title: Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored.
abstract: OBJECTIVE
  Fatigue is commonly reported by patients with rheumatoid arthritis (RA) but is rarely a treatment target. The aim of this study was to explore the concept of fatigue as experienced by patients with RA.
  
  
  METHODS
  Fifteen patients with RA and fatigue (> or =7 on a 10-cm visual analog scale) were individually interviewed and asked about the description, cause, consequence, and management of fatigue. Transcripts were systematically analyzed by 2 researchers independently, relevant phrases were coded, and earlier transcripts were checked for the emerging codes. A random sample of analyses were independently reviewed. A total of 191 codes arising from the data were grouped into 46 categories and overarching themes.
  
  
  RESULTS
  Vivid descriptions reflect 2 types of fatigue: severe weariness and dramatic overwhelming fatigue. RA fatigue is different from normal tiredness because it is extreme, often not earned, and unresolving. Participants described physical, cognitive, and emotional components and attributed fatigue to inflammation, working the joints harder, and unrefreshing sleep. Participants described 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 but when they did, they felt it was dismissed. Participants held negative views on the management of fatigue.
  
  
  CONCLUSIONS
  The data show that RA fatigue is important, intrusive, and overwhelming, and patients struggle to manage it alone. These data on the complexity of fatigue experiences will help clinicians design measures, interventions, and self-managment guidance.
authors.affiliation: University of Bristol, UK. Sarah.Hewlett@bristol.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Hewlett
authors.forename: Zoë
authors.initials: Z
authors.lastname: Cockshott
authors.forename: Margaret
authors.initials: M
authors.lastname: Byron
authors.forename: Karen
authors.initials: K
authors.lastname: Kitchen
authors.forename: Sue
authors.initials: S
authors.lastname: Tipler
authors.forename: Denise
authors.initials: D
authors.lastname: Pope
authors.forename: Maggie
authors.initials: M
authors.lastname: Hehir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D001294:Attitude to Health; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology