainly related to functional status, as measured by Health Assessment Questionnaire (HAQ) scores, as well as levels of depression and anxiety. This was the case both before and after tocilizumab treatment.

The researchers concluded: "In these long-standing rheumatoid arthritis patients, fatigue levels were high and mainly explained by HAQ and psychological distress, but improved with treatment indicating a link with disease activity. The pathophysiological basis of rheumatoid arthritis fatigue should be further explored."

A spokesperson from Arthritis Research UK commented: "This research challenges the common misconception that the fatigue of rheumatoid arthritis and other arthritic diseases occurs as a result of the symptoms, and not from the underlying mechanisms that drive the disease.

"Arthritis Research UK have committed to funding innovative research that will help alleviate the unrecognised burden of fatigue by both improving its management and better understanding the processes that cause it."

- See more at: http://www.arthritisresearchuk.org/...uccessful-treatment.aspx#sthash.PrD2jEoX.dpuf

 

[Dolphin]

http://www.clinexprheumatol.org/abstract.asp?a=9059

Fatigue in rheumatoid arthritis: quantitative findings on the efficacy of tocilizumab and on factors associated with fatigue. The French multicentre prospective PEPS Study

L. Gossec, G. Steinberg, S. Rouanet, B. Combe

Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique; AP-HP, Pitié Salpêtrière Hospital, Department of rheumatology, F-75013, Paris, France.


Abstract

OBJECTIVES:

Fatigue is an important aspect of rheumatoid arthritis (RA).

The objective was to assess fatigue levels and its determinants over the first 4 months of tocilizumab (TCZ) treatment in RA patients.

METHODS:

We performed a multicentre prospective study of RA patients treated with intravenous TCZ in open-label prescription conditions.

The first 5 infusions (4 months) were assessed.

The primary endpoint was the percentage of patients with variation of the FACIT fatigue scale from inclusion to 4 months, above the minimal clinically important difference (MCID) of 4 points.

Fatigue was also assessed by the patient acceptable symptom state for fatigue (PASS) question.

Variables related with fatigue and with fatigue improvement including other patient reported outcomes, depression and anxiety, and disease activity, were assessed before and after treatment.

Analyses: univariate and multivariate logistic regressions.

RESULTS:

Of 719 patients, 610 had evaluable data: mean age 56±13 years, disease duration 12±10 years, 490 (81%) women. At baseline, fatigue levels were high: 73% patients had unacceptable fatigue.

At 4 months, 378 patients (62%) reached MCID improvement for fatigue.

Fatigue reduction was rapid, seen as early as after 2 weeks.

Fatigue was mainly related to functional status (HAQ score), depression and anxiety, both before and after TCZ treatment.

Moderate predictors of fatigue improvement were evidenced.

CONCLUSIONS:

In these long-standing RA patients, fatigue levels were high and mainly explained by HAQ and psychological distress but improved with treatment indicating a link with disease activity.

The pathophysiological basis of RA fatigue should be further explored.

PMID: 26344671 [PubMed]

Received: 08/01/2015 - Accepted : 13/03/2015 - In Press: 07/09/2015

 

[Bob]

Tocilizumab[1] (INN, or atlizumab, developed by Hoffmann–La Roche and Chugai and sold under the trade names Actemra andRoActemra) is an immunosuppressive drug, mainly for the treatment of rheumatoid arthritis(RA) and systemic juvenile idiopathic arthritis, a severe form of arthritis in children. It is ahumanized monoclonal antibody against theinterleukin-6 receptor (IL-6R). Interleukin 6 (IL-6) is a cytokine that plays an important role in immune response and is implicated in the pathogenesis of many diseases, such asautoimmune diseases, multiple myeloma andprostate cancer.

https://en.m.wikipedia.org/wiki/Tocilizumab

 

[SOC]

In these long-standing RA patients, fatigue levels were high and mainly explained by HAQ and psychological distress but improved with treatment indicating a link with disease activity.

Ya think? Let's see, treatment with a monoclonal antibody against the IL-6 receptor improves symptoms. Yeah, I'd say that "indicates" the fatigue has a physical rather than psychological basis.

I wonder who is "explaining" fatigue by HAQ and psychological distress and what (if any) real evidence they have for this explanation. Or is it the usual "We don't know, so it must be psychological"?

It's good to see researchers looking into the biological basis of fatigue, whatever the disease.

 

[Bob]

In these long-standing RA patients, fatigue levels were high and mainly explained by HAQ and psychological distress but improved with treatment indicating a link with disease activity.

Let's see, treatment with a monoclonal antibody against the IL-6 receptor improves symptoms. Yeah, I'd say that "indicates" the fatigue has a physical rather than psychological basis.

Yes, I noticed that too. It seems that RA patients must get subjected to a load of crap as well. i.e. being told "you're fatigued because of the way you react to your illness." etc.