title: Determinants of fatigue in Crohn's disease patients.
abstract: OBJECTIVE
  Crohn's disease (CD) is often associated with severe fatigue. Little is known about patients who may be at the highest risk for fatigue. Therefore, we assessed the disease phenotype and factors related to fatigue in the presence of CD in two different populations.
  
  
  METHODS
  Patients presenting at the clinic of a referral hospital and a general hospital were included in the study. They completed questionnaires including the Checklist Individual Strength, the Hospital Anxiety and Depression Scale, a questionnaire on disease activity, and one on medication use. The Montreal classification and sociodemographics were obtained from medical records. Hemoglobin and C-reactive protein levels were measured at baseline.
  
  
  RESULTS
  In total, 425 patients were included (276 women, mean age: 42 years). Compared with patients from the general hospital, patients at the referral hospital had worse disease activity, worse disease behavior, more bowel resections, and a higher percentage of side-effects to medication and use of anti-tumor necrosis factor (TNF). The prevalence of fatigue was significantly higher in the referral patients compared with the general patients (65.7 vs. 52.5%, respectively; P=0.01). Similar results were found in patients in remission (53.3 vs. 40.5%; P=0.061). Factors related to fatigue were the use of anti-TNF at baseline, side-effects to 5-aminosalicylic acid, disease activity, female sex, and shorter disease duration. Furthermore, we found improvement in fatigue and a trend toward lower disease activity after 1 year of anti-TNF use.
  
  
  CONCLUSIONS
  A high percentage of CD patients suffer from fatigue. As a more aggressive phenotype seems to be associated with more severe fatigue and patients in remission still suffer from fatigue, a multidimensional approach for fatigue is warranted in these patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands. l.vogelaar@erasmusmc.nl
authors.forename: Lauran
authors.initials: L
authors.lastname: Vogelaar
authors.forename: Adriaan
authors.initials: A
authors.lastname: van't Spijker
authors.forename: Antonie J P
authors.initials: AJ
authors.lastname: van Tilburg
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Reinier
authors.initials: R
authors.lastname: Timman
authors.forename: Christien J
authors.initials: CJ
authors.lastname: van der Woude
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D003863:Depression / Q000209:etiology; D005221:Fatigue / Q000209:etiology*; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha