RT Journal Article
SR Electronic
T1 The Longitudinal Course of Fatigue in Antineutrophil Cytoplasmic Antibody–associated Vasculitis
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.190113
DO 10.3899/jrheum.190113
A1 Lucy O’Malley
A1 Katie L.  Druce
A1 Dimitrios Chanouzas
A1 Matthew D.  Morgan
A1 Rachel Jones
A1 David R.W.  Jayne
A1 Neil Basu
A1 Lorraine Harper
YR 2019
UL http://www.jrheum.org/content/early/2020/01/27/jrheum.190113.abstract
AB Objective Fatigue is common and burdensome in antineutrophil cytoplasmic antibody–associated vasculitis (AAV). This study aimed to understand how fatigue changes over time following treatment initiation and to determine whether individuals with the poorest prognosis can be robustly identified. Methods One hundred forty-nine patients with AAV and new-onset disease recruited to 2 clinical trials (RITUXVAS and MYCYC) were followed for 18 months. Fatigue was measured at baseline and 6-month intervals using the vitality domain of the Medical Outcomes Study Short Form-36 quality of life questionnaire and compared to a cohort of 470 controls. Group-based trajectory modeling (GBTM) determined trajectories of the symptom to which baseline characteristics and ongoing fatigue scores were compared. Results Fatigue levels at diagnosis were worse in patients than controls [median (interquartile range; IQR) 30 (10–48) vs 70 (55–80); p < 0.001], with 46% of patients reporting severe fatigue. Fatigue improved after 6 months of treatment but remained worse than in controls (p < 0.001). GBTM revealed varied trajectories of fatigue: low fatigue stable (n = 23), moderate baseline fatigue improvers (n = 29), high baseline fatigue improvers (n = 61), and stable baseline high fatigue (n = 37). Participants who followed stable high fatigue trajectories had lower vasculitis activity compared to improvers, but no other demographic or clinical variables differed. Conclusion This study longitudinally measured fatigue levels in patients with AAV. Although most patients improved following treatment, an important subgroup of patients reported persistently high levels of fatigue that did not change. Few clinical or laboratory markers distinguished these patients, suggesting alternative interventions specific for fatigue are required. [clinicaltrialsregister.eu, RITUXVAS EudraCT number: 2005-003610-15; MYCYC EudraCT number: 2006-001663-33]