Is improvement of fatigue in Rheumatoid Arthritis a proper effect of biologics?

Background: The objective of our present study is to assess the relation between persistent fatigue and rheumatoid arthritis (RA) disease activity and its functional impact and to determine if the positive effect of biologics on fatigue is due to good disease response or to a different pathway.

Methods: A study cohort of patients with established RA was conducted. We included patients who were initiation a biologic after at least failure of one conventional synthetic Disease Modifying Anti-Rheumatic Drug synthetic (csDMARDs). At baseline, patients had a moderately to highly active disease. Demographic characteristics, disease activity and functional impact were assessed by disease activity score (DAS28CRP) and health assessment questionnaire (HAQ) scores. Fatigue was evaluated by the Functional Assessment of Chronic Illness Therapy-Fatigue scale questionnaire (FACIT-F). Patients were examined before initiating biotherapy, then after three months and six months.

Results: Thirty women with RA, with a mean age of 52.5 years, were included. At baseline, 57% received anti-TNFα: Etanercept (n=9), Adalimumab (n=6), Infliximab (n=2) and 43% received Rituximab. Good Eular response was obtained in 80% of patients at the third month and 97% of patients at the sixth month. In the analytic study, a significant amelioration after 3 months of biotherapy was found in both disease response (DAS28CRP) and fatigue (FACITF), respectively (p=0.01,p<0.001 and p<0.001). The disease activity decreased significantly also after sixth month (p=0.01, p<0.001 and p=0.012). In the linear multivariate analysis, the regression of visual analogic pain (VAS pain) was the only predictors of the improvement of fatigue.

Conclusion: Biologics contribute to improve fatigue in patients with established RA and this effect seems to be independent from the clinical efficacy of this treatment.

Keywords: Fatigue; biotherapy; rheumatoid arthritis.