Clinicians neglecting impact of RA fatigue

[Guest guest]

Clinicians neglecting impact of RA fatigue

Oct 25, 2005 Gandey

Bristol, UK - Researchers suggest that doctors are focusing all of

their efforts on the pain and disability of rheumatoid arthritis (RA)

and are forgetting about the intrusive and often-overwhelming effect

of fatigue [1]. " These qualitative data show that for these patients

with RA, fatigue is a frequent, extreme, and multidimensional

experience. The consequences of fatigue intrude on every sphere of

life and cause major disruption and distress, " report the

researchers, led by Dr Hewlett (University of Bristol Academic

Rheumatology, UK). " Participants reported that they struggle to

manage their fatigue with little professional support, perceive it to

be dismissed, and assume it cannot be treated and that they must

manage alone. " The findings appear in the October 15, 2005 issue of

Arthritis and Rheumatism.

Contacted by rheumawire to comment on the work, Dr Gareth Treharne

(University of Birmingham, UK) said, " Hewlett and colleagues' paper

should be commended for tackling a complex issue such as fatigue in

RA with a rigorously in-depth methodology. " He says the group

responds to increasing calls to involve patients in the development

of their healthcare and go beyond the biomedical model. " Their

qualitative analysis of interview data is perhaps the best way of

gaining structured insight into patients' opinions. " He also

complimented the group for including among its coauthors a patient

research partner. " This adds further validity to the findings, " he said.

RA fatigue

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Reportedly affects 88% to 98% of RA patients.

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Can disrupt patients' lives on a daily basis.

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Said by patients to be rated in importance as similar to pain.

In this small study, Hewlett and her team interviewed 15 RA patients

with fatigue. Patients registered more than 7 on a 10-cm visual

analog scale, and they were asked to describe their fatigue, its

cause, consequence, and management. Two researchers independently

analyzed transcripts from the interviews and coded relevant phrases.

They identified 191 codes and grouped them into 46 categories and

themes. Additional researchers then reviewed and verified a random

sample of this work.

" Hewlett and colleagues used purposive sampling of RA patients with

notably high fatigue as is necessary to get to the heart of a focused

issue, " Treharne told rheumawire. He pointed out that the 15

participants were, however, demographically wide, including men and

women, younger and older patients, recently diagnosed and

longstanding patients, as well as some patients who were employed and

others who were not. " While readers from a quantitative background

may consider this sampling method biased and ungeneralizable, it

provides insight into the experience of severe fatigue levels seen in

around a third of RA patients when assessed with the visual analog

scale used in the study. It is this enhancement in insight and the

wider understanding of an issue that are the most important outcome

of such studies, " he said.

" Professionals have expended a lot of effort in managing pain and

disability and now need to address fatigue with some urgency. "

Hewlett and her team point out that fatigue is a significant symptom

experienced almost universally by RA patients. The cause, they write,

is likely to be multidimensional, involving inflammation, pain,

anemia, poor sleep, and psychosocial factors. Hewlett and colleagues

say that RA fatigue is different from typical feelings of drowsiness

because the exhaustion is extreme, often not earned, and is unresolving.

They report, " Participants described physical, cognitive, and

emotional components and attributed fatigue to inflammation, working

the joints harder, and unrefreshing sleep. " The researchers also

point out that the fatigue had far-reaching effects on physical

activities, emotions, relationships, and social and family roles.

" Participants used self-management strategies, but with limited

success. Most did not discuss fatigue with clinicians, and those who

did felt it was dismissed. "

The patients described in the paper said that they learned to plan

activities and to pace themselves, and most felt that little could be

done to treat fatigue. " These data on the complexity of fatigue

experiences will help clinicians design measures, interventions, and

self-management guidance, " the researchers write. " Professionals have

expended a lot of effort in managing pain and disability and now need

to address fatigue with some urgency. "

Hewlett S, Cockshott Z, Byron M, et al. Patients' perceptions of

fatigue in rheumatoid arthritis: Overwhelming, uncontrollable,

ignored. Arthritis Rheum 2005; 53:697-702. 16208668