What Is the Most Substantial Predictor of Fatigue Among Patients With PsA?

Patients with psoriatic arthritis (PsA) often experience fatigue, and according to a new study, disease activity is the most substantial predictor of fatigue in PsA.

To reach this conclusion, the researchers assessed data on 677 women and 351 men with PsA who met the Classification Criteria for Psoriatic Arthritis. By recording the demographic features and clinical conditions of the 1028 patients, the researchers determined that the patients had a mean age of 47 years and a mean disease duration of 6.4 years.

The following measurements were used to assess the patients’ clinical parameters: the Disease Activity Score 28 (DAS28), Disease Activity in Psoriatic Arthritis (DAPSA), Clinical DAPSA (cDAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Fibromyalgia Rapid Screening Tool (FiRST), minimal disease activity (MDA), and very low disease activity (VLDA). Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy (FACIT-F) and a 10-point VAS (VAS-F). 

The mean VAS-F score was 5.1. Among all patients, 12.8% had mild or no fatigue, 24.6% had moderate fatigue, and 62.5% had severe fatigue. 

“Fatigue is a substantial problem in patients with PsA that needs to be considered in the core set of domains,” the researchers wrote.

Patients with DAS28 remission, DAPSA remission, cDAPSA remission, MDA, or VLDA had significantly better fatigue scores compared with patients without remission in these areas. And as DAS28, DAPSA, or cDAPSA disease activity levels increased, fatigue scores significantly increased.

The researchers found that VAS-F scores correlated with the scores of the BASDAI, BASFI, PsAQoL, HAD-A, FiRST, pain VAS, and patient global assessment.

According to FiRST scores, 255 patients (24.8%) had fibromyalgia. Among these patients, FACIT-F and VAS-F scores were significantly higher.

In regression analysis, VLDA, BASDAI score, FiRST score, high education level, HAD-Anxiety, and body mass index were independently associated with fatigue. 

“Other correlates of fatigue were female gender, educational level, anxiety, quality of life, function, pain, and fibromyalgia,” the researchers concluded.

—Colleen Murphy


Duruöz MT, Gezer HH, Nas K, et al. The impact of fatigue on patients with psoriatic arthritis: a multi-center study of the TLAR-network. Rheumatol Int. 2020;11(40):1803-1815. doi:10.1007/s00296-020-04628-y