title: Changes in fatigue over 2 years are associated with activity of inflammatory bowel disease and psychological factors.
abstract: OBJECTIVE
  Cross-sectional studies have identified high levels of fatigue in patients with active or quiescent inflammatory bowel disease (IBD), but there has been little attention to the long-term effects of fatigue in these patients. We performed a longitudinal study of fatigue in patients with IBD to determine its course and contributing factors.
  
  
  METHODS
  Data were obtained from participants in the Manitoba IBD Cohort Study (N = 312; 51% with Crohn's disease), a longitudinal population-based study. Symptomatic disease activity was measured every 6 months for 2 years to characterize long-term disease patterns as active, fluctuating, or inactive, based on the validated Manitoba IBD Index. We collected data concurrently on fatigue (Multidimensional Fatigue Inventory), psychological function, and laboratory biomarkers at the point of study entry and 1 and 2 years later.
  
  
  RESULTS
  Of the study participants, 26% had consistently inactive, 29% had fluctuating, and 45% had consistently active disease over the 2-year time period. Mean levels of fatigue were strongly associated with disease activity; participants with consistently inactive disease had the lowest level of fatigue at each time point. Multivariate analyses indicated fatigue levels increased over time regardless of disease pattern (P < .001). Adjusting for disease activity, disease type and age, sex (female; P < .001), and psychological variables of distress (P < .001), reduced psychological well-being (P = .002) and poor sleep quality (P < .001) were associated independently with increases in fatigue over time.
  
  
  CONCLUSIONS
  Fatigue can increase over time in patients with IBD, even when their disease is in remission. Psychological factors are useful targets for intervention to reduce fatigue.
authors.affiliation: IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada. lgraff@hsc.mb.ca
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Graff
authors.forename: Ian
authors.initials: I
authors.lastname: Clara
authors.forename: John R
authors.initials: JR
authors.lastname: Walker
authors.forename: Lisa
authors.initials: L
authors.lastname: Lix
authors.forename: Rachel
authors.initials: R
authors.lastname: Carr
authors.forename: Norine
authors.initials: N
authors.lastname: Miller
authors.forename: Linda
authors.initials: L
authors.lastname: Rogala
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000473:pathology / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods; D055815:Young Adult
keywords: C-reactive protein; CD; CRP; Crohn's disease; Fatigue; IBD; ICC; Inflammatory Bowel Disease; Longitudinal; MIBDI; Manitoba Inflammatory Bowel Disease Index; Psychological Functioning; UC; inflammatory bowel disease; intraclass correlation; ulcerative colitis